Candace Esham

Delaware Elder Care Advocacy Coalition

Monthly Newsletters

June 2025

Welcome to the June issue of our monthly newsletter. Our mission is to promote legislation for Delaware aging residents to ensure they receive quality care and thrive. Each month in our newsletter we plan on updating you on legislation both in our state and any legislation that leads to exceptional care across other states. Also, we will have a key spotlight on an issue or deep dive into a resource.

Update on Bills from Last Session

            We are committed to providing updates as we receive them on the six laws passed last legislative session. Implementation and enforcement of laws are equally as important as creating them. James Berryhill, Legislative Director for the Department of Health and Social Services recently provided the following status update:

  • Senate Bill 215– This bill amends Title 16 of the Delaware Code relating to state inspections of long-term care facilities (skilled nursing facilities and assisted living facilities) to require inspections on a frequency aligned with the Centers for Medicare & Medicaid Services (CMS).  Status: Inspections have begun and are ongoing. As of May 15, 2025, all nursing homes and assisted living facilities have had a survey within the required timeframe.
  • Senate Bill 216– This bill increases the civil penalties for violations of statutes related to Long Term Care Facilities that are determined to pose a serious threat to the health and safety of a resident.  Status: Implementation is in progress. The increased penalties have been imposed as part of the regulatory response.
  • Senate Bill 150– This bill defines dementia care services and activity services, and it requires assisted living facilities that offer dementia care services have sufficient staff to meet the needs of each resident, including a sufficient number of dedicated activity staff.  It also requires that the staff who work with residents receiving dementia care services complete dementia care services training and identifies certain requirements for such training. A DHSS resource is required to oversee the program. A reclassification of an open role is needed. Status: The reclassifications are still working their way through the process.
  • Senate Bill 151– This bill requires assisted living facilities that advertises, markets, or otherwise represents that the facility provides dementia care services disclose information related to these services.  With a standardized form, families can compare facilities to make an informed decision on where to place their loved one. A DHSS resource is required to oversee the program. A reclassification of an open role is needed. Status: The reclassifications are still working their way through the process.
  • House Bill 300– This bill requires the Department of Health and Social Services to maintain a public registry of assisted living facilities that are accredited and/or certified to provide memory care services by an approved independent accrediting organization. It also defines memory care services and secured memory care unit. Status: A draft licensure form has been created to document accreditation status. Updates to integrate this into the assisted living facility regulations are in progress
  • House Bill 204– This bill requires temporary staffing agencies with positions in long-term care facilities to report several records to the Division of Health Care Quality.  Status: Draft regulations were circulated to long-term care associations and shared with both facilities and the temporary staffing agencies they use. Comments have been reviewed, and the draft is now under legal review. The fiscal note was removed based on the assumption that registration fees would support the staffing needed to implement the bill. At this time, no new staff have been added, so the Division of Health Care Quality (DHCQ) is moving forward as capacity allows.

Additional comment from James: “Please note that collectively, these bills represent a substantial revision to the assisted living regulations, and the work to implement them is ongoing and resource-intensive.”

Recent Neglect in Delaware

            The Division of Health Care Quality, Office of Long-Term Care Residents Protection provides a quarterly report to the Nursing Home Residents Quality Assurance Commission. We recently obtained copies of these reports from 2022 to present. A review of the 1st Quarter 2025 report further reinforces the urgency of implementation and enforcement of the laws from last session. In a survey of Milford Place Assisted Living on September 30, 2024, a record review indicated a resident “eloped from the facility on 9/18/24, exiting the facility through the unsecured, unsupervised front entrance door.” A survey on February 14, 2025 at the Brandywine Assisted Living Fenwick Island facility determined the “facility failed to provide the needed supervision and services to prevent an elopement. R1 eloped from the facility on 2/1/25 and was found outside in the facility in the parking lot, close to a busy highway.” Other forms of neglect found at facilities included improper treatment of pressure ulcers, medication errors, failure to offer sufficient fluid intake to maintain proper hydration and health and improperly using a mechanical lift causing significant harm. Overall, 17 citations of “immediate jeopardy” were documented. Immediate jeopardy (IJ) refers to a situation where noncompliance with regulations has caused or is likely to cause serious injury, harm, impairment, or death to a resident.

Homicide at The Summit

            Isabel Hughes of The News Journal published an update, “Family sues over killing at care facility,” on May 27, 2025 to the homicide investigation of Ms. Hsia at The Summit. The article documents the details of the lawsuit, which claims the parent company “operated with a goal of “maximizing profits” rather than providing a safe environment for residents.” Understaffing was also specifically mentioned in the lawsuit and article.

Monthly Spotlight: Update on Extra Funding

Last year, in February 2024, we reported the operating budget for Delaware fiscal year 2024 (HB 195) included an extra $25 million in addition to the Medicaid funding already provided. All Delaware-licensed long-term care facilities were required to develop and submit a compensation report outlining base compensation levels for all direct care providers operating in their facilities for calendar years 2023 and 2024. The report was submitted to the Chief Clerk of the House of Representatives, the Secretary of the Senate, the Office of the Controller General, and the Office of Management and Budget before January 31, 2025. Recently we obtained the compensation reporting data for skilled nursing facilities that was submitted to the General Assembly.

  • According to a letter written by the Acting Director, Division of Managed Care Policy Center for Medicaid and CHIP Services, this was for a “uniform increase established by the state for nursing facility services.”  
  • The total dollar amount approved for the separate payment is $25,464,731.  
    • Estimated federal share of this state directed payment: $15,464,731
    • Estimated non-federal share of this state directed payment: $10,000,000
    • This translates to $32.53 per day per encounter (per resident who is covered under Medicaid).
  • The reason for this increase was “due to the lingering effects of the COVID-19 pandemic and impact on workforce retention and associated strain on Delaware’s nursing facilities.” (see page 8 of letter)

In one letter provided to the General Assembly, facilities state their centers were required to “use significant nursing agency staff to provide the level of quality care to our residents.” Another facility director stated, “one winner of the pandemic were staffing agencies.” Rate changes from 2019 to 2024 vary among facilities. Assisted living facilities were not included in the facilities receiving extra funds from Medicaid.

The Consumer Voice partnered with Michigan Elder Care Initiative to release a report, “Public Funds into Private Pockets: How Nursing Homes May Be Hiding Profits and Depriving Residents of Care and Quality” on June 4, 2025. The report states “nationally, Medicare and Medicaid pay nursing homes nearly $70 billion each year to provide care to nursing home residents.” Transparency and accountability for how these taxpayer funds are spent is severely lacking. Specifically, four for-profit nursing home chains are reviewed in the report with a deep dive into the financial reports and inadequate care. We will continue to advocate for more transparency of funding to ensure investments leading to quality care are prioritized.

Thank you for being a part of our advocacy community and we look forward to hearing any feedback from you.

Sincerely,

Candace Esham

Founder of Delaware Elder Care Advocacy Coalition

Keep in touch with us:

Email: DelawareElderAdvocates@gmail.com

Facebook: Delaware Elder Care Advocacy Coalition Facebook page

Need a dementia-care support group?

Need to find assistance in Delaware:

How to file a complaint:

  • Complaint & Incident Reporting for Division of Health Care Quality: 24-Hour, Toll-Free Phone: 1-877-453-0012.

Or online form: https://dhss.delaware.gov/dhss/dhcq/reportabuse.html

Once the official complaint is filed, pictures can be submitted.