Abstract
As Alzheimer’s disease and related dementias (ADRD) become more common, there is a growing need for programs that improve the quality of life for individuals living with these conditions. Understanding existing community-based models of engagement is essential for identifying effective, scalable solutions. Adult Social Day Services (ASDS) offer opportunities for socialization and cognitive engagement for individuals who require minimal assistance with activities of daily living. Although promising, ASDS programs are used unevenly, and their overall effectiveness remains unclear. To address this gap, we conducted a parallel convergent mixed-methods study using data from a fee-based ASDS program located at a senior center in a northeastern U.S. town. Using a population-level survey, stakeholder focus groups, and in-depth interviews with current and former participants and their families, we examined the program from multiple perspectives. Findings suggest the ASDS model has strong potential for scaling, replication, and adaptation as a community-based dementia intervention, with benefits for participant well-being and caregiver support.
Keywords
• Evaluates the Adult Social Day Service model as a potential respite option for dementia caregivers. • Offers a detailed examination of the benefits and challenges of Adult Social Day Services. • Provides a clear definition of Adult Social Day Services within the broad framework of Adult Day Programs.
• Informs policy to support funding for flexible, inclusive, adult day service models. • Guides future research that evaluates the effectiveness and accessibility of Adult Social Day Services.What This Paper Adds
Applications of Study Findings
Introduction
The U.S. older adult population is expanding rapidly, with approximately 10,000 baby boomers turning 65 each day (Genworth, 2021). As this demographic grows, the demand for services that support healthy aging and enable older adults to remain in their homes has intensified; in fact, 75% of Americans aged 50 and older express a strong preference to age in place (AARP, 2024). This need is especially evident among the 7.2 million Americans aged 65 and older living with Alzheimer’s disease and related dementias (ADRD) (Alzheimer’s Association, 2025).
Dementia-centered supports encompass a wide range of services designed to address the unique needs of individuals living with dementia as well as their caregivers. These supports include, but are not limited to, adult day health services (ADHs), which provide structured programs of health, social, and therapeutic activities in a supervised setting; Adult Social Day Services (ASDS) that offer opportunities for social and cognitive engagement in a safe environment; and memory cafés, which are informal gatherings where individuals with dementia and their caregivers can connect, share experiences, and engage in stimulating activities (Akincigil et al., 2024). Additionally, respite care services offer temporary relief for caregivers by providing short-term care for individuals with dementia in various settings, including in-home or facility-based care (Sieglet et al., 2015). Furthermore, dementia-friendly initiatives aim to raise public awareness, reduce stigma, and promote inclusive communities where individuals with dementia can live with dignity and greater independence (Akincigil et al., 2024).
Among the available interventions for people living with dementia, ASDS provide opportunities for socialization and engagement in physical activity, cognitive exercises, and emotional support in small group settings. These programs are beneficial for older adults who may experience physical or cognitive health changes that make independent participation difficult, as well as for those who are socially isolated or do not drive. ASDS offer interactive activities including games, chair exercises, arts and crafts, music therapy, and social engagement, allowing participants to explore new interests and socialize in a safe, structured environment. Programming is typically offered in half- or full-day increments and is designed to provide meaningful engagement for participants while offering relief and support for caregivers. As a non-medical model, ASDS are intended for individuals with sufficient functional independence to engage without direct physical assistance or on-site medical intervention. These programs provide respite from caregiving responsibilities and connect caregivers to vital resources and support networks.
Given the limited research specific to Adult Social Day Services, we expanded our literature review to include studies of adult day services broadly. Existing studies of adult day services demonstrated reduced caregiver stress, improved participant mood and behavior, delayed institutionalization, and associated cost benefits—outcomes that are relevant to ASDS and support their role in enhancing participant well-being and caregiver support (Gitlin et al., 2024; Sadarangani et al., 2022; Zarit et al., 1998). Research has demonstrated that engaging individuals living with ADRD in interventions that promote cognitive stimulation, physical exercise, and social interaction can have a positive impact on their quality of life (Ruthirakuhan et al., 2012) and can help to maintain cognitive function, enhance emotional well-being, and support daily functioning, thereby allowing individuals to live as independently and meaningfully as possible (Preez et al., 2018). According to Yates et al. (2019), such multi-faceted interventions not only address the diverse needs of those with ADRD but also contribute to slowing the progression of symptoms and reducing caregiver burden. Social engagement has been associated with minimizing dementia risk among older adults, as it increases neuronal connections and more efficient processing in the brain despite brain changes (Alzheimer’s Association, n. d.).
The current landscape of ASDS models for older adults, particularly those living with dementia, reflects a growing recognition of the models’ potential to promote well-being while addressing caregiver needs for respite, helping families manage intensive caregiving responsibilities and potentially delaying or preventing the need for institutional care (O’Keeffe et al., 2014). Despite these known benefits, there are significant gaps in knowledge of ASDS and adult day services broadly. ASDS remain underutilized, largely due to insufficient public awareness and limited dissemination of information regarding their effectiveness and availability (Sadarangani et al., 2024). Funding for ASDS is often limited and fragmented across sources such as Medicaid waivers, state-funded initiatives, private payments, and grants, which contributes to inconsistencies in service provision and hinders efforts to scale and sustain services effectively (Sadarangani et al., 2024). Few longitudinal studies examine the long-term outcomes of participants or caregivers, and there is no standardized framework for evaluating program quality across sites (Anderson et al., 2018). Addressing these gaps will be essential to expanding equitable, high-quality dementia-friendly day services in the future.
Methods
As part of an effort to evaluate ASDS as effective community-based models for supporting individuals living with dementia, the research team conducted a parallel convergent mixed-methods assessment designed to capture information at multiple levels of the community and service system. Recognizing the diversity of ASDS programmatic models, this community case study aimed to describe one program’s design and to assess demand for it within the town. In this study, “demand” refers to factors such as community awareness of the program, caregiving experiences—including the types of care provided—and preferences for support and service delivery. The overarching project purpose was to ensure that the program’s capacity and structure aligned with the needs of the community it serves.
The ASDS program examined in this study was situated in a northeastern town with a population of approximately 36,000 residents. The town’s self-sustaining, fee-based ASDS was administered by the local senior center, which also served as its physical location. Eligible participants for the program were adults aged 60 and older or younger individuals who had been diagnosed with early-onset ADRD. Most participants presented with some level of cognitive impairment. To ensure appropriate program participation, individuals were required to meet specific functional eligibility criteria including the ability to follow instructions and function safely within an ambulatory setting. Participants also needed to independently perform essential activities of daily living, such as self-feeding, toileting, and administering their own medications. This convergent mixed-methods design incorporated three complementary data sources collected in parallel: (1) in-depth interviews with current and former program participants and their families, program staff, and regional aging service professionals, (2) stakeholder-level focus groups, and (3) a population-level community survey.
A total of 17 key informant interviews were conducted via Zoom or in person, including a mix of current and former ASDS participants and caregivers, ASDS staff, and regional stakeholders familiar with the adult day network. Interview participants were intentionally selected to provide multiple perspectives on the program, including those who interact directly with ASDS, those working in the broader caregiving and adult day industry, and individuals knowledgeable about population-level program needs. The research team asked the current and former participants and their caregivers about their experiences identifying and enrolling in ASDS, what aspects of the program they found most beneficial, and areas they felt could be improved to better support individuals living with dementia and their families. Interview questions specifically included: (1) how participants first learned about ASDS; (2) factors influencing their decision to enroll; (3) perceptions of program quality; (4) challenges encountered during participation; and (5) suggestions for program improvement. Participants were encouraged to reflect on what initially drew them to ASDS, how it impacted their daily lives, and any barriers they encountered along the way. Interviews with program staff were designed to better understand current program operations including enrollment processes and opportunities for improvement. Interviews with regional aging service professionals provided more information about the referral pathways to ASDS and barriers to accessing these services.
Moreover, four focus groups were conducted with caregivers and residents, board members from the town Council on Aging (COA), and directors from the region’s Area Agency on Aging (AAA) and other local COAs. Community members, including the town’s COA board, were asked to reflect on their personal caregiving experiences and what role ASDS had played or could have played in those experiences. Other local COA directors were asked about their communities’ perceived needs for ASDS and the broader context influencing program utilization. Focus group prompts included questions about caregiver and resident awareness of ASDS, perceived gaps in local caregiving supports, community attitudes toward ASDS, and expectations for how ASDS could meet the needs of residents aging in place. These focus groups served as stakeholder-level and program-level data sources, capturing contextualized community perspectives on service gaps, expectations, and barriers. Both focus groups and interviews were audio recorded. Focus groups were held on-site of the senior center where the program is operated; and the interviews were completed via Zoom. Conversations ranged from 30 minutes for interviews to 60 minutes for focus groups. Interviewees and focus group participants were recruited in a variety of ways—by email, phone, and in-person. This was a convenient sample of residents who volunteered to participate and were identified by the Director of the senior center as having relevant perspectives to the topic. A total of 44 people participated in the qualitative portion of the project; 27 individuals participated across four focus groups and 17 individuals were interviewed.
In collaboration with community partners, a 24-item, web-based survey was distributed to assess the anticipated need for caregiver support services—including ASDS—as well as the experiences of current and former caregivers and general awareness of available ASDS. The survey content assessed at the population-level, (1) perceived need for caregiver support programs, including ASDS; (2) the experiences of current and former caregivers; (3) awareness and knowledge of ASDS; and (4) demographic characteristics relevant to understanding the scope of caregiver needs within the community (e.g., race/ethnicity, care recipient health conditions, living arangement).
The survey targeted members of the general public living in the town who were 50 years of age or older. To reach the intended population, residents of the town age 50 and older received postcards alerting them to the opportunity to participate in the survey. A total of 8,323 postcards were mailed to the town’s residents. Additional outreach was conducted through electronic newsletters and promotion at local community events. To enhance accessibility, printed versions of the survey were made available in English and Chinese at key community locations, including the senior center and the public library. The survey was translated into Traditional Chinese, and a back-translation was performed by members of the research team to ensure accuracy. A total of 1,076 residents completed the survey, including 15 in Chinese that were translated by research staff, yielding a 13% response rate.
Parallel Convergent Mixed-Methods Design and Key Findings
Note. ASDS = Adult Social Day Services. The table presents qualitative and quantitative findings aligned using a parallel convergent mixed-methods design.
Results
This study triangulated findings from three primary data sources—1) caregiver and COA focus groups, (2) interviews with participants and caregivers, program staff, and aging service professionals, and (3) a community-based survey of town residents aged 50 and older—to develop a comprehensive understanding of caregiving experiences, participant outcomes, and community-level awareness of ASDS (Table 1). Data from these sources were integrated iteratively, with qualitative findings informing interpretation of survey patterns, and survey results contextualizing and expanding insights from focus groups and interviews. This approach enabled identification of convergent themes across sources, providing a robust understanding of program experiences and broader caregiving needs.
Findings From Focus Groups with Caregivers
In the two caregiver focus groups, participants described the day-to-day realities of caring for individuals with ADRD and other serious illnesses, highlighting the intense physical and emotional demands of long-term caregiving. They highlighted the challenges of providing near-constant care while attempting to navigate fragmented systems of support.
Many caregivers emphasized the all-consuming nature of their responsibilities. One caregiver who was caring for an individual with Parkinson’s disease shared, “I’m at my wits’ end. The immobility problem has really made it difficult for me to care for her because it’s almost 24 hours a day. The only time I have off is when she’s sleeping.” Similarly, a caregiver for a person living with Alzheimer’s disease noted, “It’s 24/7. You sleep very lightly because the moment you hear any noise at night, you don’t know what’s happening and need to react.” A key transition point commonly reported by caregivers was the moment they recognized it was no longer safe to leave the person in their care alone at home. This shift marked a significant increase in caregiving intensity and often prompted families to consider additional support services. Several interviewees also expressed anxiety about their own health and well-being, particularly concerns about what would happen to their loved one should the caregiver become unable to continue providing care.
References to support services such as home care arose in terms of both financial burden and the practical challenges of finding and managing help. One former caregiver lamented the lack of evening and weekend coverage offered by home care agencies, while another recounted a companion provider arriving on the wrong day—while the caregiver was at a medical appointment. As he explained, “It’s not only about finding care; you have to screen out whatever services are out there to provide you a little help. It’s very scary.” Caregiving during the COVID-19 pandemic further exacerbated these challenges. Many caregivers were shut out of critical medical appointments, cutting off their already limited access to information and support at a time when resources were most strained. Furthermore, Chinese community members indicated a need from more programing that is culturally and linguistically tailored to meet their needs.
These firsthand accounts reveal the cumulative burden of caregiving—and the gaps in support that compound it. Caregivers described a continuum of strain, from relentless physical and emotional labor to the financial and logistical hurdles of securing reliable home care. They pointed to pivotal transition moments—such as the decision to stop leaving loved ones unattended—and to periods of acute crisis, notably the early pandemic, when even basic services could vanish overnight. Together, these narratives underscore the urgent need for flexible, around-the-clock respite options, streamlined referral pathways, and culturally and linguistically tailored outreach efforts to ensure that both caregivers and care recipients obtain the comprehensive support they require.
Findings From Focus Groups With COA Board Members and Staff
Focus groups with COA board members in the town and regional COA staff members shed light on opportunities to improve program reach. Some focus group participants perceived the ASDS group setting as undesirable for certain personality types or suitable mostly for individuals with advanced cognitive impairment, perceptions that kept some individuals and caregivers from considering the program. Professional COA staff members noted the value of trust-building with senior center participants who might have family members eligible for the supportive day program and the opportunity to better engage caregivers by welcoming them to visit the supportive day program. Such perceptions suggest a need to refine messaging around the program eligibility and consider alternative programming that might better serve those unable or unwilling to participate in the group setting.
Interview Findings: Participants and Caregivers
Interviews with participants and caregivers from the town’s ASDS consistently reported positive outcomes for both participants and caregivers. The program was highly praised for fostering a strong sense of purpose, social connection, and engagement through tailored activities. Program caregivers emphasized the relief it provided by offering reliable respite care, as well as the compassion and attentiveness of its staff and volunteers. The structured routine and social interaction offered by the program—often informally referred to as a “social club” by both staff and participants—were seen as mutually beneficial, contributing to participant well-being and reducing caregiver burden.
Participants reported developing camaraderie and emotional support through shared experiences. One participant with mild cognitive impairment remarked, “I realized that we’re all sort of in the same boat in some way with memory problems or aloneness. It’s just a nice way to take away memory problems.” Focus group participants who had experience with the program echoed this sentiment, highlighting the peace of mind they experienced from knowing their loved ones were engaged in meaningful and stimulating activities. One caregiver, comparing the program to another local option, emphasized the superior quality of the services offered: “At least with the [name] Center, the activities that they do there are extremely stimulating for [participant name] and even after two years.”
Caregivers of program participants reported notable improvements in the well-being of those in their care as well as personal benefits from the respite the program provided. One caregiver observed that the participant became healthier physically, demonstrated improved communication, and was able to participate in more activities following enrollment in the program: “After joining, she was more physically healthy, she was able to keep longer conversations and participate in more activities.” Another caregiver emphasized both participant and caregiver benefits, stating, “She has absolutely blossomed with it. She has been very happy with the program, I have been thrilled with it, it gives me time to get things done around the house.”
The perceived impact of the program extended beyond quality of care. One caregiver described the program as critical to both their own and the participant’s well-being: “This program has saved my life; it has probably saved his life […] The fact that he has a hot meal every day is great in case I don’t feel like cooking—I don’t feel guilty. They just take such good care of him. It’s a remarkable program and I am just so thankful that it was available to him.” Another caregiver noted the importance of having a safe and engaging environment for their loved one: “To get some kind of respite by at least having her there, knowing she’s safe, being engaged, it takes a weight off my shoulders. So I can do other things like laundry, cooking, whatever needs to get done.”
In addition to respite and participant engagement, caregivers and program participants highlighted the compassion, approachability, and continuity of the program’s staff as key strengths. Participants reported that the program served as a connector to essential services, including Meals on Wheels, and consistently provided nutritious hot meals during lunchtime for those enrolled. Focus group participants cited the availability and value of additional programming offered through the senior center and broader aging services network. These included games and music programs, support groups, and telephone-based bingo, which one former caregiver described as “a lifesaver” during the COVID-19 pandemic. Peer support—particularly from those with shared caregiving experiences—was also frequently described as a critical resource.
Despite a need for caregiver respite and the benefits conferred by the town’s ASDS program participants, caregivers noted that transportation to and from the program and program fees were barriers to entry. Transportation was available for a small fee to residents of the town where the program was based; however, the many participants residing in nearby towns were required to secure their own transportation to and from the program. One caregiver explained her experience struggling to find outside transportation from their home in a town 17 miles away: “You cannot believe how hard I tried to get transportation. The distance was just too far. Even in the private pay, no one wanted to do it.” Ultimately, the caregiver relied upon a patchwork of family members to shuttle their loved one to the program. Program fees were largely paid privately but, in some cases, were offset by state subsidies, reflecting yet another hurdle shouldered by caregivers.
Interview Findings: Program Staff and Aging Services Professionals
Interviews with program staff described ASDS as largely self-funded, relying on private-pay fees, a revolving fund, and contracts with the regional COA/Aging Services Access Point (ASAP). Reimbursement rates were negotiated regionally through ASAPs and varied by community—for example, at this ASDS site, the regional COA/ASAP reimbursed $50 for a full day and $27 for a half day—with programs covering overhead and administrative costs. Administrators also sought supplemental grant funding. Despite these efforts, limited margins and the unpredictability of funding made sustaining the program a persistent challenge. Aging service professionals explained that ASDS were not eligible for reimbursement by state or federal health care subsidies, contrary to the more medically focused Adult Day Health programs.
Survey Findings: Community Perspective on Caregiving Supports
Current Caregivers
Community Survey Respondents
Note. 11 respondents reported ages under 60 and were included in this group.
Current Caregiver Demographics (n = 489)
Notes. Current caregivers were defined as those who are currently providing care or have provided care in the past 5 years to a person who is disabled, frail, or struggling with a physical or mental health condition.
aFor gender, 30% selected male.
bFor race/ethnicity, the question was check-all that apply.
Profile of Caregiver Relationships and Weekly Time Commitment
Notes. Current caregivers were defined as those who are currently providing care or have provided care in the past 5 years to a person who is disabled, frail, or struggling with a physical or mental health condition. Totals do not sum to 100%. Question responses were check all that apply.
aSurvey question: What is your relationship to this person?
bSurvey question: Approximately how much time do/did you spend providing care to this person?
Care Recipient Condition(s) as Cited by Current Caregivers
Notes. Current caregivers were defined as those who are currently providing care or have provided care in the past 5 years to a person who is disabled, frail, or struggling with a physical or mental health condition. Totals do not sum to 100%. Question responses were check all that app.
What supports would have been most valuable to you during your time providing care or assistance?
Notes. Current caregivers were defined as those who are currently providing care or have provided care in the past 5 years to a person who is disabled, frail, or struggling with a physical or mental health condition. Totals do not sum to 100%. Question responses were check all that apply.
Familiarity with Adult Social Day Service by Caregiver Status
Notes. Totals do not sum to 100%. Question responses were check all that apply.
aCurrent caregivers were defined as those who are currently providing care or have provided care in the past 5 years to a person who is disabled, frail, or struggling with a physical or mental health condition.
bNon-caregivers were defined as those who selected “no” to providing care in the past 5 years.
cFuture caregivers were defined as those who anticipate providing care for friends or family members as they get older.
Future Caregivers
Survey respondents who anticipated caregiving for aging family members or friends in the future were asked: “Given your resources, do you feel confident you will be able to provide care for this friend or family member who you anticipate caring for as they get older?” Responses varied: 29% felt fairly confident, 28% somewhat confident, 22% slightly confident, 6% completely confident, and 2% indicated they do not expect to be involved in their care. These findings indicate that many future caregivers feel only moderately prepared. Limited confidence may reflect concerns about balancing responsibilities, accessing resources, or managing complex care needs, and may be compounded by low awareness of programs like ASDS. Early outreach and education, including information on respite services and care planning, could help increase preparedness, promote timely program use, and reduce future caregiver stress.
Discussion
This mixed-methods study highlights the evolving landscape of caregiving and community-based dementia supports in a mid-sized northeastern town. As the population of older adults grows, so does the need for services that support people living with ADRD while enabling caregivers to sustain their roles. Consistent with national trends showing a strong preference for aging-in-place (AARP, 2021), these findings underscore the importance of community-based services such as ASDS within the local care continuum as well as the challenges accessing them.
Caregiver interviews highlighted substantial and ongoing demands associated with the caregiving role, and benefits of and barriers to ASDS program participation. Caregivers described physical fatigue, emotional strain, and increasing responsibility as dementia progressed—particularly once care recipients required continuous supervision. These accounts are consistent with prior descriptive research on caregiving burden and underscore why respite-oriented services are commonly sought as care needs intensify (Akincigil et al., 2024; Du Preez et al., 2018; Siegler et al., 2015). Among caregivers who were using ASDS at the time of the evaluation, participants described the program as a valued source of support. Reported benefits included opportunities for social engagement for care recipients and periods of relief for caregivers. These perceptions align with existing literature describing the potential role of adult day programs in supporting caregiver routines and participant engagement (Gitlin et al., 2024; Ruthirakuhan et al., 2012; Zarit et al., 1998). Barriers to program entry, however, included limited transportation access and perceptions that the program was not a fit for the care recipient.
Results of our survey of adults age 50 and older in the town indicated limited familiarity with ASDS within the broader caregiving sample, with two-thirds of respondents reporting little to no familiarity. This pattern is consistent with prior work describing underutilization of adult day programs associated with limited public awareness and inconsistent outreach (Sadarangani et al., 2024). Factors such as variable program naming, non-medical orientation, and limited integration with healthcare referral systems may influence how caregivers encounter or understand ASDS (Gaugler et al., 2021). The survey also identified respondents who anticipate providing care in the future and who expressed uncertainty about preparedness to do so. While this evaluation does not assess future behavior or service use, these findings suggest that earlier engagement and information-sharing may be relevant areas for program outreach. Such efforts may be particularly important for populations that have historically had less access to caregiving supports (Akincigil et al., 2024; Gaugler et al., 2021).
Based on participant feedback, several programmatic considerations emerged with implications for stakeholders and organizations serving older adults. Referral pathways to the program were limited and referring providers often lacked clarity on the ASDS offering and intended participant. ASDS providers could offer clearer communication about program scope and eligibility criteria for families and referral sources such as medical providers, neighboring COAs, places of worship, and other local community organizations who work with older adults. Targeted, proactive outreach such as educational events offered by ASDS providers to share the benefits of their programming could attract eligible participants and families while expanding referral pathways to ASDS programs. In addition to increasing awareness of the current ASDS programming, caregivers, ASDS program participants, and program staff identified a need for greater flexibility in service delivery, including potential in-home companion models for individuals unable or unwilling to attend group-based programming, and onsite companion supports within senior or community centers. Such expanded programming would require additional, reliable financial support and/or creative financial models. Rather than relying upon grants and other one-time funding sources, ASDS would benefit from more consistent, flexible funding. Stakeholders with knowledge of the ASDS landscape described a participant pool with increasingly complex medical conditions, a phenomenon also being experienced by adult day health programs, as home and community-based services help keep some older adults from entering nursing home care. Despite this trend, federal and state reimbursement rates for adult day health and ASDS have not increased significantly.
In sum, this study adds to the growing evidence base supporting ASDS as person-centered, community-based interventions for people living with ADRD and their caregivers. While the benefits of ASDS are well documented among users, their broader impact is shaped by awareness, accessibility, and system-level integration. Addressing these factors is essential to strengthening the role of ASDS within the aging services ecosystem and ensuring equitable access to meaningful support. While findings cannot be generalized beyond this setting or used to infer causal effects, they highlight areas for potential program refinement, outreach, and future evaluation.
Limitations
While these insights are critical—particularly in understanding caregiver burden, respite needs, and perceptions of program value—they represent only one facet of the ASDS model’s impact. Notably limited in the data are the direct voices of individuals living with dementia or cognitive impairment. While interviews were conducted with two ASDS participants living with dementia or cognitive impairment, we did not speak with eligible participants who were not enrolled in the ASDS, whose lived experiences are equally important in evaluating program effectiveness and identifying opportunities for improvement. Similarly, learnings from caregivers who participated in the population-level survey should be interpreted as reflecting familiarity within the sampled population rather than awareness among those eligible for ASDS.
These limitations underscore the need to clarify the multifaceted goals of the ASDS model. While caregiver support and respite are essential outcomes, the programs are also designed to promote engagement, socialization, and quality of life for participants themselves. Future research and evaluation efforts should incorporate additional perspectives of individuals with dementia to ensure a more comprehensive understanding of program strengths and areas for growth. Including these voices will help inform service delivery approaches that are person-centered and aligned with the dual mission of supporting both caregivers and care recipients.
Footnotes
Acknowledgments
The authors would like to thank the staff and leaders of the supportive day program upon which this research was conducted for their support and partnership in the research process. As well, the authors are deeply grateful to the many residents who shared their thoughts as part of the data collection.
Ethical Considerations
This study received ethical approval from the University of Massachusetts Boston Institutional Review Board (IRB #3848).
Consent to Participate
Informed consent was obtained from all participants prior to data collection.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Massachusetts Executive Office of Aging and Independence.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Other Identifying Information
Portions of this research will be presented at the 2025 Annual Conference of the Gerontological Society of America. No other identifying information is included to preserve the integrity of the peer-review process.