Memory Care in Delaware

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

According to Genworth Financial’s 2019 Cost of Care Survey, the average cost of assisted living in Delaware is $6,035 per month. This is almost $2,000 more than the $4,051 national average and significantly more expensive than the rates paid in neighboring Pennsylvania and Maryland, where the average assisted living costs are $3,913 and $4,300, respectively. The price is even higher in New Jersey, where the average cost is $6,400 per month. Based on a 25% increase over the amount paid for standard assisted living in Delaware, the estimated cost of memory care is $7,544 per month.

Assisted living in Delaware’s capital, Dover, costs $6,180 per month, which is $145 above the state average and $2,129 higher than the national median. This is also substantially more expensive than the rates charged in nearby Baltimore, Maryland, and Philadelphia, Pennsylvania, where assisted living care costs $4,225 and $4,875 per month, respectively. Using the $7,544 estimate made previously, Delaware seniors in need of memory care can expect to pay around $1,500 over the rates charged for basic assisted living.

Delaware Medicaid Programs for Memory Care

Diamond State Health Plan – Plus

Delaware Medicaid offers the Diamond State Health Plan – Plus Long Term Care Community Services Program to eligible low-income residents who wish to remain in the community, instead of being placed in a nursing home. The LTCCS managed care program covers medical and personal care services for individuals receiving memory care in assisted living settings, but it does not pay for room and board. A personalized plan of care is developed for each program member, which specifies the services required to meet their needs. Those in need of memory care can receive case management, assisted living care and cognitive services. Depending on their needs, members may qualify for additional benefits, such as community transition assistance; physical, speech and occupational therapy; private duty nursing and transportation services, among others.

• Who Is Eligible: Enrollment in the DSHP – Plus program is mandatory for Delaware residents aged 65 and older who require memory care or other long-term care services. To qualify, seniors must meet the eligibility requirements for Medicaid coverage and be assessed as needing a nursing home level of care. Applicants must also meet the program’s income limit, which is set at 250% of the current Federal Benefit Rate, and have no more than $2,000 in countable assets.
• How to Apply: Those who wish to enroll in the DSHP – Plus program can contact the Division of Medicaid and Medical Assistance at 800-996‐9969 or visit the nearest State Service Center handling Long Term Care Medicaid enrollment.

Non-Medicaid Financial Assistance Programs for Memory Care in Delaware

Delaware Optional State Supplementation Program

Delaware provides eligible residents living in state-licensed assisted living facilities with an Optional State Supplement payment, which may be put toward the cost of memory care services or used for personal expenses. Seniors who qualify for Supplemental Security Income receive the extra funds along with their monthly benefit check from the Social Security Administration. Individuals who do not qualify for SSI but meet the state’s eligibility requirements receive their monthly benefit payment from the Delaware Department of Health and Social Services.

• Who Is Eligible: Disabled adults and seniors aged 65 and older may qualify for OSS benefits if they meet the financial eligibility requirements of the federal SSI program, and they do not need a nursing home level of care. The state may also approve those who meet all the requirements but are over the SSI income limit.
• How to Apply: Seniors who apply for SSI benefits at the SSA office in Dover, Lewes or New Castle are automatically enrolled in the OSS program. Those deemed ineligible for SSI benefits may apply for the OSS program by contacting the State Service Center location serving their area.

Medicare Advantage Plans

Delaware seniors currently enrolled in Original Medicare Parts A and B may switch to a Medicare Advantage plan to recoup some of the costs they pay for memory care in an assisted living facility. MA plans, or Medicare Part C, are available through Medicare-authorized private insurance companies. The Centers for Medicare and Medicaid Services requires that Part C plans provide the same basic coverage as Parts A and B. Many plans also offer Part D coverage for prescription drugs, as well as a range of extra benefits. Depending on the particular plan, these extras may include dental and vision care, wellness programs, personal emergency response systems, nonmedical transportation and personal care services.

Recent CMS rule changes have enhanced the coverage options available through MA plans, and seniors may now use an assisted living facility as their official address with an MA insurance provider. These updates may allow Delaware seniors to sign up for an MA plan that reimburses certain costs for memory care and other long-term care services, such as the UnitedHealthcare Assisted Living Plan. The exact coverage provided differs between MA plans and providers, so seniors should ensure that a specific plan meets their needs before enrolling.

• Who Is Eligible: Only Original Medicare beneficiaries are eligible to switch from Part A and B coverage to a Medicare Advantage plan.
• How to Apply: Seniors can sign up for an MA plan during their initial Medicare enrollment period, the annual Medicare Advantage open enrollment period or Medicare’s yearly fall open enrollment period. Delaware residents can use the Medicare plan finder tool to compare the cost and coverage of MA plans available in their area. To enroll in a particular plan, seniors can contact the provider or call Medicare at 800-633-4227.

More Ways to Pay for Memory Care

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It’s best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.
• Life Insurance: Some life insurance policies allow policyholders to cash out their policy before a qualifying death. There may be some downsides to accessing a life insurance benefit early, so be sure to read more about the process.

Memory Care Regulation

Assisted living facilities that provide memory care are licensed by the Delaware Department of Health and Social Services (DHSS), Division of Long Term Care Residents Protection. The division is responsible for monitoring compliance with federal and state regulations governing long-term care facilities, as well as performing annual surveys and unscheduled inspections. DLTCRP staff also respond to incidents and complaints regarding quality of life, quality of care and violations of residents’ rights in assisted living facilities.

An ALF that offers special services, such as memory care, must provide a disclosure document that details the facility’s:

• Philosophy of care
• Population served
• Admission and discharge criteria and processes
• Assessment, care planning and implementation procedures
• Staffing and training policies
• Resident activities
• Nutrition and hydration services
• Policy regarding wandering
• Psychosocial services
• Safe storage plan for medication
• Costs

Facility Scope of Care

Assisted living facilities in Delaware provide housing, supervision, personalized assistance and health care and supportive services for individuals who need help with activities of daily living. Facilities must ensure that each resident’s care plan is implemented properly and provide all required personal services, arrange access to necessary health care and social services and facilitate or arrange opportunities for leisure activities and social interaction. Residents may receive care from licensed hospice programs and home health care agencies, with prior approval from the ALF’s director.

Admissions Requirements

Licensed assisted living facilities in Delaware may accept adults and elderly individuals with a range of conditions, including Alzheimer’s disease and other forms of dementia. The following table offers an overview of the conditions and circumstances that determine whether an individual may be admitted or continue receiving memory care in an assisted living facility, based on the applicable rules and regulations.

Care Plan Requirements

Prospective ALF residents must have a medical evaluation and RN assessment completed 30 days before admission, and a reassessment must be conducted within 30 days of move-in. Based on these assessments, a service plan must be developed to meet the individual’s care needs. This plan should detail the services to be provided and address all aspects of their care, including:

• Nutrition and hydration
• Personal care
• Psychosocial and emotional care
• Licensed nursing services
• Rehabilitative services
• Interpretive services
• Assistive technology
• Durable medical equipment
• Environmental services

Medication Management Requirements

The rules regarding ALF staff providing assistance with medication self-administration are contained in the state Board of Nursing regulations. The rules require that within 30 days of a new resident’s admission, an RN must assess their ability to self-administer medication and determine whether they need assistance. An RN must also conduct regular reviews to ensure that medications have been received, are properly labeled and stored and are not causing any adverse side effects. Only aides who have passed an exam may assist residents with self-administering medications.

Facility Requirements

Delaware assisted living facilities, including those that offer memory care, may offer private rooms, as well as shared rooms for no more than two residents. Private rooms must provide at least 100 square feet of living space, and shared rooms must offer 80 square feet of living space per resident. Facilities may feature private bathrooms accessed from individual resident rooms or shared bathrooms that serve no more than four residents. If in-unit bathrooms do not contain a tub or shower, such facilities must be provided in a readily accessible location. ALFs must provide residents with in-unit kitchen facilities or access to a central kitchen. State regulations stipulate that facilities providing memory care must detail any specialized physical environment and design features in their disclosure documents.

Staffing Requirements

ALFs in Delaware must have a sufficient number of trained staff on duty to provide adequate care for all residents. Staff employed by facilities that offer memory care must be properly trained and hold appropriate certifications and licenses to ensure the needs of residents are met.

Delaware regulations include minimum requirements for ALF management staff, based on the size of the facility.

• Facilities with up to 24 beds may employ a part-time administrator and must have an RN director of nursing on duty for 20 hours per week, at a minimum.
• Facilities with 25 or more beds must have a full-time administrator and RN director of nursing.

Newly hired care staff must receive a comprehensive orientation on state-mandated topics, which include residents’ rights, the health and psychosocial needs of residents being served, infection control, first aid and the facility’s fire, life safety and emergency disaster plans. Staff members must also receive at least 12 hours of ongoing training annually.

Medicaid Policy

Delaware Medicaid administers the Diamond State Health Plan – Plus, a managed long-term care entitlement program that covers services in assisted living facilities for eligible state residents, including those who require memory care.

Reporting Abuse

Concerned parties can report witnessed or suspected abuse, exploitation or neglect of an assisted living facility resident by calling the Division of Health Care Quality’s 24-hour, toll-free report line at 877-453-0012. Alternatively, individuals may complete and submit an online complaint form.