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DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN Division of Quality Assurance F02107D (05/2017) STATE OF WISCONSIN Family Adult Day Care Certification Standards FAMILY ADULT DAY CARE (ADC) NEW PROVIDER
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How to fill out family adult day care

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Start by gathering all necessary information and documents required to fill out the family adult day care form.
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Begin by filling out personal information, such as your name, address, contact details, and any relevant identification numbers.
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Provide information about the adult family member who will be receiving care, including their name, date of birth, and any special needs or medical conditions they may have.
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Indicate the preferred schedule for the adult day care, including the days and hours of care required.
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Specify any dietary restrictions or preferences for the adult family member, if applicable.
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Provide emergency contact information, including the names, phone numbers, and relationships of individuals who should be contacted in case of an emergency.
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Fill out any additional sections or forms required by the specific family adult day care program, such as medical release forms or waivers.
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Review the completed form for accuracy and completeness before submitting it.
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Submit the filled out form by following the instructions provided by the family adult day care program.

Who needs family adult day care?

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Family adult day care services are beneficial for individuals who require daily care and supervision but prefer to remain in a home-like setting rather than a traditional nursing home or facility.
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It is particularly suitable for elderly individuals who are still relatively independent but may need assistance with activities of daily living or medication management.
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Family adult day care can also be helpful for individuals with cognitive impairments, such as dementia or Alzheimer's disease, as it provides a structured and supportive environment.
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Furthermore, family adult day care can offer respite for family caregivers who need a break from their caregiving responsibilities and support in managing stress and burnout.

What is FAMILY ADULT DAY CARE (ADC) Form?

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Instructions for the FAMILY ADULT DAY CARE (ADC) form

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Family adult day care is a program that provides care and supervision for adults who cannot be left alone during the day.
Any individual or organization that operates a family adult day care program is required to file.
To fill out family adult day care, you must provide information about the program, including the services offered, staff qualifications, and safety protocols.
The purpose of family adult day care is to provide a safe and supportive environment for adults who require supervision during the day.
Information that must be reported on family adult day care includes program details, staff qualifications, safety protocols, and client demographics.
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