Understanding Indiana's “three levels of care” for day centers
Still Waters Adult Day Center is one of Indiana’s few Level-2 certified facilities.
There are only about 40 adult day care centers in Indiana. Adult day cares (ADCs) have a legal definition from the Indiana Family and Social Services Administration (PDF): any place that offers "a social environment for older adults” alongside programming and professional care. Facilities must have space for group activities as well as a kitchen, bathing areas, quiet rooms, examination/medication rooms, and outside space.
Compared with nursing homes, at-home nursing care, or other specialized facilities, ADCs are dramatically more cost-effective, costing about a third to half as much as traditional care. But there aren't many of us in the Indianapolis metro area, and some facilities better serve patients than others.
Indiana's Social Dynamic, Social-Medical, and Enhanced Medical Day Center levels
"Indiana defines day centers with three levels of care," says Diana Keely, Executive Director of Still Waters ADC. She describes the three levels as:
Social Dynamic
Social and Medical Dynamic
Enhanced Medical Dynamic
"Still Waters is a Level 2 Social and Medical Dynamic day care center. That means we have a nurse on-site at all times, and all the staff here at Still Waters are Certified Nursing Assistants (CNAs) or higher."
All Indiana ADCs do some intake process. "If someone comes in, they meet with the nurse, and they do an intake to figure out what their needs are," says Keely. This process is not medical in nature, but does ask for a complete medical history and works to understand what challenges a person might face day-to-day. "If someone requires Level 3, we can't take them yet," says Keely. As of fall 2025, Still Waters ADC is working to become one of the exceedingly rare Level 3-certified ADCs in Indiana, but that process takes time and regulatory review.
Patients with severe medical issues that may require advanced monitoring, such as people prone to strokes or seizures throughout the day but can otherwise feed themselves, move around, and use the restroom, are best served by Level 3 ADCs. Level 2 ADCs, such as Still Waters, can provide medical care, including medications that require injections or the management of oxygen tanks.
"There are more Level 1 ADCs than twos or threes," says Keely. "And the quality of care differs dramatically between facilities, no matter their levels."
Still Waters provides vastly better nursing-to-patient ratios than traditional Hoosier nursing homes.
Indiana Family and Social Services Administration regulations require minimum nursing standards at nursing facilities, and even in those long-term care residential facilities the average nurse-to-patient ratio is 40:1. "Nursing facilities in Indiana are in a constant struggle to meet demand for nurses amid Medicaid services and funding issues, educational requirements, and sheer demand. But the ratios are not great. One nurse is in charge of 40 patients. For most nurses, that's enough time to spend about 10-20 minutes a day with a patient."
Regulatory requirements for ADCs are much different. "Among the three types of ADCs, in a Level 2 ADC, the nurse ratio is 1:6. We're in the application process for Level 3, where the ratio is 1:4, which we already meet," says Keely.
Not all Adult Day Care centers focus on the elderly, but Still Waters does. "We're 55+ only," says Keely, noting some facilities offer services for much younger people, including those with medical issues, people who have suffered traumatic brain injuries, and people with mental faculty decline.
"The nurses and support team here at Still Waters do great work with everyone who spends time with us every day. Our patients are happy, caregivers benefit from knowing their loved ones are safe, and the costs are lower than virtually any other option," says Keely. "When you're evaluating where to go for adult day care, ask about their licensing and levels of care. It can help you make the right decision for all involved parties."
FAQs about Indiana ADC care levels
Do Medicaid services help cover costs for ADCs?
Yes, but funding is very tight and getting tighter. Various Indiana-run programs, like Pathways to Aging, that are funded in part by Medicare and Medicaid are struggling to maintain funding amid rising costs, such as transportation costs. Still Waters provides services at dramatically lower costs, including pick-up and drop-off rides, thanks in part to donations and the support of Castleton United Methodist Church.
Is Out-of-School Learning or Child Care provided as part of ADC levels?
No, those services are provided by "traditional" child day care. Adult day care centers typically don't provide educational services or a set curriculum, except in rare cases where someone past the age of 18 may be working toward a High School Equivalency diploma through out-of-school learning programs. But these cases are rare. The programs we offer are engaging, though, like many of the therapies, crafts, and arts we host here at Still Waters.
Should I be worried about placing my parents or loved ones in a Level 1 ADC?
Like how any school, day care, hospital, or healthcare provider can vary dramatically from one facility to the next, it depends. Caregivers should always visit with an ADC, discuss their licensing requirements, the type of approved provider they are, and the quality and cost of their services to make informed decisions. A Level 1 ADC can be an excellent fit for a lot of people. And sometimes, it’s just not a good fit or not the right place.
And even if a person may "only" need a Level 1 ADC, they can still feel right at home in a Level 2 or Level 3 ADC. “Typically, a person starts with a Level 1 facility, but they may progressively need a Level 2 and later a Level 3 facility,” says Keely. “Higher-level facilities like Still Waters can ease the transition as loved ones need more care.” Talk to an intake specialist to learn more.
