DELAWARE ASSISTED LIVING AND REST RESIDENTIAL UTILIZATION STATISTICS REPORT JANUARY – DECEMBER 2007 Published July 2008 Bureau of Health Planning & Resources Management Blue Hen Corporate Center 655 S. Bay Road, Suite 206 Dover, Delaware 19901 (302) 741-2960 Judith Chaconas, Director DOC#: 35-05-20\08\07\05 ACKNOWLEDGMENTS The Bureau of Health Planning and Resources Management wishes to express its appreciation for the cooperation it has received from the Delaware Health Care Facilities Association and from all the private and public facilities that participated in this project. THIS REPORT WAS PREPARED BY Carol Schofield, Management Analyst Department of Health & Social Services Division of Public Health Bureau of Health Planning & Resources Management TABLE OF CONTENTS PREFACE 1 SUMMARY 1 DEFINITIONS 2 STATE POPULATION 4 FACILITY CHARACTERISTICS * Characteristics 5 * Facility Demographics and Capacity 6 UTILIZATION * Utilization/Availability Comparison 7 * Residents by Source of Payment 8 RESIDENT MOVE-IN BY CRITERIA * Resident Move-ins by Prior Geographic Location 9 * Resident Move-ins by Residence Type 10 * Percent of Resident Move-ins by Gender 11 * Move-ins by Race, Age and County – Assisted Living - Male 12 * Move-ins by Race, Age and County – Assisted Living - Female 13 * Move-ins by Age, Race and County – Rest Residential 14 RESIDENT MOVE-OUTS BY CRITERIA * Resident Move-outs by Gender 15 * Resident Move-outs by Race, Age and County – Assisted Living - Male 16 * Resident Move-outs by Race, Age and County – Assisted Living - Female 17 * Resident Move-outs by Race and Age – Rest Residential 17 * Resident Move-outs by Destination Residence Type 18 PREFACE This is the third edition of the Delaware Assisted Living and Rest Residential Utilization Statistics Report produced by the Delaware Division of Public Health, Bureau of Health Planning and Resources Management. The information in this report is provided in accordance with Title 16, Delaware Code, Chapter 20 - Uniform Health Data. The purpose of this chapter is to establish a health information data base that will assist the health care system advance the general well-being of the population by better directing and improving the availability of health care services. The State of Delaware strives to foster the appropriate and efficient use of health care by requiring the reporting of information necessary to, among other things, evaluate health care utilization patterns. This report will be made available to health care purchasers, health care insurers, health care providers, health care planners, the general public and other interested parties. The information in this report represents a compilation of utilization statistics submitted monthly to the Bureau of Health Planning and Resources Management by facilities licensed to provide assisted living and rest residential services in Delaware. Note: * Percentages are based on the number of billable days available and utilized and not the number of individuals. * Percents may appear as greater than or less than 100% due to rounding. * Any percent equaling less than one appears as zero. * All Delaware rest residential facilities are located in New Castle County This report is to be quoted or referenced using the following format; Delaware Health and Social Services, Division of Public Heath, Delaware Assisted Living and Rest Residential Utilization Statistics Report, published February, 2008” SUMMARY STATEMENT This report presents characteristics of Delaware’s assisted living and rest residential facilities and their residents for the calendar year 2006. The information relates to the following: * Characteristics of facilities (number of facilities and licensed capacity) * Utilization data (resident days, occupancy, resident move-in and resident move-out) * Resident characteristics (demographics, including age, race, gender, location and type of living facility resident move from or moved to, etc.) DEFINITIONS (The State of Delaware Administrative Code, Title 16, Ch 11, 3225) Assisted Living is a housing option that provides supportive services to residents. Supportive services usually include personal care and light medical or nursing care. Generally, assisted living care allows a resident more independence than nursing home care. In Delaware, the Assisted Living Waiver can pay part of the cost of assisted living care for those who qualify. Assisted Living - 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. Assisted living facilities provide: Administration of Medication - The process whereby a single dose of a prescribed drug is given to a resident by an authorized licensed person, as described in Title 24 Del.C. Ch 19, 1902. Assistance with Self-Administration of Medication (AWSAM) - Help with medication provided by facility personnel who are not nurses or nurse practitioners but who have successfully completed a Board of Nursing-approved medication training program in accordance with the Delaware Nurse Practice Act, Title 24 Del.C. Ch. 19, 1902 and applicable rules and regulations. Medication Log – A written document in which licensed personnel and unlicensed personnel who have completed AWSAM training record administration/assistance with the resident’s medications. Assistance with any item, piece of equipment or product system whether acquired commercially off the shelf, modified, or customized that is used to increase or improve functional capabilities of adults with disabilities. Activities of Daily Living (ADLs) - Normal daily activities including but not limited to ambulating, transferring, range of motion, grooming, bathing, dressing, eating, and toileting. Instrumental Activities of Daily Living (IADLs) - Home management skills, such as shopping for food and personal items, preparing meals, or handling money. Rest (Residential) Home - 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. Rest residential facilities provide: Shelter, housekeeping services, board, personal surveillance or direction in the activities of daily living Activities of Daily Living - Getting out of bed, bathing, dressing, eating and ambulation. Personal Care Services - Those services that include general supervision of, and direct assistance to, individuals in their activities of daily living to insure their safety, comfort, nutritional needs and well-being. Rehabilitation - The restoration of an ill or injured person to self-sufficiency at his highest attainable level. Supervision - Direct overseeing and inspection of the act of accomplishing a function or activity by a responsible person who is not a resident. Legend of additional definitions for the purpose of this document Term Definition AL Assisted Living facility Medicaid Waiver The Assisted Living Medicaid Waiver program is a community based residential services program administered by the Division of Services for Aging and Adults with Physical Disabilities (DSAAPS). The program is targeted to older persons and adults with physical disabilities who are age 18 years and over and who meet Medicaid nursing home admission criteria. (per Delaware Medicaid Provider Policy Manual, General Policy 1.32.4.1) Move-ins Residents moving into a facility Move-outs Residents moving out of a facility RR Rest residential facility Respite Care Respite Care service gives families and caregiver’s temporary relief from providing care for frail older adults and paid by Care Delaware on a sliding scale basis. STATE POPULATION A larger number of assisted living facilities are located in New Castle County than in the two remaining counties combined. This is congruent with the larger population as demonstrated in the graph below. This graph shows the anticipated growth in the State of Delaware through the year 2030. (DHSC Population Consortium) Figure A-3 Projected Population Growth Delaware and Counties, 1990-2030 (Figure not shown) The following chart shows the anticipated Delaware growth increase for specific age groups through the year 2020. Anticipated Delaware Growth Increase For Specific Age Groups Age 2007 2008 2009 2010 2015 2020 65-69 34608 36389 38191 39520 49936 56148 70-74 28297 28687 29504 29972 36623 49351 75-79 24450 24691 24666 24920 26264 32180 80-84 18020 18505 18732 19019 20092 21341 85 and up 15987 16802 17731 18634 21964 24339 Total 123369 127082 130833 134075 154879 183359 The chart below provides the anticipated percentage of increase from prior time period, in the population of Delaware citizens aged 65 and above. It identifies the probable growth of 49% from 2007 through 2020. Delaware Percent Anticipated Increase From Prior Year 2007 2008 2009 2010 2015 2020 3% 3% 3% 2% 16% 18% DELAWARE FACILITY CHARACTERISTICS Facilities are comprised of units/rooms providing individual and occasionally duel occupancy living space for residents. Facilities are licensed in accordance to the number of residents/beds and not by the number of units. There are 26 private assisted living facilities and three private rest residential facilities in the state of Delaware. Delaware has one public assisted living facility located in Sussex County and no public rest residential facilities. 2007 DELAWARE FACILITY DEMOGRAPHICS AND LICENSED CAPACITY County Facility Name Assisted Living Rest Residential New Castle Arden Courts 56 0 Captain's Deck 101 0 Cokesbury Village 49 0 Eden Rock 26 0 Forwood Manor 37 0 Foulk Manor North 44 0 Foulk Manor South 51 0 Gardens White Chapel 132 0 Gilpin Hall 0 18 Ingleside Assisted Living 60 0 Jeanne Jugan 0 26 Masonic Home of DE 0 52 Methodist Country House 40 0 Millcroft 36 0 Rockland Place 97 0 Shipley Manor 15 0 Somerford House 72 0 Somerford Place 52 0 Sunrise of Wilmington 84 0 The Lorelton 86 0 Windsor Place 60 0 Total New Castle County 1098 96 Kent Green Meadows at Dover 96 0 Heritage at Dover 83 0 State Street Assisted Living 94 0 Westminster Village 99 0 Total Kent County 372 0 Sussex Brandywine Assisted Living 105 0 Heritage at Milford 80 0 Methodist Manor House 75 0 Peach Tree Acres 20 0 Seaford Center 19 0 Stockley Center 15 0 Total Sussex County 314 0 Statewide 1506 96 UTILIZATON UTILIZATON AVAILABILITY COMPARISON ASSISTED LIVING The following graph identifies the percent of all Delaware assisted living beds located in each county and the percent of those beds that were utilized. For the year of 2007 there was a statewide utilization rate of 81%. Percent of all 2007 Delaware Assisted Living Beds Available and Utilized by County New Castle Kent Sussex Statewide Percent of utilization 80% 77% 87% 81% Percent of statewide beds located in county 62% 21% 18% 100% REST RESIDENTIAL All rest residential beds are located in New Castle County and are 65 percent utilized. RESIDENTS BY SOURCE OF PAYMENT ASSISTED LIVING Less than one percent of assisted living residents paid to reside in an assisted living facility by any means other than self pay or the Medicaid Waiver. Percent of 2007 Delaware Assisted Living Residents by Source of Payment New Castle Kent Sussex Statewide Medicaid Waiver 5% 18% 17% 10% Self Pay 94% 82% 83% 89% Other 1% 0% 0% 1% REST RESIDENTIAL Rest residential service is not covered by the Medicaid Waiver. The source of payment for rest residential service in Delaware for the year 2007 was 94% self pay and 6% financial aid from other sources. RESIDENT MOVE-IN BY CRITERIA RESIDENT MOVE-INS BY PRIOR GEOGRAPHIC LOCATION The graphs below identify the percent of residents moving into each county from specific geographic locations. (Example: Of the all residents moving into New Castle County 86% were prior residents of that county, 1% previously lived in Kent County, 1% in Sussex County, 2% in Maryland, etc.) The three states listed have boundaries shared with Delaware. Ten percent of the residents moving into Delaware assisted living facilities were prior residents of other states. All rest residential facilities are located in New Castle County. ASSISTED LIVING Percent of 2007 Delaware Assisted Living Move-Ins by Prior Geographic Location New Castle Kent Sussex MD NJ PA Unknown New Castle 86% 1% 1% 2% 3% 4% 3% Kent 14% 62% 6% 5% 2% 4% 7% Sussex 6% 12% 63% 6% 3% 2% 9% Statewide 59% 13% 13% 3% 3% 4% 5% REST RESIDENTIAL Percent of 2007 Delaware Rest Residential Move-Ins by prior Geographic Location New Castle 93% Kent 0% Sussex 0% Maryland 0% New Jersey 4% Pennsylvania 2% Unknown 2% MOVE-INS BY PRIOR RESIDENCY TYPE The graphs below provide the percentage of residents moving into Delaware facilities by prior residency type within each county and statewide. (Example: Of all residents moving into New Castle County assisted living facilities, 52% previously lived in private homes, 21% came from nursing homes, 5% from hospitals, 14% from other assisted living facilities and less than 1% from rest residential facilities. The remaining 8% is unknown.) All rest residential facilities are located in New Castle County. ASSISTED LIVING Percent of 2007 Delaware Assisted Living Residents Moving Into Each County and Statewide by Prior Residency Type Private Nursing Other AL RR Home Home Hospital Facility Facility Unknown New Castle 52% 21% 5% 14% 0% 8% Kent 70% 15% 5% 10% 0% 0% Sussex 65% 12% 9% 11% 0% 3% Statewide 58% 18% 6% 12% 0% 6% REST RESIDENTIAL Percent of 2007 Delaware Rest Residential Move-Ins by Prior Residency Type Private Home 31% Nursing Home 11% Hospital 9% AL Facility 5% Other RR Facility 2% Unknown 42% MOVE-INS BY GENDER The graphs below compare the percent of male and female residents moving into Delaware facilities by county and statewide. ASSISTED LIVING Percent of 2007 Delaware Assisted Living Move-Ins by Gender Male Female New Castle 32% 68% Kent 23% 77% Sussex 31% 69% Statewide 30% 70% REST RESIDENTIAL Percent of 2007 Delaware Rest Residential Move-Ins by Gender Male 40% Female 60% MOVE-INS BY RACE, AGE, COUNTY AND STATEWIDE ASSISTED LIVING MALE The graph below compares male resident move-ins by age, race, county and statewide. County refers to the county in which the assisted living facility is located. (Example: Of all male residents moving into facilities located in New Castle County, 3% were white males less than 65 years of age, 2% were black males less than 65 years old, 8% were white males between 65 and 74 years of age, etc.) Percent of 2007 Delaware Male Assisted Living Move-Ins by Age, Race, County and Statewide White Black Other White Black Other White Black Other White Black Other <65 <65 <65 65-74 65-74 65-74 75-84 75-84 75-84 85+ 85+ 85+ New Castle 3% 2% 0% 8% 1% 0% 43% 1% 0% 39% 2% 1% Kent 3% 0% 0% 13% 0% 0% 43% 7% 3% 27% 0% 3% Sussex 9% 0% 0% 9% 0% 0% 40% 0% 0% 37% 5% 0% Statewide 4% 1% 0% 9% 0% 0% 42% 2% 0% 37% 2% 1% ASSISTED LIVING FEMALE The graph below compares female resident move-ins by age, race, county and statewide. County refers to the county in which the assisted living facility is located. (Example: Of all female residents moving into facilities located in New Castle County, 1% were white females under 65 years of age, 7% were white females between the age of 65 and 74, etc.) Percent of 2007 Delaware Female Assisted Living Move-Ins by Age, Race, County and Statewide White Black Other White Black Other White Black Other White Black Other <65 <65 <65 65-74 65-74 65-74 75-84 75-84 75-84 85+ 85+ 85+ New Castle 1% 0% 0% 7% 0% 1% 35% 1% 0% 52% 2% 0% Kent 0% 0% 0% 6% 0% 0% 49% 3% 1% 38% 2% 1% Sussex 4% 0% 0% 3% 1% 0% 21% 2% 0% 67% 2% 0% Statewide 2% 0% 0% 6% 0% 1% 35% 2% 0% 52% 2% 0% REST RESIDENTIAL The graph below shows the percent of male and female rest residential move-ins by age and race. (Example: Of all rest residential move-ins 18% were white males less than 65 years of age and 3% were white females less than 65 years of age.) Percent of 2007 Delaware Male and Female Rest Residential Move-Ins by Age and Race White Black Other White Black Other White Black Other White Black Other <65 <65 <65 65-74 65-74 65-74 75-84 75-84 75-84 85+ 85+ 85+ Male 18% 0% 0% 0% 0% 0% 18% 5% 0% 59% 0% 0% Female 3% 0% 0% 3% 0% 0% 27% 0% 0% 67% 0% 0% RESIDENT MOVE-OUTS BY CRITERIA RESIDENT MOVE-OUTS BY GENDER The graphs below show that a greater percent of assisted living move-outs throughout the state are female and that the percent of resident move-outs from rest residential facilities is more evenly distributed between the genders. ASSISTED LIVING Percent of 2007 Delaware Assisted Living Resident Move-Outs by Gender New Castle Kent Sussex Statewide Male 30% 19% 34% 29% Female 70% 81% 66% 71% REST RESIDENTIAL Percent of 2007 Delaware Rest Residential Move-Outs by Gender Male 51% Female 49% RESIDENT MOVE-OUTS BY RACE, AGE, COUNTY AND STATEWIDE ASSISTED LIVING MALE The graph below identifies the percentage of male move outs for specific age groups and race by county and statewide. (Example: Of all male move-outs from New Castle County, 2% were less than 65 years of age, 9% were between 65 and 74 years of age and 35% were between 75 and 84 years of age, etc.) Percent of 2007 Delaware Male Assisted Living Move-Outs by Age, Race, County and Statewide White Black Other White Black Other White Black Other White Black Other <65 <65 <65 65-74 65-74 65-74 75-84 75-84 75-84 85+ 85+ 85+ New Castle 2% 0% 0% 9% 0% 0% 35% 0% 1% 51% 2% 1% Kent 4% 0% 0% 22% 0% 0% 22% 0% 0% 52% 0% 0% Sussex 4% 0% 0% 2% 0% 0% 43% 0% 0% 48% 2% 0% Statewide 3% 0% 0% 9% 0% 0% 36% 0% 1% 50% 2% 1% ASSISTED LIVING FEMALE The graph below shows the comparison of female resident move-outs by age, race, county and statewide. (Example: Of all female move-outs from New Castle County, 1% were white less than 65 years of age, 7% were white between 65 to 74, 1% were other between 75 and 84, etc.) Percent of 2007 Delaware Female Assisted Living Move-Outs by Age, Race, County and Statewide White Black Other White Black Other White Black Other White Black Other <65 <65 <65 65-74 65-74 65-74 75-84 75-84 75-84 85+ 85+ 85+ New Castle 1% 0% 0% 7% 0% 1% 32% 1% 1% 57% 1% 0% Kent 2% 1% 0% 4% 1% 0% 39% 1% 2% 47% 2% 1% Sussex 2% 0% 0% 5% 0% 0% 18% 0% 0% 75% 0% 0% Statewide 1% 0% 0% 6% 0% 0% 31% 1% 1% 58% 1% 0% REST RESIDENTIAL The graph below shows the percent of male and female rest residential move-outs by age and race. Percent of 2007 Delaware Male and Female Rest Residential Move-Outs by Age and Race White Black Other White Black Other White Black Other White Black Other <65 <65 <65 65-74 65-74 65-74 75-84 75-84 75-84 85+ 85+ 85+ Male 16% 0% 0% 6% 0% 0% 16% 3% 0% 58% 0% 0% Female 3% 0% 3% 3% 0% 0% 20% 0% 0% 70% 0% 0% MOVE-OUTS BY DESTINATION ASSISTED LIVING The graph and chart below demonstrate the comparison of resident move-outs by destination resident type. (Example: Of the all residents moving out of New Castle County assisted living facilities, 19% returned home, 32% went into nursing homes, 10% went into hospitals, etc.) Percent of 2007 Delaware Assisted Living Move-Outs by Destination Return Nursing Assisted Rest Home Home Hospital Living Resident Death Unknown New Castle 19% 32% 10% 8% 0% 25% 7% Kent 20% 42% 17% 7% 0% 13% 0% Sussex 28% 35% 7% 6% 1% 19% 4% Statewide 21% 34% 10% 8% 0% 21% 5% REST RESIDENTIAL The graph below identifies the percent of rest residential move-outs by destination resident type. Percent of 2007 Delaware Rest Residential Move-Outs by Destination Return Home 11% Nursing Home 23% Hospital 20% Assisted Living 2% Death 2% Unknown 43% CONCLUSION: In the year 2007 there was an 81% utilization rate of current assisted living facilities and a 65% utilization rate of rest residential facilities. These services are primarily utilized by residents 65 years of age or greater. The Delaware Population Consortium projects a 49% growth in population within this age group between the years 2007 and 2020. This concludes the Delaware State Assisted Living and Rest Residential Utilization Statistical report for the calendar year 2007. Bureau of Health Planning & Resources Management Blue Hen Corporate Center 655 S. Bay Road, Suite 206 Dover, Delaware 19901 (302) 741-2960 DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health