Journal article
Toward a Payment Model for Augmenting Adult Day Services (ADS) with Caregiver Support: Costs, Willingness, and Ability to Pay for the ADS Plus Program
Innovation in aging, v 9(9), igaf089
15 Sep 2025
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background and Objectives
The evidence-based Adult Day Services (ADS) Plus program, delivered by ADS staff to caregivers, offers dementia education, support, and strategies to manage care challenges and has been shown in randomized trials to decrease caregiver depressive symptoms and increase ADS utilization. This study examines costs, cost savings, and caregiver willingness and ability to pay for this evidence-based program.
Research Design and Methods
In a 34-site cluster-randomized trial (16 ADS Plus sites; 18 ADS-only usual care sites) involving 203 caregivers, we surveyed program delivery costs, payer-perspective costs (healthcare utilization, formal care/social services utilization), and societal-perspective costs (caregiver time + payer costs) at baseline and 12-months. Enrollees were caregivers who reported on their outcomes and those of the person living with dementia. Costs were calculated using unit costs or appropriate wage rates. We assessed mean per-dyad costs and the between-group difference in mean change in payer and societal costs from baseline to 12-months. Multi-level mixed models considered clustering, and caregivers’ willingness-to-pay (WTP) and ability-to-pay (ATP) were evaluated.
Results
ADS Plus delivery costs were $433/dyad over 12-months. From the payer perspective, ADS Plus resulted in non-statistically significant but policy-significant cost savings of $1,501 (95% CI: -$2,771, $4,804). From a societal perspective, ADS Plus led to cost savings of $1,185 (95% CI: -$11,187, $7,036). ADS Plus caregivers’ median per-session WTP was $90 at baseline and $100 at 12-months, compared to $50 and $100 for usual care. ADS Plus caregivers’ median ATP was $31.50 at baseline and $50 at 12-months, versus $25 at both time points for usual care.
Discussion and Implications
ADS Plus yielded meaningful cost savings, though statistical significance was not achieved. Caregivers were WTP and ATP toward ADS Plus sessions, which could offset program costs. This study elucidates the financial implications of incorporating caregiver support into community-based dementia care programs.
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Details
- Title
- Toward a Payment Model for Augmenting Adult Day Services (ADS) with Caregiver Support: Costs, Willingness, and Ability to Pay for the ADS Plus Program
- Creators
- Laura T Pizzi (Corresponding Author) - Rutgers, The State University of New JerseyKatherine M Prioli - Environmental and Occupational Health Sciences InstituteAlexa Molinari - Rutgers, The State University of New JerseyEric Jutkowitz - Brown UniversityKatherine A Marx - Johns Hopkins UniversityDavid L Roth - Johns Hopkins UniversityJoseph E Gaugler - University of MinnesotaLaura N Gitlin - Drexel University
- Publication Details
- Innovation in aging, v 9(9), igaf089
- Publisher
- Oxford University Press
- Number of pages
- 10
- Grant note
- National Institute on AgingEconomics at Rutgers UniversityInternational Society for PharmacoeconomicsCollege of Nursing and Health Professions at Drexel UniversityCenter on Aging and Health, Division of Geriatric Medicine and Gerontology at Johns Hopkins University
The grant sponsor had no role in study design, data collection, data analysis, or decision to publish the communicated data. The authors of this economic study are currently affiliated with the Center for Health Outcomes, Policy, and Economics at Rutgers University (L. T. Pizzi, K. M. Prioli, D. L. Roth, and A. Molinari), the International Society for Pharmacoeconomics and Outcomes Research (L. T. Pizzi), College of Nursing and Health Professions at Drexel University (L. N. Gitlin), the Center on Aging and Health, Division of Geriatric Medicine and Gerontology at Johns Hopkins University (D. L. Roth), and the University of Minnesota (J. E. Gaugler). E. Jukowitz was affiliated with the Department of Health Services, Policy & Practice at Brown University School of Public Health at the time of his contribution to this study; as of July 2025, he is affiliated with the School of Public Health, University of Minnesota.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Nursing and Health Professions
- Web of Science ID
- WOS:001599714700001
- Scopus ID
- 2-s2.0-105020041370
- Other Identifier
- 991022116773304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Geriatrics & Gerontology
- Gerontology