State Assisted Living Policy: 1998. Delaware



Assisted living agencies: Title 16 Health and Safety, Part II, Chapter II, § 63.0 et seq.

Rest residential homes Delaware code, Part II §59.0 et seq.

General Approach

Regulations governing assisted living were adopted in 1998. The philosophy of the regulations is stated in the opening "purpose" section and directs that the "services are provided based on the social philosophy of care and must include oversight, good, shelter and the provision or coordination of a range of services that promote quality of life of the individual. The social philosophy of care promotes the consumer's independence, privacy, dignity and is provided in a home-like environment."


Assisted living is a residential arrangement for fee for dependent elderly and adults with disabilities which provides assistance with activities of daily living and other services that promote the consumer's quality of life.

Rest residential home is an institution that provides resident beds and personal care services for persons who are normally able to manage activities of daily living. The home should provide friendly understanding to persons living there as well as appropriate care in order that the resident's self-esteem, self-image and role as a contributing member of the community may be reinforced.

Tenant Policy

Assisted living The rules do not allow agencies to provide services to people who have conditions that exceed the agency's capabilities or who present a danger to self or others or engage in illegal drug use. Two other groups of consumers cannot be served--unless the attending physician certifies that despite the presence of the following factors, the consumer's needs may be safely met by a service agreement developed by the agency, the attending physician, a registered nurse, the consumer or his/her representative if the consumer is incapable of making decisions and other appropriate health care professionals:

  • Consumers whose medical conditions are unstable to the point that they require frequent observation, assessment and intervention by a licensed professional nurse, including unscheduled nursing services, and

  • Consumers who are bedridden for 14 consecutive days.

Facilities may not serve residents who need transfer assistance from more than one person and a mechanical device, unless special staffing arrangements have been made, or residents who present a danger to self or others or engage in illegal drug use.

Rest residential homes No specific requirements are stated other than in the definition of a resident.

Living Unit

Assisted living The rules require individual living units. Consumers must have access to a readily available central kitchen if one is not provided in the unit. Bathing facilities must be provided in the unit or in a readily accessible area. Sharing of a bedroom is limited to two consumers and only with their consent.

Rest residential homes provide 100 square feet for single occupancy and 80 square feet per resident for multiple occupancy. No more than four people may share a room. One bath tub or shower and one toilet and wash basin are required for every four residents.


Assisted living Services are based on an assessment of the consumer completed 30 prior to admission and reviewed and revised within 14 days of admission, if appropriate, and a medical evaluation completed within 30 days prior to admission. A service agreement describes the scope, frequency and duration of services and monitoring. A managed risk process may be part of the service agreement. The agreement must address the need for personal services; nursing services; food services; environmental services including housekeeping, trash removal, laundry and safety; social/emotional services; financial management; transportation; individual living unit furnishings; assistive technology and durable medical equipment; rehabilitation services; qualified interpreters; and reasonable accommodations for persons with disabilities. The agreement includes shared responsibility and bounded choice except for people who are bedridden or have unstable medical conditions.

Provisions for Cognitively Impaired Residents

The regulation require that each agency shall develop policies to prevent cognitively impaired residents from wandering away from safe areas and the safe storage of medications.

Rest residential homes provide shelter, housekeeping, board, personal surveillance or direction in activities of daily living.


Beneficiaries with income below 250% of the SSI level will be eligible for waiver services. The room and board payment from the beneficiary will be $548 and three levels of reimbursement for services are planned. The payment levels were devised based on an analysis of spending for HCBS waiver clients living in their own homes and participants in the adult foster care program.



  Level I  

  Level II  

  Level III  

Room and board  













Assisted living The assisted living agency shall provide appropriate training to staff to meet the needs of the consumers. The content and attendance of staff training programs shall be documented.

Rest residential homes Nurse aide/nurse assistant staff must complete a training course approved by the State Board and Nursing and the Board of Health. Aides/assistants must be certified prior to employment. Section 609 describes the curriculum and the competencies that must be measured in the following areas: nurse aide role and function; environmental needs; psycho- social needs; and physical needs. Section 59.610 describes the qualifications of instructors and the training instructors must receive.

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