Every director knows the early morning phone call. A daughter rings at 7:40 to say her father isn’t doing well and won't be coming in. The driver adjusts the route and the day goes on.
Add those calls up over a month, though, and they start to matter. An empty chair still needs staff on the floor and a lunch ordered. For most adult day centers, the revenue only arrives when the participant does.
Last week that math made the local news. WCAX reported that two Vermont adult day centers are facing closure, with the state down to 11 certified programs from 17 before the pandemic. The report cited a Medicaid rate of $26.54 an hour against costs of around $36, and said centers need to run at roughly 80% capacity to survive. State officials are working with both centers on stabilization funding, and neither closure is final. But directors in plenty of other states will recognize the story.
Rates are a policy fight, and one worth joining. Attendance is something you can work on this week.
Why attendance matters more than enrollment
It is easy to measure a center by how many people are on the books. But adult day center attendance, the number who actually walk through the door each day, is what pays the bills.
Look at how most programs are paid. The CDC's most recent national data found that 79% of adult day participants in 2022 used Medicaid, and in most states Medicaid pays for adult day services only when the service is actually delivered. Private-pay families usually pay by the day as well. CareScout's 2025 Cost of Care Survey puts the national median for adult day health care at $95 a day.
As a rough illustration, if one participant misses one day a week, at $95 a day that is about $4,940 of care not delivered, and not billed, over a year. Ten participants with the same pattern add up to nearly $50,000. Your rates will differ, but the shape of the problem holds.
There is a care cost too. The same CDC data shows about a third of participants have Alzheimer's disease or another dementia, and routine is part of what helps them. Missed days break that routine, and a run of absences is often the first sign that something has changed at home.
Find the pattern before you fix it
Most centers record absences. Fewer look at them. A name crossed off the daily sheet tells you who was missing, but not why, and not whether it is happening more often.
Start by recording a reason every time someone is absent on StoriiCare using our tags feature. Keep the list short so staff use it effectively: illness, hospital stay, medical appointment, transportation, caregiver schedule, family trip, declined to come, and unknown. If "unknown" turns out to be your most common reason, your first job is getting better information.
After a month, sit down with the numbers and look for:
- Participants whose attendance has dropped compared with their usual pattern
- Days of the week that run consistently lower
- Reasons that keep coming up, such as transportation on a particular route
This is where paper gets hard. StoriiCare's attendance tools track absences and generate real-time attendance reports, so a director can spot trends by participant or by day without tallying sheets by hand at the end of the month.
A same-day absence routine your team can start tomorrow
The goal is not to pressure families. It is to make sure every absence gets a human response while that response can still make a difference.
- Check who is missing by 10 a.m. Compare the day's attendance against the schedule so no absence slips by unnoticed. (StoriiCare’s register toggle provides this in one click)
- Call every unplanned absence the same day. Keep it warm and short: "We missed Robert today. Is everything okay?" Log the reason.
- Flag anything that sounds clinical. A fall, new confusion or a hospital visit should go to your nurse or care manager so the care plan can be reviewed.
- Offer a practical fix when there is one. A different pickup time, a later start, or a reminder call the night before.
- Follow up after two absences in a row. Make a second call, ideally from a staff member the family knows well.
- Review the week on Friday. Spend ten minutes with your program manager looking at anyone whose attendance is slipping.
None of this needs new staff, but it does need an owner. In many centers that is the front desk or a program assistant, with the director reviewing the weekly summary.
Focus on the reasons you can control
Some absences are simply part of life. People get sick, and families go on vacation. But several common reasons are within your reach.
Transportation is usually the big one. If one route runs late, the participants on it are more likely to give up on the harder mornings. Check whether absences cluster around a driver, a pickup window or a part of town.
Caregiver schedules come next. AARP's Caregiving in the US 2025 report found that 63 million Americans are family caregivers and six in 10 of them are also employed. Half of those working caregivers report disruptions such as arriving late or leaving early. If your hours don't line up with a caregiver's shift, attendance will suffer on exactly the days they need you most. Ask families directly whether an earlier drop-off or later pickup would help.
Declining to come deserves a closer look. A participant who says they don't want to go might be bored, or might be having a hard time with a particular group. Sometimes a new seat, a small job to do during the day, or a favorite program moved to Monday is enough to change the answer.
Keep families close between visits
Families who feel connected to the center tend to treat it as a fixed part of the week rather than an optional extra. When they can see what their loved one did yesterday, it is easier to get them out the door tomorrow.
We covered this in more depth in What Families Really Want to Know About Their Loved One's Day. The short version is that regular, specific updates build the kind of trust that keeps people enrolled. A family that already hears from you often will pick up when you call about a missed day.
For many caregivers, your center is what makes their week possible. One caregiver in the Vermont story called her mother's center "my lifeline." It is worth reminding families of that, gently, when routines start to slip.
Small numbers, steady gains
A phone routine won't close a funding gap on its own. But a few extra attended days per participant each month add up, on your billing and in the lives of the people you serve. Start with reason codes and same-day calls, add the Friday review, and give it a full quarter before you judge the results.
If you'd like to see how StoriiCare can help your team track attendance and spot patterns earlier, book a demo.
