In Delaware regulations, housing communities that offer room and board with security, supervision, and personal and health care for people who cannot live independently are 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 activities of daily living (ADLs) a resident needs help with, such as 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 that go beyond regular care and adequately address the needs of people with Alzheimer’s disease or another dementia. Extra security is required, and staff at these residences must have additional training (though regulations are not specific about what that training is).
There are 20 memory care communities in Delaware. There are also four board and care homes, which offer services similar to assisted living (including memory care in some cases) in a smaller, more house-like environment. Delaware residents can receive free assistance in locating and evaluating these memory care homes to ensure they meet one’s needs and budget. One can begin this process by completing this short form.
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 $7,190, which breaks down to about $86,280 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 $7,370 per month and $88,440 annually. Families seeking more affordable options may find slightly less expensive memory care options in neighboring states, especially Maryland and Pennsylvania. In Maryland, the average cost of memory care is $5,120 per month; in New Jersey, memory care costs about $7,630 per month; and in Pennsylvania, the average cost is about $4,690 per month ($5,810 in Philadelphia). These costs will vary, of course, because all assisted living community costs vary, but if your loved one in New Castle, Kent, or Sussex County has dementia you should look at all options including out-of-state.
Within 30 days of moving into a residence, your loved one must have an assessment completed by a registered nurse or other medical professional who works for the residence, 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. Whether you pay extra for this assessment will depend on the residence; there may be an additional “assessment fee,” or there may be a “community fee” that covers multiple move-in costs including the assessment and other details like getting the living unit cleaned and painted. A medical evaluation by a doctor is also required within the same time frame. This evaluation may be paid for by the residence but, again, it depends on the specific assisted living community’s policy. Anyone considering moving into a Delaware assisted living or memory care home is entitled to a document that lists all charges and potential charges, and this document will tell whether assessments and evaluations are covered.
Moving into memory care does not require an official diagnosis of Alzheimer’s, vascular dementia, or any other related disease. The services a residence provides are based on symptoms that vary widely, even among people with the same sickness. Also, dementias are often difficult to diagnose. (For more on diagnosis, click here.) The point of assisted living, and especially memory care, is to match your loved one with a staff that can help with specific needs, not necessarily a specific disease. https://www.dementiacarecentral.com/aboutdementia/diagnosing/
Memory care homes must provide potential residents with a detailed list of services suitable for people with dementia, including specialized staff training. Be sure to file this document in case of new management or any other change at the residence.
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. Unlike many other states, Delaware regulations do not require dementia-friendly building layouts, like curving hallways that do not lead to dead ends. Before choosing a home, be sure to inspect it with an eye on whether someone with Alzheimer’s disease can easily navigate corridors. Secure outdoor areas are also beneficial for people with dementia, and Delaware does not have a rule requiring outdoor access for memory-care residents, so look for these as well.
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.
Regulations in Delaware do not have rules about the process for evicting someone in assisted living, so the residence will set its own policies. It’s very important to be clear on what exactly it would take for your loved one to be asked to leave. Can you be evicted for nonpayment? Will a change in medical condition mean you need to find another home? These are important questions to ask up front. Get the policy in writing before agreeing to a move-in contract.
Aggressive or inappropriate behavior can get your loved one evicted from assisted living, but only after the residence has documented the behavior for 60 days, and made a reasonable effort to fix the problem. If you receive an eviction notice and need to know next steps, click here.
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.
Because veterans are statistically more likely to develop dementia, the VA’s Aid & Attendance pension program for veterans and surviving spouses (available in all states including Delaware) can be vital for your loved one who served. Aid & Attendance 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 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 is also one veterans’ home in Delaware, which is a residential care facility that provides long-term care for veterans. It’s in Milford, in the central part of the state, and accepts residents who need nursing-home-level care. Memory care may be provided. Payment is made directly from the VA to the facility. The Delaware Veterans Home has 150 beds. Contact the home before visiting to see if your loved one is eligible to live there (click here). Keep in mind: State veterans’ homes are typically reserved for veterans whose need for care stems at least 70 percent from their military service.
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.