| Florence Johnson, an Assistant Professor in the U-M School of Nursing and member of Institute of Healthcare Policy and Innovation (IHPI) speaks to Shalini Kathuria Narang about new findings from the National Opinion Research Center (NORC) at the University of Chicago for the University of Michigan (U-M) Institute for Healthcare Policy and Innovation.

Narang: In what way do you envision new findings from U-M National Poll on Healthy Aging influence caregiver-related policy discussions at state and national levels? 

Johnson:  At the national level, these findings can inform broader policy conversations about setting minimum standards for caregiver services and supports across states. Federal policymakers can use this evidence to develop guidelines that ensure a baseline level of care and protection for family caregivers, regardless of where they live. National data can also strengthen arguments for federal investment in caregiving infrastructure-such as expanding funding for respite care, caregiver navigation, and workforce support while acknowledging caregiving as a critical component of public health and aging policy.

At the state (Michigan) level, these findings can help bring urgency and clarity to conversations about caregiver support by showing how access or lack of access to services affects caregivers’ mental health, financial stability, and ability to remain employed. Poll data can be used to highlight the importance of investing in community-based services, such as respite and adult day services, and to make the case for dedicated state funding. The findings could also inform the development of a centralized registry or resource platform that allows caregivers to easily compare services, understand costs, and identify supports that meet their needs. By grounding policy discussions in real caregiver experiences, states can move beyond piecemeal approaches and toward more accessible, coordinated systems of support.

Ultimately, the strength of the poll lies in its ability to translate caregiver experiences into actionable data. 

Read more: Caregiving and Caregiver Help

How can awareness be enhanced of existing adult day programs and respite care, and local organizations like Area Agencies on Aging, that address the needs of adults aged 60 and older and their caregivers?

Public messaging efforts that feature caregiver voices and emphasize stress relief, improved mental health, and the ability to keep loved ones at home longer can help counter stigma and misconceptions about eligibility and cost. Creating centralized, easy‑to‑navigate directories paired with live navigational support can reduce the burden caregivers face when searching for help. Partnering with trusted community organizations such as churches, senior centers, libraries, and community health workers, particularly in Black, rural, immigrant, and low‑income communities can further extend reach and build trust. Strengthening the visibility of Area Agencies on Aging through healthcare systems, employers, and insurance portals can position them as a first point of contact rather than a hidden resource. Finally, using population‑level data to highlight gaps in awareness and access can inform policy discussions and underscore the importance of investing in outreach, navigation, and caregiver support infrastructure at both the state and national levels.

Can you speak about one or more successful programs that communities have made available for people with disabilities and older adults?

Many communities across the country have developed successful, community‑based programs that support older adults living with disabilities and dementia, while also offering meaningful relief for family caregivers. These programs tend to share several core features: person‑centered, clinically informed, socially engaging and critically-affordable and accessible. When these elements come together, adult day programs can serve as both a care resource and a point of stability for families navigating long‑term caregiving.

A widely recognized example in Michigan is DAYBREAK at the Hannan Center, which has become a trusted model for dementia‑specific adult day services. DAYBREAK is intentionally designed to serve older adults living with dementia, reflecting an understanding that cognitive impairment requires specialized environments, staffing, and programming. Its long‑standing partnership with the Alzheimer’s Association–Greater Michigan Chapter reinforces clinical alignment with best practices in dementia care and caregiver education while also strengthening community credibility and referral pathways.

Several program features distinguish DAYBREAK as a successful and caregiver‑centered model. The care ratio of 1:5, allows staff to provide close supervision and individualized attention-an element that caregivers frequently cite as essential for peace of mind. The availability of on‑site nursing services adds a layer of clinical oversight that reassures families managing complex medical and behavioral needs. Just as importantly, participants are cared for in a socially and mentally stimulating environment that promotes engagement, dignity, and routine, rather than isolation.

Programs like DAYBREAK demonstrate that adult day services can be both high‑quality and accessible when care design, staffing, affordability, and community partnerships are aligned. Importantly, their success also offers broader lessons for other communities. Adult day programs are most effective when they are visible, trusted, easy to understand, and responsive to the lived realities of caregiving. Collaboration with healthcare providers, Area Agencies on Aging, community health workers, and faith‑based and neighborhood organizations helps ensure these programs do not remain “hidden gems” but instead become part of routine caregiving pathways.

Can you elaborate about the channels to get the word out about adult day programs, and costs/fees?

Enhancing awareness of adult day programs and helping caregivers understand associated costs and service expectations requires a multi-channel, community-embedded approach that prioritizes trust, clarity, and accessibility. Our interviews revealed that caregivers most often learned about adult day programs through word of mouth, emphasizing the value of informal, interpersonal networks in caregiving decision‑making. This finding points to the critical role of trusted messengers rather than passive information dissemination. Caregiver navigators can be a strong tool in this space. Beyond healthcare and formal services, community‑based and culturally rooted spaces emerged as critical channels for information sharing. Churches, faith-based organizations, community centers, senior centers, barbershops, salons, and local nonprofits are trusted environments where caregiving conversations naturally occur. Disseminating information about adult day programs in these spaces through brief presentations, printed materials, or trusted community leaders can significantly expand reach, particularly among Black caregivers and others who may have limited engagement with formal aging-service systems. 

Equally important is improving transparency around costs, fees, and service structure, which emerged as a substantial barrier in our interviews. Adult day service providers offered a wide range of costs for adult day programs, ranging from free or subsidized services to fees as high as $190 per hour. In many cases, caregivers reported learning about costs only after significant inquiry or site visits, contributing to confusion and delayed decision-making. Transportation was often not included in program fees, and hours of service varied considerably, further complicating caregivers’ ability to assess feasibility, particularly for those balancing employment or long-distance caregiving.

There is a need for clear, standardized communication about what adult day programs offer, how much they cost, what services are included, and what additional expenses, such as transportation, caregivers should anticipate. 

Creating centralized, easy-to-understand directories or registries that show program features, fees, hours, and eligibility requirements could help caregivers make better comparisons earlier in their caregiving journeys and cut down on the need for informal networks. Pairing these tools with live navigation support through Area Agencies on Aging or caregiver navigators would further reduce burden and inequities in access.

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What are the most common ways/channels via which caregivers hear about adult day programs?

Our interviews found that caregivers most commonly learned about adult day programs through word of mouth, reflecting a well-documented national pattern. Adult day services are often described as a “hidden gem” within the long-term care system, available, effective, but unevenly visible. Heavy reliance on informal networks means awareness is unequally distributed, privileging caregivers who are well‑connected or already engaged with aging services, while leaving others, particularly Black, rural, and lower‑income caregivers less likely to learn about available support until they reach a crisis point. 

Taken together, this reliance on word of mouth/informal networks points out the need for stronger, more proactive referral systems and reinforces our broader argument that access to caregiving supports is shaped by social context, trust, and structural pathways, not just service availability.

Shalini Kathuria Narang is a Bay Area-based freelance journalist. She has reported and written on health, wellness, diaspora, travel, technology and trends.