Assisted Living in Delaware

Agency: Department of Health & Social Services, Division of Long Term Care Residents Protection
Phone: (302) 577-6661

Assisted living is a special combination of housing, supportive services, supervision, personalized assistance, and health care designed to respond to the individual needs of those who need help with activities of daily living and/or instrumental activities of daily living.

Facility Scope of Care:
Assisted living is designed to offer living arrangements to medically stable persons who do not require skilled nursing services and supervision. An individual who requires intermittent nursing care for a limited period of time may live in an assisted living facility. Additionally, there are specific conditions that prohibit a resident from being in an assisted living facility regardless of whether care is provided by staff or an outside entity (see Move-In/Move-Out Requirements).

Move-In/Move-Out Requirements:
An assisted living facility may not admit, provide services to, or permit the provision of services to individuals who, based on the uniform resident assessment, meet any of the following conditions: (1) Require care by a nurse that is more than intermittent or for more than a limited period of time; (2) Require skilled monitoring, testing, and aggressive adjustment of medications and treatments where there is the presence of, or reasonable potential of, an acute episode unless there is a registered nurse (RN) to provide appropriate care; (3) Require monitoring of a chronic medical condition that is not essentially stabilized through available medications and treatments; (4) Bedridden for more than 14 days; (5) Have stage III or IV skin ulcers; (6) Require a ventilator; (7) Require treatment for a disease or condition that requires more than contact isolation; (8) Have an unstable tracheotomy or a stable tracheotomy of less than six months duration; (9) Have an unstable PEG tube; (10) Require an intravenous or central line with an exception for a completely covered subcutaneously implanted venous port, provided the assisted living facility meets the following standards: (a) Facility records must include the type, purpose, and site of the port, the insertion date, and the last date medication was administered or the port flushed. (b) The facility must document the presence of the port on the Uniform Assessment Instrument, the service plan, interagency referrals, and any facility reports. (c) The facility shall not permit the provision of care to the port or surrounding area, the administration of medication or the flushing of the port or the surgical removal of the port within the facility by facility staff, physicians, or third party providers. (11) Wander such that the assisted living facility would be unable to provide adequate supervision or security arrangements; (12) Exhibit behaviors that present a threat to the health or safety of themselves or others; and (13) Are socially inappropriate as determined by the assisted living facility such that the facility would be unable to manage the behavior after documented reasonable efforts for a period of no more than 60 days. The provisions above do not apply to residents under the care of a hospice program licensed by the Department of Health and Social Services as long as the hospice program provides written assurance that, in conjunction with care provided by the assisted living facility, all of the resident's needs will be met without placing other residents at risk

Resident Assessment:
There is a required resident assessment form, although it is not available on-line. In addition, assisted living facilities must develop, implement, and adhere to a documented, ongoing quality assurance program that includes an internal monitoring process that tracks performance and measures resident satisfaction. On at least a semi-annual basis, each facility must survey each resident regarding his/her satisfaction with services provided. Facilities must retain all surveys for at least two years and they will be reviewed during inspections. Documentation that addresses actions that were taken as a result of the surveys must be maintained for at least one year

Medication Management:
Facilities must comply with the Nurse Practice Act. Residents may receive assistance with self-medication by designated care providers who have completed the 'Assistance with Self- Administration of Medication' (AWSAM) training course. Facilities must keep records on file for those who have completed the course and must complete and submit an annual AWSAM report on a form provided by the Board of Nursing. Administration of medication may only be performed by an RN or a licensed practical nurse. The facility must establish and adhere to written medication policies and procedures that address a series of issues related to obtaining, storing, and administering medication. A quarterly pharmacy review is required

Physical Plant Requirements:
Resident kitchens must be available to residents either in their individual living unit or in an area readily accessible to each resident. For all new construction and conversions of assisted living facilities with more than 10 beds, there must be at least 100 square feet of floor space for each resident in a private bedroom and at least 80 square feet of floor space for each resident sharing a bedroom

Residents Allowed Per Room:
A maximum of two residents is allowed per resident unit.

Life Safety:
Assisted living facilities must comply with all applicable state and local fire and building codes. Facilities must develop and implement a plan for fire safety and emergencies through staff training and drills and a plan for relocation and/or evacuation and continuous provision of services to residents in the event of permanent or temporary closure of the facility. The evacuation plan must be approved by the fire marshal having jurisdiction and include the evacuation route, which must be conspicuously posted on each floor and in each unit. Facilities are required to orient staff and residents to the emergency plan, conduct fire drills in accordance with state fire prevention regulations, conduct other emergency drills or training sessions on all shifts at least annually, and maintain records identifying residents needing assistance for evacuation. Specified incidents must be reported within eight hours to the Division of Long Term Care Residents Protection including fire due to any cause, abuse, neglect, mistreatment, financial exploitation, resident elopement, death of a resident, significant injuries, a significant error or omission in medication/treatment, a burn greater than first degree, attempted suicide, poisoning, an epidemic, and other events.

Alzheimer's Unit Requirements:
An assisted living facility that offers specialized care for individuals with memory impairment must disclose its policies and procedures that describe the form of care and treatment provided that is in addition to the care and treatment required by law and regulation.

Staff Training for Alzheimer's Care:
Staff must be adequately trained, certified, and licensed to meet the requirements of the residents.

Staffing Requirements:
Each facility must have a director who is responsible for the operation of the program. Facilities licensed for 25 beds or more must have a full-time nursing home administrator. Facilities licensed for five through 24 beds must have a part-time nursing home administrator on site and on duty at least 20 hours per week. The director of a facility for four beds or fewer must be on site at least eight hours a week. Each facility must have a Director of Nursing (DON) who is an RN. Facilities licensed for 25 or more beds must have a full time DON; facilities licensed for five to 24 beds must have a part-time DON on site and on duty at least 20 hours a week; and a DON of a facility for four or fewer beds must be on site at least eight hours a week. Resident assistants must be at least 18 years of age. At least one awake staff person must be on site 24 hours per day who is qualified to administer or assist with self-administration of medication, has a knowledge of emergency procedures, basic first aid, CPR, and the Heimlich Maneuver. Overall staffing must be sufficient in number and staff must be adequately trained, certified, or licensed to meet the needs of the residents and to comply with applicable state laws and regulations.

Staff Education Training:
Staff must be adequately trained to meet the needs of the residents and the facility must provide and document staff training. Resident assistants must receive facility-specific orientation covering specified topics.

Medicaid Policy and Reimbursements:
A Medicaid home and community-based services waiver covers assisted living services.