2022 Edition

Adult Day Services (CA-AD) 5: Service Elements

Social, education, health, and supportive services promote regular participation, optimal functioning, and independence.

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Individuals who participate regularly in Adult Day Services achieve and maintain an optimal level of well-being, functioning and health, and remain in their preferred community residence.
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Program curriculum or sample daily program schedule
  • Participant/personnel ratios
  • Education curricula
  • Examples of health and wellness activities
  • Interviews may include:
    1. Program director
    2. Relevant Personnel
    3. Persons served
  • Review case records


CA-AD 5.01

A varied program of social, educational, and supportive activities developed with program participants provides opportunities for:
  1. stimulation of talents and abilities;
  2. skill development and maintenance;
  3. acquiring and using practical information; and
  4. supported or competitive employment, as applicable to the service population.
Examples: Programming takes into account issues such as age-related dementia, brain injuries, mental illness, HIV/AIDS, gender/sexuality, and race/ethnicity.


CA-AD 5.02

Programs are:
  1. age-appropriate;
  2. culturally diverse; and
  3. adjusted to the functional levels of individual program participants.


CA-AD 5.03

An activity schedule is published and provides participants with choices.


CA-AD 5.04

Service recipients have the opportunity to interact with the community through:
  1. presentations, lectures, or workshops provided by community members; and
  2. planned trips within the community.

Fundamental Practice

CA-AD 5.05

The health and well-being of each service recipient is promoted through:
  1. contact with the person's physician at intake, as needed;
  2. education designed to enhance the individual’s optimum level of functioning and independence;
  3. basic assistance with activities of daily living;
  4. a nutrition program that meets individual needs and preferences;
  5. emergency medical and dental services, and first aid when needed; and
  6. notification of caregivers when changes in functioning are observed.
Examples: Nutrition programs can include:
  1. culturally competent nutrition;
  2. education;
  3. nutritious snacks; and 
  4. one or more balanced meals prepared according to the dietary needs of persons served and the current Canada Food Guide.
Health services can include:
  1. health assessments and monitoring;
  2. medication administration and help with self-administered medications; and 
  3. skilled nursing services.

Fundamental Practice

CA-AD 5.06

The ratio of personnel to participants is defined for all programs and activities, and is:
  1. adjusted according to degree of frailty or disability; 
  2. frequently reassessed in response to the changing needs of the group; and
  3. reviewed annually.


Generally, the ratio is at least one adult for every five to ten participants. The ratio for Alzheimer's patients is one adult for every four participants. Ratios may be achieved by use of volunteers in support positions.