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Delaware Senate Democrats

Task Force recommendations would overhaul long-term and memory care industry

May 26, 2023

DOVER – A legislative panel tasked with reviewing Delaware’s long-term and memory care facilities and policies for the first time in a generation is recommending a series of updates and reforms to the industry, including increased funding and Medicaid reimbursement, expanded oversight and accountability at all levels, better recruitment, retention and training, and improved services for facility residents.

Comprised of lawmakers, state agency workers, resident advocates and long-term care facility staff, the Long-Term Care and Memory Care Task Force was established last year to investigate the state’s existing policies regarding long-term care facilities, and to recommend actions that will help to create a robust and well-regulated system of care capable of meeting the needs of Delaware residents.

The task force finalized its report on Thursday, following 14 public meetings held over the past year in the first major review of long-term care in Delaware since the passage of Eagle’s Law more than 20 years ago. The task force was charged with:

  • Reviewing how long-term care facilities meet minimum staffing ratios.
  • Reviewing and proposing options to address the staffing needs and ratios of nursing facilities, intermediate care facilities for individuals with disabilities, assisted living facilities, and memory care units within these facilities.
  • Reviewing and proposing options to address activity staffing needs of nursing facilities, intermediate care facilities with disabilities, assisted living facilities, and memory care units within these facilities.
  • Developing additional requirements to properly provide care for individuals diagnosed with Alzheimer’s disease and other dementias.

“The long-term and memory care industry provides critical care to an extremely vulnerable population in Delaware. Unfortunately, the state has not taken a thorough look at whether these facilities are providing consistent, quality care to residents in years, and that has left us with a lot of work to do on the residents’ behalf,” said Rep. Kendra Johnson, who chaired the task force.

“The task force has identified several areas where we need to do better. My commitment going forward is to take these recommendations and see them through as a legislator. We owe it to Delawareans – both residents of these facilities and their families – to fight to make these improvements and overhauls to make the industry function as it should. These recommendations are a roadmap for us, and I’m ready for us to move forward with them.”

Delaware’s population has aged significantly in recent decades, a trend that is only expected to continue in the foreseeable future. Between 2020 and 2050, the 85+ population is expected to increase by 158.1% and the 80-84-year-old population by 86.3%.

The task force identified several challenges facing long-term care in Delaware, including a national workforce shortage, limited oversight by state regulatory authorities, and a need to better respond to the specialized care needs of residents with Alzheimer’s disease and other dementias.

“As our grandparents and parents get older, almost every family in Delaware will eventually have to grapple with the many challenges that long-term and memory care facilities are facing, some of which are national trends and some are very specific to the First State,” said Sen. Spiros Mantzavinos, who co-chaired the task force.

“Thanks to the hard work and dedication of my fellow task force members over the last year, I think we have made real progress in identifying areas where our state can make short- and long-term enhancements to improve the level of care available in Delaware,” he said. “Now it’s our job to make sure that the General Assembly acts on these recommendations so the families who depend on these services can sleep at night knowing we are doing all we can to protect the health and welfare of their loved ones.”

As part of the report the task force approved Thursday, the panel issued 18 recommendations, ranging from the state reviewing existing policies and updating various requirements and standards for long-term care facilities, to increasing retention efforts and requiring the facilities to improve their own internal policies and procedures.

Specifically, the task force recommended:

  • Create standing committees on aging and eldercare in the Senate and House of Representatives in the 153rd General Assembly.
  • Conduct a thorough review and revision of relevant statutes and regulations related to long-term care.
  • Promote culturally competent care in long-term care facilities.
  • Call on DHSS and other state entities to embrace a person-centered acuity model for staffing requirements to support residents and ensure that sufficient care is available to meet their needs, including the needs of residents receiving memory care services.
  • Urge DHCQ to review existing qualification requirements for long-term care facility staff on a regular basis to ensure quality of care.
  • Implement robust and comprehensive recruitment and retention initiatives for healthcare workers in long-term care.
  • Increase Medicaid reimbursement rates for long-term care facilities and consider the adoption of a regular and systematized procedure for reviewing reimbursement rates.
  • Develop comprehensive and transferrable memory care training requirements.
  • Increase funding and resources for the Division of Health Care Quality and the Office of the Long-Term Care Ombudsman.
  • Investigate State oversight bodies’ practices regarding communication with residents and family members to promote greater transparency, understanding of relevant laws and procedures, and access to relevant resources.
  • Increase oversight for temporary staff and temporary staffing agencies.
  • Review oversight for assisted living facilities.
  • Expand state oversight of memory care services.
  • Evaluate current survey policies related to medication management for residents receiving memory care services, and ensure CMS regulations, within skilled nursing facilities, on psychotropic medications are, to the extent possible, applied to any memory care units in other facility types.
  • Require long-term care facilities to prioritize transparency, clarity, and honesty in all advertising and promotional materials, as well as in facility disclosures.
  • Require long-term care facilities to prioritize the development and implementation of a comprehensive and tailored resident and family orientation program.
  • Call on facilities to establish clear lines of ongoing communication between facilities and family and caregivers in the event of changes in condition. 
  • Establish a stakeholder group to meet regularly to provide a forum for continued public engagement on issues related to long-term care.

“With an aging population that continues to grow in Delaware, it is critical that we do all we can to protect one of our most vulnerable sectors,” said Rep. Ruth Briggs King, a member of the task force. “As a member of the Joint Finance Committee, I am pleased to report that increased reimbursements for Delaware’s long-term care facilities – a recommendation of our report – is expected to be included as part of the FY 2024 operating budget. That is just one step in the right direction of ensuring long-term care residents receive the quality care they and their families very much deserve.”

“As the aging population in Delaware grows, it’s important that lawmakers look at the challenges that not only patients, their families and the industry as a whole is facing,” said Sen. Brian Pettyjohn, a member of the task force. “These recommendations, forthcoming legislation and continued discussions will help move the ball forward and ensure that quality long-term and memory care is available to generations of Delawareans to come.”

Rep. Johnson and Sen. Mantzavinos said lawmakers are actively drafting legislation to implement some of the task force’s recommendations this year and expect to file those bills in the coming weeks.