By Indy Senior Advisor Care Team · September 14, 2026
Indiana has no adult day care license. Oversight arrives only through Medicaid waiver certification, which means a private-pay-only program answers to no one. Here is what the state does require, what it costs, and what to ask.
The Option Most Families Skip Past
There is a gap in the middle of the senior care market that almost nobody shops for. On one side is in-home care, billed by the hour, one aide with one person. On the other side is a move into assisted living, which is permanent in the way that matters emotionally even when the lease says otherwise. Adult day services sit between them, and most families in the Indianapolis metro never seriously look.
The reason is usually not cost or availability. It is that the phrase sounds like day care, and adult children flinch at applying that word to a parent. So the conversation skips to touring communities, and a family that could have bought itself another eighteen months at home starts pricing a move instead.
What an adult day program actually does is narrower and more useful than the name suggests. Your mother goes to a building during business hours on a set schedule, some number of days a week and hours a day. She eats there. There are planned activities. Staff supervise her, help with personal care, and handle medication. Then she comes home. If the thing standing between your father and staying in his house is that he cannot be alone from eight to five while you work, this is the product built for exactly that problem.
It is also the option families reach for too late, after the caregiving has already broken something. Our page on what to do when you cannot keep doing this alone covers the broader set of relief options. This post is about the one nobody researches.
Indiana Has No Adult Day Care License
Start here, because it changes how you shop.
Indiana licenses assisted living communities. The Indiana Department of Health issues a Residential Care Facility license under 410 IAC 16.2-5, one tier, and you can ask to see it. Nursing homes hold a separate Comprehensive Care Facility license. Home health agencies and personal services agencies are licensed too.
Adult day is not on that list. We could find no Indiana licensure category that covers adult day programs, and FSSA's own published adult day materials are provider certification documents, not license applications. What exists instead is certification through FSSA's Division of Aging, and it attaches to a program because of who pays it, not because of what it is. A program that bills Indiana's PathWays Waiver, the Health and Wellness Waiver, the Traumatic Brain Injury waiver, or CHOICE dollars brokered by the Area Agency on Aging has to be certified, surveyed on site, and held to written standards. A program down the road that takes only private checks is outside that system entirely.
That is not a scandal and it does not mean private-pay programs are bad. Plenty are excellent, and some are run by churches and community centers that have done this well for decades. It means the verification step families assume exists does not exist, and the burden shifts to you. If a program tells you it is state licensed, the right response is a polite question: licensed by whom, under what, and may I see it.
It also means the state's standards are still the best yardstick you have, even for a program that is not bound by them. You can ask any program whether it meets them. The answer, and how readily it comes, tells you a great deal.
What the State Actually Requires of a Certified Program
FSSA publishes the adult day service requirements plainly, in a document last updated in August 2025. The physical plant list alone is worth carrying on a tour.
A certified adult day facility must provide 100 square feet per participant if it has office space, or 60 square feet per participant if it does not. It needs a dividable multipurpose room or area for group activities including dining, a kitchen area, an exam and medication room, a quiet room, bathing facilities, toileting facilities, storage, a room for counseling and interviewing participants and family members, a reception area, outside space, furnishings, and accessibility throughout every area participants use.
Read that list again and notice two items. The quiet room is the one that matters for dementia. A participant who becomes overstimulated at two in the afternoon needs somewhere to go that is not the main room and is not a hallway. A program without one manages that moment by sending people home. The counseling and interviewing room is the other: it means conversations about your mother are supposed to happen somewhere other than the front desk.
Certification also requires an on-site visit to verify compliance with the federal Settings Rule, staff hired and credentialed at the time of certification, background check results, negative TB test or chest x-ray results, proof of liability insurance, and a written operations manual covering incident reporting, HIPAA, file retention, quality assurance, personnel policy and more.
Programs may also separately apply to provide transportation, so they can bring participants from home and back. That is a distinct authorization, not something bundled in. Ask about it directly rather than assuming the van you saw in the lot is theirs.
Level 1, Level 2, Level 3 — and the Staffing Ratio
Indiana certifies adult day at three levels, and the differences are concrete enough to use as a shopping question.
Level 1 programs monitor all activities of daily living and give hands-on help as needed, provide comprehensive therapeutic activities, and monitor medication or administer it. They need a registered nurse consultant to conduct health assessments and be available as needed. Minimum staff ratio: one to eight.
Level 2 adds assistance with medication and, importantly, at least one full-time LPN with monthly RN supervision. Minimum staff ratio: one to six.
Level 3 adds direct health interventions as needed, comprehensive therapeutic intervention rather than just activities, at least one qualified full-time staff person dedicated to participants' psychosocial needs, and rehabilitation and restorative services including physical, speech and occupational therapy, coordinated or available. Minimum staff ratio: one to four.
Here is how to use this. Ask a program what level it is certified at, and ask what its actual ratio is on a Tuesday afternoon rather than what its minimum is. Those are different numbers and the gap between them is the whole story. A Level 1 program at one-to-eight is fine for a parent who is physically steady and mildly forgetful. It is the wrong setting for someone who is midway through a dementia course and needs a hand in the bathroom, and a program that admits her anyway is telling you something about its judgment.
If your parent has a diagnosis and you are early in figuring out what comes next, our page on the first month after a dementia diagnosis covers the sequencing.
The Price Is Not What Families Expect
Adult day sounds like the cheap option. In Indiana it is cheaper than the alternatives, but it is not cheap, and Indiana is a genuinely expensive state for it.
The 2025 CareScout Cost of Care Survey puts adult day health care in Indiana at about $127 a day. That is the thirteenth most expensive in the country and roughly a third above the national median, which fell five percent to $95 a day. Indiana runs below the national average on assisted living and well below on in-home care. On adult day it does not.
That is a statewide median. CareScout publishes state figures only, so there is no Indianapolis-metro adult day number from any primary source, and anyone who quotes you one cannot show you where it came from. The same caution we apply to every other cost figure on this site applies here.
The arithmetic below is ours, built from those published medians, not a quote from any local program. At $127 a day, five days a week, a year of adult day runs about $33,000, or roughly $2,750 a month. Indiana's median assisted living cost is $5,639 a month. So five-day adult day runs about half of assisted living, while your parent keeps her house and her bed.
The more useful comparison is against in-home care. Indiana's median non-medical caregiver rate is $35 an hour. Six hours of an aide at your father's kitchen table costs $210. The same six hours at an adult day program costs $127, and that $127 buys a full day, a meal, a nurse on the premises and other people to talk to. Divide it out and adult day is running somewhere between $16 and $21 an hour depending on the length of the day.
That is the real argument for this option, and it is an argument about isolation as much as money. We ran the hourly numbers for in-home care separately in the real math on in-home care in Marion County. Adult day wins on cost per supervised hour by a wide margin. It loses on flexibility, because it happens on the program's schedule and not yours, and it does nothing at all for nights and weekends.
Who Pays, and the Rulebook That Has Not Caught Up
Adult day services are a covered service under Indiana's PathWays Waiver, the Health and Wellness Waiver and the TBI waiver. PathWays is the one that applies to most Hoosiers 60 and older; it replaced the old Aged and Disabled Waiver on July 1, 2024, and it pays for care services rather than room and board. Our piece on PathWays, RCAP and the waitlist lays out that structure.
There is a second, less-known door. Under 455 IAC 2-5-1(e), adult day services are among the services an Area Agency on Aging may broker with CHOICE or Title III money rather than Medicaid. CHOICE is Indiana's state-funded program, it is not Medicaid, and its eligibility rules are different. For a family whose parent has too much income for Medicaid and not enough for a $2,750 monthly private check, that is the path worth asking about. We covered it in how Indiana's CHOICE program pays for help at home.
One honest oddity, because it will confuse anyone who goes reading the rules directly. 455 IAC 2-5-1(a) still lists adult day services under the aged and disabled Medicaid waiver, a program that no longer exists under that name. The rule was readopted in September 2024, two months after PathWays launched, without the list being rewritten. The service is real and covered; the rulebook simply uses the old label. If a provider or a website quotes you the A and D waiver as a current program, that is where it came from.
Getting waiver coverage still runs through an eligibility determination first. Indiana moved who performs that assessment, and we walked through who conducts the level of care assessment now and what the call looks like.
And if the honest answer is that your family is providing the care and needs to be paid for it rather than buying days out of the house, structured family caregiving is a different PathWays service worth comparing against this one.
Six Questions for an Actual Visit
Go in person, on a weekday, mid-morning, unannounced if they will allow it. What a program looks like at 10 a.m. on a Wednesday is the product.
Ask what level the program is certified at, and who certified it. If the answer is that it is not certified because it does not bill Medicaid, that is a legitimate answer and not a disqualifier. Follow it with: which of the state's adult day standards do you meet anyway, and can you walk me through the building against them.
Ask the ratio question twice. What is your required minimum, and what was your actual staff-to-participant ratio yesterday afternoon. Afternoon matters because that is when both staffing and participants thin out and when sundowning starts.
Ask what happens on a bad day. Specifically: if my mother becomes agitated at two o'clock, what do you do, and at what point do you call me. A program with a quiet room and a plan answers this in two sentences. A program without one answers it by describing when they send people home.
Ask about medication, precisely. Monitoring medication, assisting with medication and administering medication are three different things in Indiana's own level definitions, and the difference is who is licensed to do what. Find out which one applies to your parent's list.
Ask about transportation as a separate service, not an amenity, and ask what the total looks like on paper: the daily rate, the transportation charge, whether there is a minimum number of days, and what happens to the charge when your parent is sick and stays home.
Then call CICOA Aging & In-Home Solutions, the Area Agency on Aging for Marion, Hamilton, Hendricks, Johnson, Boone and Hancock counties, at 317-803-6131. Options counseling is free and they have no building to fill. FSSA's own adult day guidance also points providers to the Indiana Association of Adult Day Services at iaads.net, which is a reasonable place to see who is operating in the metro. What one call to CICOA actually gets you is more than most families expect.
