HOME CARE HEROES AND DAY SERVICE STARS PODCAST

Episode: The Future of Adult Day Services with Tia Sauceda

November 25, 2025 | 38 minutes 55 seconds

KENNETH ACCARDI: OK, well, hey everybody. Welcome to this latest installment of the Home Care Heroes and Day Service Stars podcast. We have an unbelievably great guest for today. Her name is Tia Sauceda, and Tia is actually the new director of NADSA, the National Adult Day Services Association.

She's succeeding the inimitable Donna Hale, who's been there for a really long time. And she's really positioned to take NADSA and adult day services to the next level. So first of all, welcome Tia, and thank you for being here today.

TIA SAUCEDA: Oh my gosh, thank you for having me. I'm thrilled to be here.

KENNETH ACCARDI: All right. So let's just drive in. I actually, for the first time in three years, I was unable to attend the conference this year. I heard it was outstanding back in Chicago, very centrally located. So I am thrilled that you're popping in and taking over and all that sort of thing. But just kind of maybe lay it out for us—let's start with your background. This isn't like your first rodeo in day services. So maybe give us a little rundown of your background in adult day services.

TIA SAUCEDA: OK, yeah, sure. So I was a young adult, I guess early twenties, and I was going to school for sociology. I found a woman who was an activity coordinator at a facility and I was writing a paper and went and met her. And I literally was just moved—this has to be the best job in the world. You're doing activities with older adults.

So this is how old I am—I literally opened the phone book, right, and went down the line and found a place, an adult day center. This is back in the very early 2000s when, you know, we think it's a best kept secret now, it was a really best kept secret back then. And so I started as an activity coordinator just a couple of days a week, and I instantly fell in love with the idea of adult day and what it provides to the participants and their families.

I worked as an activity coordinator for a few years and then I moved to the Denver area and I was hired to open a day center quite literally from an empty room and a notebook. And it was one of the greatest accomplishments of my life. I still think about that as really one of my highlights. I started a day program with one person and then two people—and it's really hard actually when you have just a couple of people. It's easier when you have fifty. And so I was there for about ten years, and then I had the opportunity to move to a PACE program and worked there for a little while in their non-PACE center.

I missed the small nonprofit feel, so I moved back to another organization very similar to my first and was there for the last ten years. At that point I was running four day centers—some specializing in people living with dementia, and then we had a day center for younger adults with disabilities. And I loved it. It was wonderful. And then COVID happened, right around five years ago, and that just changed the game. Like it completely changed everything.

I used to say, the good news is people don't live here, but the bad news is people don't live here. And so we had to really pivot and change and lean into our home care services and providing services in people's homes for that period of time.

The last couple years of my career there, I oversaw all of our services—adult day service, in-home care services, care management, and chores program. Through that I was really able to create an integrated care model that allowed us to truly care for the whole person. And that just was, again, another highlight.

In August, I took the role as Executive Director here at NADSA, and it does feel really wonderful to be leading such a great organization truly centered around adult day services, which is where my passion lies. So that's kind of how I got here.

KENNETH ACCARDI: Fantastic. I love it. So let's unpack some of that. I think, you know, we don't want to—you made some allusions to yourself being old—you're a very young person. And I think that if I remember correctly from some earlier conversations, you were running that day center in your second job as a twenty-four-year-old. Is that about right?

TIA SAUCEDA: Yeah, yeah, yeah.

KENNETH ACCARDI: So that's a big challenge. And I think that having a job versus running a company are very different things. And like you said, it's hard to start out with one participant, two participants, and grow that up. But that's fantastic. And then even before that you were all focused on the activities.

I guess one of the things for me—I'll tell a personal story. So my mom actually around 2018, 2019, she was falling now and again. She's today 88, she'll be 89 in January, in a month and a half. And at the time she had fallen a few times, she didn't want to have home care, didn't feel like she needed it. And we got her to go to a day center and she really liked it because, first of all, she actually described it in the context of "I'm going to camp," right? Because it felt to her like summer camp where she would see kids. And she was looking forward to seeing her friends.

And I think just the action of getting out of bed in the morning and getting there—her physical stamina improved, her balance improved and that kind of thing. So I think it had a real positive impact on my mom and others. But in this world we live in today with the baby boomers all aging—we're going to have baby boomers starting to hit 80 years old in the next couple months here—and so much demand. I really think that adult day is so important and growing in importance because of, if nothing else, the staff ratios. You can take care of let's say fifty folks with, in most cases, in most states you need like maybe one staff per seven folks. So if you have like eight staff, you could take care of fifty people, whereas in home care you need fifty people to take care of fifty people.

So I guess, you know, you've had so many parts of this experience—what are some of your big things about adult day and what it does for people in comparison to, let's say, even staying in their home, their own home, which is much more desirable than going in a nursing home. But what are some of your big success stories in your adult day career?

TIA SAUCEDA: Yeah, well, I'm glad to hear your mom found an adult day center and that she was willing to go. That's so exciting. You know, I get it, right? None of us really think that this is what we're going to need. Nobody's like, "Oh, pick me, I can't wait to go to adult day," right? Like, I don't think I'm going to need it, although I think I probably will. I will love adult day, but we have to change the perception.

And for me, adult day is the best of all worlds, right? You get to stay living in your home. You get to be in your community. You build real friendships. I mean, I was always blown away by the true connection that our participants found with one another, the true purpose that they found in each day. You know, you don't get to a certain age and you don't get to a certain diagnosis and stop being you, right? Like you still need something that speaks to your soul, that connects with you. An adult day for a lot of people is that.

Additionally, it's the most cost-effective care you can provide. You alluded to it with staffing ratios. I mean, there are economies of scale that come from an adult day center. So not only is it a better place to be—and I mean, I get it, sometimes you do want to stay at home and you need someone to come help you with your day-to-day, and that's absolutely wonderful. You can have both, right? Like I think the perfect answer is that you have both. But we saw isolation and not having human connection is so imperative to people's mental health and their ability to thrive, and adult day provides that.

I have so many stories of people, and that's my favorite thing to do—to share those. We had a gentleman who did not want to be there. He had been working up until maybe six months prior. His wife had passed. She was his primary caregiver. The daughter stepped in. She didn't know what she was getting into, right? Her mom had kind of handled everything. And so she brought him in and she was like, "Hey, I have to go to work. Can Dad try this?"

And first day he was really just, I think nervous, frankly. Fearful, right? Like this is a new space for most people at that time in their lives. And he had kind of a rough first day. And she came to pick him up and I said—he was a mason. So he worked a physical trade his whole life, and he was not about leisure. Like, you know, this wasn't like, "Oh, in my retirement I'm going to just sit back and relax."

So I was working on a project and we had a WIC office down the hall and we were clipping coupons just for fun, right? And I said, "Hey Mario, can you come help me? I am on a deadline, like I am behind." And so I had him help me clip these coupons. And long story short, he became so passionate about making sure that the WIC office down the hall had the coupons every week. He would clip them. He would spend his time sorting them. We would walk them down the hall to the women, and they would put it in the office for the mothers to pick up when they came to get their benefits.

And if you had told this man five years earlier that he would have found contentment and purpose clipping coupons, frankly, he would have had some real choice words for you, right? But because it was a real purposeful project and it wasn't made up, right? Like this was really providing a value. He had a lot of success and was in that program for five or more years. That's five years that his daughter was able to continue working. That's five years that he was not in a skilled nursing facility at a higher restriction and a higher cost.

And so that's just one example of the beauty of adult day. And I mean, truly connecting with others—you don't lose that just again because you have a diagnosis or you get to a certain age. So adult day can really provide magic in that it really connects with people. Adult day was person-centered before person-centered was a thing, you know? And so I just think that the opportunity is so great for us and now is the time, right? It can be a little bit daunting to figure out what each state looks like, but I'm telling you, adult day is the future.

KENNETH ACCARDI: Perfect. I totally agree with you. And you know, I gave my meager little single person example about my one little mommy. But when you added to it—I mean, we talked about the social dynamic and the connections that are formed, and then having a sense of purpose. So I think it's really creative. I'd like to get into this a little bit later in the discussion about activities and actually, I don't hear about a lot of activities that are taking on work that's actually helping the group down the hall and things like that. So I think we should talk about that.

But one thing we didn't really touch on is nutrition. So folks, especially if they're living alone, I mean, we know that they're going to get a good meal and it's going to be a balanced meal when they're at the center. And really, it's more affordable. So all these different kinds of pieces.

As I mentioned to you, a lot of the folks who listen to this podcast are home care folks. And a lot of times home care folks are like, "Oh my gosh, I can never do adult day. You need like a facility or something like that." And you've done home care, you've done PACE programs, you've done adult day care. What's your thought on having, let's say, a blended program? So let's say somebody here is running a home care agency, they have 70 clients, they are having much more demand than they could find caregivers for, and they're like, "I wonder if I put a day program in place, if that might help some folks." What would you say to them?

TIA SAUCEDA: I would say absolutely. I mean, the best of both worlds would come from having a full continuum of support for somebody. And there will always be some folks who really aren't appropriate for adult day and home care is best, right? And that's a great option for folks.

But if you even took, like if you're running 70 clients, let's say, and you could convert 30 of them into adult day participants, not only would you now be able to provide care for longer because home care is usually a couple of hours, like two to three hours—the reimbursement rate's pretty low in the grand scheme of things, right? Especially because it's a one-on-one service. And you know, I live in Colorado and so there are minimum wage—each city has minimum wage requirements and that can make it really challenging to provide in-home care. If your wages have to keep going up plus benefits, there is a threshold of what people can afford for that.

Whereas adult day, again, that's an economy of scale. You can come to an adult day center and get eight hours of care, where as a home care agency, maybe before you were providing three at the most, frankly. And so I really think there's opportunity there.

Additionally, you have to be careful in how you do this, right? Of course. But there's opportunity to leverage your staffing in a better way. You might only need three staff members during the day if you're running a small program, you know, ten to fifteen people—you'd need probably three people. From there, you could also have some synergy in care, right? Like it's possible you could have someone who provides day program care three days a week and then two days a week is in their home providing in-home care. People like that. People like having their same provider. They like that consistency. And it's all about trust, right? At the end of the day, when you're in this role, you're building trust with the person that you're working with. And so even if that helps get them in the door, I think that could be really beneficial.

I would say starting an adult day center isn't any harder than starting an in-home care organization. In fact, there are a lot of similarities in terms of how payment is done and how it's structured. Yes, there are some nuances that are adult day specific and there are nuances that are in-home care specific. But in most cases, honestly, if you can do the in-home care side, you can manage the adult day side because it's usually—it's just, it's not easier, it's just different. Like it's easier in that you just do it once instead of 70 other times, right? So you're billing for one person per day versus three-hour blocks for 70 people. So there's just some inefficiencies that come from that.

KENNETH ACCARDI: Yeah, I love it. And I think it's kind of funny because sometimes adult day folks, they're like, "Oh my gosh, I have no idea how I would provide home care," and home care folks are like, "I have no idea how I would provide adult day care." But you did talk about some of the real benefits of having an integrated program and being able to meet people.

I mean, just as an interesting story—we started with software for home care, and then when we started surveying customers in Kentucky where they have the Medicaid attendant care program—if you want to be an attendant care provider, you have to have an adult day offering. And I think that was some good insight on the part of the Kentucky government because they're looking at the same things. I mean, I could have folks in the center, they could have all these benefits, and it might be a little bit more affordable. And then some of those folks, when they leave the center in the afternoon, then they also have somebody who helps them settle back into their home and have their dinner. So they definitely go together very, very well.

And I love one thing you picked up on was about really the staff and having some synergies between your staff. So one of the big issues in home care is that a lot of caregivers don't make it through the first 90 days and some of them don't make it through the first 30 days. And one thing that I think happens is that, you know, you come in, it's like, "Oh, this sounds great, I'm going to be caring for somebody." They go through some training, and then they're thrust immediately into the home of an 82-year-old who maybe doesn't communicate with them well and it's just a shock.

Whereas if you have an adult day center, then as part of the training, it's like, "OK, hey, we're done with some training here. Why don't you go spend some hours in the day center?" And you get used to the conversation, you get used to the real people and how they communicate and various things like that.

So there's a lot there. Let me go back to where you started. The first thing you said you were was an activities director. And so as far as like, how do people differentiate? And I think it really has to do with their activities. And I'd love to hear—again, I thought it was great that you mentioned in the story you gave about basically providing a service from the adult day center. So yeah, let's talk about activities.

TIA SAUCEDA: Yeah, I mean, I think that at its core, that's what adult day is. If you have a good activity program, the rest falls into place pretty easily. Like personal care—I'm not saying it's easy, but it's a little bit—you get trained on it, you learn how to do it, it's great, right? An activity program, sometimes you really have to think way outside the box to get connected with people.

And the main thing I want folks to know is it's more than just passing time, right? Like I think sometimes you get into this feeling of, "Well, we're just going to play this bingo game to pass time." And that's not what it's about. It's about true connection with each person, understanding who they are, who they were, and then bringing that into your programming.

I love software companies because I again started old school with a pen and paper, and the idea that now this can be at the fingertips of staff—to do an assessment to understand somebody's background and then put that into your care plan through software is amazing. So I'm always just thrilled that there's so much happening in this space.

But for me, what makes a good activity is really understanding who the population is. And so your activities are not going to be the same if you're serving individuals with disabilities, younger adults, as they are going to be for your 85-plus population. But it's also like we have to stop making stereotypes of things, right?

So when I started doing activities, you would do a sing-along, right? And we would sing "Tie a Yellow Ribbon Round the Ole Oak Tree" and that's what you thought older people wanted. And now if you walk into probably any day center, they're probably playing the Grateful Dead on their Alexa device, right? And so I love that we're evolving this.

One of the important pieces I think that we need to always consider is choice as well. As we get older, especially if we're living with dementia, it's very easy for us to be basically told what to do all day, every day, right? And I don't know about you, but I'm not going to like that.

And so one of the great things that we added in my programs over the years was choice. And it's really saying, "Hey, listen, would you like to do this? Would you like to go have a discussion or reminisce about trains? Or would you like to go into the art room and create a greeting card for your daughter?" Right? Like, I mean, anything and everything. And I could talk literally for hours about how you can turn anything into an activity. As simple as a water taste test—you can make that an activity.

But I think for me, what I see adult days having the most success on is really getting to know their people first and then building it around them. And you do have to sometimes do the one-offs, right? So Mario, who I told you about, he was a one-off and he would have his little setup in an area. And that didn't mean that everyone else was clipping coupons, right? He was clipping coupons. There were three other activities going on for other people at that time. So I just think that variety is really also important.

KENNETH ACCARDI: Love it. Yeah. So it's kind of—I actually do picture my mom's adult day center and they're singing "Tie a Yellow Ribbon" or they're doing Veterans Day and they're doing the Marine song and that kind of thing. But it's kind of cool to think that now it's evolved. They're listening to The Beatles or listening to the Grateful Dead in the day center. So it's very different that way.

You know, talking about software, I think just real quickly—one thing again with a personal story, I first experienced this with my daughter in preschool. And it's like, "Well, what happened in preschool today?" And I guess all I can say is thank God there was this kid named David Butterfield in preschool because it's like David Butterfield fell off his chair every day, right? So this is like, "Well, David Butterfield fell off his chair," and that was at least the one thing that we got out of preschool every day. And then actually on my mom's side, the same kind of thing.

So we didn't really know so much what happened in the day center. And also with dementia, there's short-term memory loss and that kind of thing. And one thing in children's day centers that happens now is they pretty much have an app and you'll see pictures of what happened during the day and you could show those pictures to your kids and say, "Oh, I see you," and so on and so forth.

So that's, you know, interestingly, I've looked at some of the other software that you could have for adult day and it is just attendance and things like that. But there's so much you could do more with software by connecting to the family, sharing those pictures, sharing those stories, sending a personal note if something didn't go quite as expected or that you want the family to know about in the day. And then also just being connected to your payers, being able to submit electronic bills and also from a governance perspective, you could always show that you had the staffing ratio covered. And if there was ever a question of, "Was this person in the center at this time?" you know exactly when they came, you know exactly when they left.

And so I really do think that software is not a nice-to-have anymore. It's like really something that the day centers need. But believe it or not, I've seen some recent research that was maybe 18 months old that said that 30% still didn't have software for running their center. So there's an opportunity there.

So let's talk about NADSA. Let's—first, I mean Donna Hale, I mean, how long did Donna run NADSA? And you know, first of all, the shout-out to Donna, but let's maybe tell us a little bit about Donna. And I hope that she was pretty well celebrated at the conference because I was not aware that she was moving on, that you were taking over. But yeah, maybe talk a little bit about Donna, but also then how people who might not know about NADSA—how could they get involved in and what services and support can they get by being part of NADSA?

TIA SAUCEDA: Yeah, thank you. I love the opportunity to talk about Donna. She has become a true friend and supporter. You know, I think the announcement was made in early last year that Donna was retiring and moving on to other things. And so I'm really fortunate that I've had the last few months with her to gain information and insight, especially around conference because that's her baby, and I really have learned a ton from her.

So Donna has stayed on through my—once I added on, she stayed on as a special advisor and again, really grateful to her. I do think we celebrated her well in Chicago. She received the Ruth Von Behren Award, and that is somebody who has a huge impact on the adult day industry, and Donna has certainly done that. And so she'll be with NADSA through the end of this year, and then I know she's moving on to some great things, but in a maybe a less intense way, right? Like she now gets to focus on the things that she really loves, which I think is what everyone should do at some point in their life. And so I'm really grateful for her, for the time with her.

KENNETH ACCARDI: OK. And then, yeah, so tell us about NADSA. So like, let's say I'm either—what can I get by joining NADSA as an adult day center? Or how can I learn from NADSA if I'm thinking about starting an adult day center?

TIA SAUCEDA: Yeah, thanks. So NADSA is the association for adult day centers across the country. We have over 500 members and we serve people in Hawaii, Alaska, and everywhere to Maine in between.

And NADSA really is there to be your support in advocacy, storytelling, education, and frankly just elevating the adult day industry. And so I'm really excited for 2026. We have a lot of big things planned. We're rolling out some enhanced member benefits where members will have access to more vendors and things. I can't quite tell—it's not quite ready for launch, but it's coming and it's very exciting. We have a lot of education and so one of the things that I lived firsthand as a center director and as a program director at different levels is not everyone understands adult day, right?

And so to have your colleagues and be in a room with people who really get it is priceless. And so for me, that's what NADSA gave me as a member was this camaraderie and this ability to pick up the phone and call somebody in Texas and say, "Hey, what would you do in this situation?" Or, "I have a client who's moving to Florida and they need an adult day center." And so that community I think is invaluable. And for me that's what I think NADSA really brings is that connection and the education.

So going back to education, it's really, you know, we do monthly sessions around different topics, whether it be HR, new payment models coming out like the GUIDE model, and then we also have some boot camps. So we dig into activities, we dig into running—making the business case for adult day centers and policy and advocacy, how to advocate and be the loudest voice.

And especially right now, you know, money is tight, right? And everybody's got their hand up saying, "We need to be supported." And I think historically adult day has been maybe not the loudest voice. And so my goal is to be a louder voice and to continue to share the message with anyone who will listen, but specifically on the policy side, advocacy side, that adult day not only provides the highest level care, it does it at a fraction of the cost.

And so that's what NADSA provides is really that community and again, you know, we have levels of membership, right? So if you're starting out and you think you want to open an adult day center, we have a way for you to be a member and gain access to that information. If you're running a center and you need a membership for just one center, we have that. And then we also have multiple-site centers. So some people run two to three and there's a benefit to joining for each of those as well.

I'm really excited about the future and I think it's funny because it is easy to get a little bit bogged down in all of the world's happenings. And I just keep reminding our members that this is our opportune time, right? This is our opportunity to tell our story and to share what an impact adult day has. And so I'm excited for the future and I'm excited to be able to be part of this group in this community as we move through a difficult time, but one that I think we're going to come out on top of.

KENNETH ACCARDI: Yeah, I really do think—I think adult day just can't lose because we're going to have so much demand. People are going to want to stay in their own homes. They're going to need some supports during the day. It's better for the staffing ratios. I mean, everything I think is in adult day care's favor. And I think having a little bit more advocacy and a little bit more awareness that I'm sure you're going to drive is going to be great.

Great. So I love that you described the monthly themed programs. So this is going to be an HR month, this is going to be a recruiting month, whatever, that kind of thing. You also mentioned boot camps. So are those kind of remote or are those like, are those face-to-face boot camps or how do those work?

TIA SAUCEDA: No, those are virtual. And so we offer those three times a year and it's usually four different sessions. So like on one day there'll be two sessions and then the following week another day there will be two sessions. And so for example, our activity boot camp last year—I actually did it before I worked at NADSA, I was still part of the group—and so it was like Activities 101, what to do, how to start it. And then the next session was building activities for your diverse community. And then the next session after that was leveraging volunteers in times where that's what you have the opportunity to leverage. And I think the fourth one was around planning your activity calendar. Actually that was probably the second one, but this idea that we walked through it.

And then we did a similar one for business as well, like how to talk to—we actually had a media trainer come in and say, "How do you talk to the media? How do you get attention through your local channels?" We also talked about KPIs and working through building that plan.

I think the challenge sometimes, and I think this is true in home care too, right? Like we are such a heart-driven industry. The thing, and this is what keeps me going, is that the people I meet are in it for the right reason. And they're doing it because they want to provide a true service to their community. In addition to that, though, they have to run a business. And so for me, it's like, how can we provide those supports? Because maybe you got into adult day because you absolutely just loved the impact it would have, but you don't know the details of running a PR campaign. And so let us help you with that.

Same could be said for advocacy. Let us show you what letter to write. Let us share with you how to invite your legislators to your centers. Because that's what it's built upon is that relationship at that local level, right? I think sometimes we think, "Oh, it's at the bigger level," but no, it's really at the local level. And that's intimidating for a lot of folks. Again, home care, adult day, doesn't matter—your elected local officials need to understand the impact that you're having on their community, the number of people that you're keeping in their homes in a less restrictive environment, the number of caregivers that you're keeping not only sane, but working, right?

I mean, so I just think we can help you do that. And that's what I'm excited about is just changing it and making it something that we are now going to be the louder voice. We are going to be the ones telling the story the right way.

KENNETH ACCARDI: Perfect. All right. No, I hear you. So I'm on to my last two questions. So I wanted to ask that one first because I don't want people to wait till next fall for the next conference. I want them to get involved now. But I guess, where are we going to be gathering as a big group next and when—when and where for the big conference of 2026? Tell me about that.

TIA SAUCEDA: We're going to be in Providence, Rhode Island. And so we're thrilled to be on the East Coast September 1st through 3rd, earlier this year. And that was intentional. You know, we feel like there's a lot happening in the later fall months and so we want to make sure that we are making it easy for people to get to. It's right before the long weekend, so just extend your time and spend some more time on the East Coast.

And I'm excited because I'm a Colorado girl and I get to now go to Providence, Rhode Island, which I hear is amazing. It'll be at the Omni Providence Hotel. And we're thrilled. We really are excited. We'll have our Request for Proposals for education sessions out probably early February. So be on the lookout for that. And it's not just adult day sessions that we look for. So I would love someone to do a session on how a home care works with adult day. You know, I think that would be amazing, right?

KENNETH ACCARDI: I love it. Incredible. OK, sounds good. Yeah. And I guess I am actually here in Boston, Massachusetts, so I could be in Providence in about 45 minutes from here. And I will say if you are thinking of coming to the conference that you could extend—you could do Boston, you could do Newport very easily from there, which are both beautiful places. And Providence itself is great as well.

All right, great. So I guess just the last question, the easiest softball is how do people learn more about NADSA and how do they get involved today after being inspired by you meeting with me today?

TIA SAUCEDA: Yeah, thank you. They can visit our website. It's nadsa.org, so N-A-D-S-A dot org. And there's a section to learn about member benefits. We love our strategic partners. Without them we would not be able to operate. So if you are in the adult day space but maybe don't provide adult day, we have something for everyone. And if anyone has direct questions, I'm also always available. I like to share that with people because that is important to me that I stay connected. So people are welcome to reach out to me at my email. I know that some people are like, "Don't give that out," but I love it. So it's just—

KENNETH ACCARDI: Perfect. So what's that email? Go for it.

TIA SAUCEDA: It's T-S-A-U-C-E-D-A at nadsa.org. So tsauceda@nadsa.org.

KENNETH ACCARDI: Perfect. All right. I'm writing it down. We'll have that in the notes. And thank you so much for meeting with us today and congratulations on your role. And we're really, really excited to see where NADSA and day services are going to go. And I know that you can't fail and you're going to outshine and outperform everything that everybody is hoping for. So thank you for that.

TIA SAUCEDA: Oh, thank you. I really appreciate the opportunity to sit here and get to know you a little more an