Housing communities in Delaware that offer room and board with security, supervision, and personal and health care for people who need help with activities of daily living (ADLs) are officially called “assisted living facilities” (ALF). Residents who are medically stable—in other words, do not require regular nursing care—enter into a service agreement with the ALF to receive personalized care. This service plan includes details on which ADLs a resident needs help with, and might include dressing, eating, going to the bathroom, etc. Assisted living in Delaware must also provide leisure activities and opportunities for socialization.
An ALF that offers specialized care for people with dementia (also called “memory care”) must have policies and procedures in place that go beyond regular care and adequately address the needs of people with Alzheimer’s disease or another dementia. Dementia-friendly design features and extra security are required, and staff at these residences must have additional training (though regulations are not specific about what that training is).
Assisted living and memory care in Delaware is regulated by the Department of Health and Social Services, Division of Long Term Care Residents Protection.
The average cost of assisted living with memory care per month in Delaware is $7,897, which breaks down to about $259 per day and $94,764 annually. Delaware assisted living homes are required by regulations to provide a written statement of all costs including for optional services. Assisted living, without the additional services required for memory care, costs Delaware residents about $6,035 per month and $72,420 annually.
Delaware is one of the most expensive states in the country for assisted living and memory care. The state’s second-biggest city and capital is Dover, where memory care costs about $8,097 per month and $97,164 annually. Families seeking more affordable options may find slightly less expensive memory care options in the neighboring states of PA, MD and NJ.
Within 30 days of moving into a residence, your loved one must have an assessment completed by a registered nurse, to evaluate personal and health care needs. The assessment is to be completed on an official form (available here), and includes sections on the individual’s ability to perform activities of daily living (ADLs), dietary requirements, medical history, and more. A medical evaluation by a doctor is also required within the same time frame.
Anyone considering moving into a Delaware assisted living or memory care home is entitled to a document that lists all charges and potential charges. Additionally, memory care homes must provide potential residents with a detailed list of services that distinguish the residence as suitable for people with dementia, including specialized staff training.
Someone with the following issues may not be admitted into assisted living or memory care in Delaware:
– Needs full-time nursing care
– Needs special supervision and regular adjusting of medications
– Is medically unstable
– Is bedridden for more than 14 days
– Has stage III or IV skin ulcers
– Needs a ventilator
– Needs to be isolated due to any disease or condition
– Has an unstable tracheotomy or PEG tube
– Is dangerous to self or others
– Has unmanageable behavior
Bedrooms must be at least 100 square feet for one person or 160 square feet for two people, excluding closets and bathrooms. Two is the maximum number of people allowed to live together in one room. And rooms must have a kitchen, or there must be a kitchen that’s easily accessible for all residents. One bathroom with a toilet, sink, and shower or bathtub is required for every four residents. A plan for emergency and fire safety must be put into place, and staff must be drilled regularly.
There are no required staffing ratios in Delaware for assisted living, except to say that staff must always be adequate to meet the needs of every resident. Likewise, regulations do not specify requirements for staff training, only that training must be adequate to meet all residents’ needs.
Orientation is required for all new staff. At least one awake staff member must be in the residence at all times. Every residence is required to have a director of nursing who is also a registered nurse, and all administrators must maintain certification with the state.
The Diamond State Health Plan-Plus is a Delaware Medicaid program that provides funds for people who are elderly or low-income to cover the costs of medical care at home, in a nursing home, or in assisted living. The sub-program that helps pay for assisted living (including memory care) is called “Long Term Care Community Services” (LTCCS). It covers personal care and medical services, including assistance with activities of daily living (ADLs) like eating and bathing, but will not cover room and board. To receive support through this program, your loved one must be Medicaid-eligible, including monthly income less than $1,957 (or $3,216 for a couple) in 2020. A Medicaid eligibility test for Delaware is available here. Other services covered include medical equipment and physical and occupational therapy. To learn more, download the state’s DSHP-Plus pamphlet. To apply, contact your local Division of Medicaid and Medical Assistance.
Veterans are statistically more likely to develop dementia. Relevant in all states including Delaware is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is an amount of money added to veterans’ and survivors’ basic pensions. Applicants must be at least 65 years old (or disabled) and require assistance with activities of daily living (ADLs) like eating, bathing, and mobility. The cash assistance from these pensions can be used as the recipient wishes, meaning it can go toward the cost of memory care. In addition, the cost of residential care can be deducted from one’s income, effectively reducing the amount of calculable income used to determine the benefit amount. The latest (2020) maximum amount a veteran can receive through A&A is $27,194 per year, and surviving spouses can receive as much as $14,761. Learn more here.
There are also veterans’ homes in Delaware, which are residential care facilities that provide long-term care for veterans. In addition to nursing home care, assisted living and memory care may be provided. Payment is made directly from the VA to the facility. State veterans’ homes are typically reserved for veterans whose need for care stems at least 70 percent from their military service. Because there is often a waiting list, contact a home before visiting to see if your loved one is eligible to live there.
Other ways to help pay for memory care include tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you can claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that may include some assisted living costs.
A reverse mortgage may be a good option for a married person moving into memory care, if their spouse continues to live in the home. Should the spouse move from their home, the reverse mortgage would become due.
Elder care loans are for families to cover initial costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. For example, if one is waiting for a VA pension to be approved or waiting to sell a home.