When you or a loved one can no longer safely live alone at home, it may time to look into long-term care. This may mean finding someone who can help with personal care in the home, short-term recovery in a skilled nursing facility following a hospital stay, moving to an assisted living community for help with daily activities, or being admitted to a nursing home for round-the-clock nursing care.
The Department of Health and Social Services through its Division of Health Care Quality licenses and monitors all long-term care facilities in the state of Delaware. These include assisted living communities and skilled nursing facilities.
Delaware Aging & Disability Resource Center (ADRC)
The Delaware ADRC is a one-stop access point for information, assistance, and referral to resources that support older Delawareans and adults with physical disabilities. The ADRC can help you learn about resources, decide what services are best for you, and find the services you need.
24 hours a day, 7-days a week
- Phone: 1-800-223-9074 (toll-free)
- Email: DelawareADRC@delaware.gov
Signs an older adult might need help
Many older adults decide for themselves or with their doctor when it is time to consider long-term care, especially following a serious diagnosis, illness or fall. They may decide that taking care of their home and property is now more than they are able to handle any longer, or they may no longer wish to rely on family or friends for help with daily activities. But sometimes the older adult is not able to see—or is not ready to admit—that it is time for help.
- If you see these changes in a loved one, it may be time to start the conversation about making plans for a new living arrangement:
- Changes in appearance or grooming habits.
- Frequent falls (or fear of falling), difficulty getting in and out of a chair, or holding on to furniture for support
- Unexplained weight loss. Check to see if their refrigerator and pantry are stocked. Is food expired? Are they eating meals or only ready-made snacks?
- Forgetting to take medication as prescribed
- Confusion or forgetting things more frequently. Do they repeat things, wander or get lost? Do they recognize family members and friends?
- Withdrawal or isolation. Notice if they stop reaching out to friends and family or lose interest in favorite activities.
- Letting things go around the house, missing appointments or trouble managing personal finances
How to talk to an older adult about long-term care options
Everyone wants to be independent as long as possible and make their own decisions about where and how they live. If you notice that a loved one is showing signs of needing more support, here are a few tips to introduce the conversation of long-term care.
Start the conversation early.
• Don’t wait for an emergency when you may not have as many choices in long-term care options.
Be patient and respectful.
• No one chooses to become physically weaker or more forgetful. Understand if they push back or get defensive. Offer your help, but don’t treat them like a child.
Be positive and encouraging.
• Instead of making the conversation about what they will have to give up, point out what they will gain — more time for the things they enjoy with less house and yard work to worry about. Many long-term care facilities offer wonderful amenities and social programs.
Involve them in the process.
• Remember you are talking with an adult who wants to make their own decisions. Giving up independence is not easy at any age. Ask their opinion and make sure they are part of the decision process.
How to choose the right type of care for your needs
Many options are available for older Delawareans who need support with daily activities or medical needs. These range from in-home and community-based services to help you safely continue to live in your own home, to long-term residential options that offer 24/7 personal assistance and skilled nursing care.
Home and Community Based Services
Whenever and as long as possible, the goal is always to support people in living independently at home and allowing them to be active members of their community. If you or a loved one are finding it harder to manage daily tasks at home, help is available.
In-home personal care
The Division of Services for Aging & Adults with Physical Disabilities (DSAAPD) offers a range of in-home supports to help people continue to live safely and comfortably in their own home.
- Personal care assistance for bathing, dressing, meal preparation and medication reminders
- Home meal delivery
- Personal emergency response systems
- Home modifications for mobility and safety support
Community-Based Services
Delaware is home to a wide network of community-based day programs that offer support, connection and engagement for older adults. These programs are especially helpful for those who need support during the day while caregivers are at work or managing other responsibilities.
Adult day services, often through senior centers, provide supervised care, group meals and structured fitness, educational and social activities to help older Delawareans stay connected and engaged.
- To learn more, contact the Delaware ADRC 24 hours a day, 7-days a week
- Phone: 1-800-223-9074 (toll-free)
- Email: DelawareADRC@delaware.gov
Assisted Living
Assisted living facilities are a good option for those who can no longer live safely on their own at home. Residents continue to enjoy a sense of independence with the help of needed support for daily activities such as:
- Bathing and dressing
- Eating and toileting
- Grooming and hygiene
- Medication management
- Mobility (walking, getting in and out of chairs or bed)
- Social and recreational activities
- Transportation (getting to and from medical appointments or social outings)
Licensed assisted living facilities in Delaware.
Rehabilitation
Short-term stays in rehabilitation facilities focus on a combination of physical, occupational, speech and cognitive therapy to help people regain lost skills following an injury or illness.
Licensed Rehabilitation facilities in Delaware.
Skilled Nursing Care
Skilled nursing facilities (or SNFs) offer short-term medically necessary care and rehabilitation from injury or illness. People often go to a SNF directly from the hospital. Services may include physical, occupation or speech therapy, medication management, wound care, intravenous therapy, medical monitoring. The goal with skilled nursing is for the resident to regain independence and return to home.
Licensed skilled nursing facilities in Delaware.
Nursing Homes
Nursing homes offer long-term residential care for those who need 24/7 care that can no longer be safely provided in the home. The resident may need skilled medical supervision for a chronic medical condition, complex medication management or extensive help with activities of daily living such as bathing, eating or mobility.
Licensed nursing homes in Delaware.
Things to consider when choosing a long-term care facility
There is a lot to think about before you choose a long-term care facility for yourself or a loved one. To help get you started, view a list of all licensed long-term care facilities in Delaware. This page will give you the address, website, number of beds, information about state licensure for each facility. You will also find links to the most recent and past state survey reports as well as notices of complaints and follow-up visits for each facility.
Location. Location. Location.
Consider facilities that are close to family members or friends who will be able to visit and advocate (look out and speak up for) you or your loved one. Will you be able to get to your current doctors, favorite stores or restaurants or place of worship?
Do your research
Visit websites and browse through brochures, but don’t make your choice from those alone. First, make sure a facility offers the type of care you need. Next, check out the cost and quality of care. Read online reviews and talk to your friends and neighbors about experiences they may have had with that facility.
Compare facilities using the federal government’s Medicare Compare link.
Schedule a tour
Once you’ve found a few places that meet your needs for care, quality and cost, it’s important to visit for a tour. Seeing places for yourself, and talking to residents, staff and family members will help you narrow down your choices.
Make a second, unscheduled visit on a different day of the week or at a different time of day to make sure you get the same impression.
Look closely
First impressions are important, but pay close attention to the details. Observe interactions between staff and residents. Do staff act professionally? Are residents treated with respect and kindness? Is it a pleasant, comfortable environment?
Important things to look for:
- Do the residents appear to be well-cared-for and happy?
- Is the facility clean and well-maintained?
- Is the facility well-lit?
- Is the temperature comfortable?
- How is the noise level?
- Are there safety devices and accommodations for those with physical disabilities?
Ask questions
Facility staff are there to answer your questions, but you will also want to talk with residents and family members about their experience at the facility. In addition to learning about facility operations, nursing care and safety procedures, you will want to know about what it is like to actually live there. Ask staff and residents the same questions to get the full picture.
Questions to ask facility staff:
- What are the safety and security features and plans?
- How many patients are assigned to each staff member?
- What is the staff turnover level?
- Is there a registered nurse onsite at all hours?
- Are staff assigned to residents or will there be a new caregiver every day?
- What is the process for communicating with families?
- Is there an active Resident Council where residents have a say in activities, programs and care decisions?
- What is the cost and what does the monthly fee cover? What services will cost extra and how much are they? Does the facility accept Medicare? Medicaid? Long-term care insurance?
These questions are also for facility staff, but it may help to ask residents and their family members their thoughts, too:
- Does the facility communicate regularly with residents and their families?
- What type of social events are offered, both at the facility and community outings?
- Is transportation available to medical appointments or for other errands?
- What are the food options and how are dietary needs or special requests handled?
- Is there enough storage space and a safe place to keep personal items?
- Are residents able to bring room decor or bedding from home?
- How often are laundry services offered? Is there a cost?
- What is the visiting policy and are family members and friends made to feel welcome?
- How are residents’ spiritual and religious needs met?
How to cover the cost of care
Medicare
Medicare and Medicare Supplement, or Medigap plans only cover medical and skilled nursing care. Medicare does not cover room and board or assisted living services for help with daily activities such as bathing, dressing. You will need to pay for many services out-of-pocket.
Medicaid
For those who are eligible, Medicaid covers 100% of long-term care (nursing, room and board and necessary personal care) in a Medicaid-certified nursing facility. It also covers your post-hospital stay in a Medicaid-certified rehabilitation facility once Medicare coverage ends.
If you are in a Medicaid-approved assisted living facility, Medicaid covers your nursing care needs, but it does not cover the cost of your room and board (rent and meals) or personal care services.
Delaware also has Medicaid waiver programs to cover some Home and Community Based Services to help prevent or delay nursing home admissions. Delaware’s Medicaid program is called Diamond State Health Plan Plus. To learn more or check whether you are eligible for long-term nursing care Medicaid, and how much you will need to contribute toward the cost of different levels of long-term care, contact the Division of Medicaid and Medical Assistance at1-866-940-8963.
Personal Assets
For care that is not covered by Medicare or Medicaid, you will need to pay out-of-pocket using your existing financial resources:
- Annuities: Converting liquid assets into a guaranteed monthly income stream to pay for care facilities
- Liquid Assets: High-yield savings, CDs, and brokerage accounts
- Retirement Funds: IRAs, 401(k)s, and pensions
- Home Equity: Selling the family home, downsizing, or utilizing a reverse mortgage
Long-Term Care Insurance
Some people choose to purchase long-term care insurance to help pay for extended nursing and personal care services offered by in-home care, assisted living or nursing homes. These policies cover skilled nursing, custodial care, hospice, adult day care, and in-home health aides once you can no longer do at least two activities of daily living (bathing, dressing or eating) without help.
Visit AARP for more information about long-term care insurance.
Your Voice. Your Rights. Your Advocate.
Delaware’s Long-Term Care Ombudsman Program advocates for and protects those who live in long-term care settings, such as assisted living and skilled nursing facilities, as well as those who receive home and community-based services. To contact the State Long-Term Care Ombudsman, email DHSS_OSEC_Ombudsman@delaware.gov or call 1-855-773-1002.
Legal Services
The Legal Services Program assists Delaware residents 60 years of age or older with legal issues. Specifically, the program provides help with matters such as powers of attorney; advance directives; and consumer, housing and benefits issues. Priority is given to those in greatest social and economic need. Services are provided by the Community Legal Aid Society, Inc., Elder Law Program.
Caregivers – Delaware offers support for you, too!
Caring for someone you love is meaningful — and sometimes overwhelming. You deserve support too.
Delaware offers free and low-cost resources to help you manage the responsibilities of caregiving while also taking care of yourself.
For information about caregiver resources such as support groups, respite care or helpful tips for long-distance caregiving, call the Delaware ADRC at 1-800-223-9074.
