DELAWARE HEALTH AND SOCIAL SERVICES DIVISION OF PUBLIC HEALTH DELAWARE ASSISTED LIVING AND REST RESIDENTIAL UTILIZATION STATISTICS REPORT JANUARY – DECEMBER 2005 Published February 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 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 Service Availability 7 UTILIZATION Utilization/Availability Comparison 7 Residents by Source of Payment 9 RESIDENT MOVE-IN BY CRITERIA Resident Move-ins by Prior Geographic Location 10 Resident Move-ins by Prior Type of Residence 11 Percent of Resident Move-ins by Gender 13 Move-ins by Race, Age and County – Male 14 Move-ins by Race, Age and County – Female 15 Rest Residential Move-ins by Age, Race and County 16 RESIDENT MOVE-OUTS BY CRITERIA Resident Move-outs by Gender 17 Male Assisted Living Move-outs by Race, Age and County 18 Female Assisted Living Move-outs by Race, Age and County 19 Rest Residential Move-outs by Race and Age 20 Resident Move-outs by Destination 21 PREFACE This is the first 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. This report is to be quoted or referenced to 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” For the purpose of this report any percent equal to less than one appears as zero. SUMMARY STATEMENT This report presents characteristics of Delaware’s assisted living and rest residential facilities and their residents for the calendar year 2005. 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 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 caregivers’ 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. Figure A-3 Projected Population Growth FIGURE NOT SHOWN Delaware and Counties, 1990-2030 The following chart shows the anticipated Delaware growth increase for specific age groups through the year 2010. Anticipated Delaware Growth Increase For Specific Age Groups Age 2005 2006 2007 2008 2009 2010 65-69 32102 33094 34608 36389 38191 39520 70-74 28344 28362 28297 28687 29504 29972 75-79 23503 24093 24450 24691 24666 24920 80-84 17243 17661 18020 18505 18732 19019 85 and up 14118 14993 15987 16802 17731 18634 Total 117315 120209 123369 127082 130833 134075 The chart below provides the anticipated percentage of annual growth from prior years, in the population of Delaware citizens aged 65 and above. It identifies a growth of 13 percent from 2005 through 2010. Delaware Percent Anticipated Increase From Prior Year 2005 2006 2007 2008 2009 2010 4% 2% 3% 3% 3% 2% 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. 2005 DELAWARE FACILITY DEMOGRAPHICS AND LICENSED CAPACITY County Facility Name Assisted Living Rest Residential New Castle Arden Courts 56 0 Cokesburry Village 69 0 Eden Rock 28 0 Forwood Manor 37 0 Foulk Manor North 44 0 Foulk Manor South 51 0 Gilpin Hall 0 18 Highfield Masonic Home 0 52 Jeane Jugan Residence 0 26 Methodist Country House 37 0 Methodist Manor House 66 0 Millcroft 32 0 Pioneer House 4 0 Rockland Place 97 0 Shipley Manor Assisted Living 15 0 Somerford House 72 0 Somerford Place 52 0 Sunrise of Wilmington 84 0 The Lorelton 86 0 Windsor Place 65 0 Total New Castle County 895 96 Kent Heritage at Dover 80 0 State Street Assisted Living 84 0 Westminster Village 99 0 Total Kent County 263 0 Sussex Brandywine Assisted Living 110 0 Heritage at Milford 80 0 Methodist Manor House 66 0 Peach Tree Acres 20 0 Seaford Center Assisted Living 19 0 Shockley Center 15 0 Village at Green Valley 21 0 Total Sussex County 331 0 Total Statewide 1489 96 SERVICE AVAILABILITY ASSISTED LIVING Percent of Delaware Assisted Living Beds by County New Castle 60% Kent 18% Sussex 22% REST RESIDENTIAL -All rest residential beds are located in New Castle County. UTILIZATION vs. AVAILABILITY COMPARISON ASSISTED LIVING Delaware Assisted Living Bed Days Available vs. Bed Days Utilized New Castle Kent Sussex State Wide # of available bed days 326675 95995 120815 543485 # of bed days utilized 270703 77349 100742 448794 Percent of Delaware Assisted Living Services Utilized Statewide and by County New Castle 83% Kent 81% Sussex 83% Statewide 83% REST RESIDENTIAL Number of Delaware Rest Residential Bed Days Available vs. Bed Days Utilized # of available bed days 35040 # of bed days utilized 21542 Sixty one percent of the available rest residential bed days were utilized. All rest residential beds are located in New Castle County. RESIDENTS BY SOURCE OF PAYMENT ASSISTED LIVING Percent of Delaware Assisted Living Residents by Source of Payment New Castle Kent Sussex Statewide % Medicaid Waiver 3% 12% 13% 7% % Self Pay 88% 88% 87% 88% Other 9% 0% 0% 5% *Other includes private insurance, veteran’s benefits, respite care etc. * Any percent equaling less than one appears as zero REST RESIDENTIAL Percent of Delaware Rest Residential Residents by Source of Payment Self Pay 95% Financial Aid 5% *Financial aid is from sources other then Medicaid. Medicaid does not cover this service. RESIDENT MOVE-IN BY CRITERIA RESIDENT MOVE-INS BY PRIOR GEOGRAPHIC LOCATION ASSISTED LIVING The chart below identifies the number of residences moving into each county and statewide, from specific geographic locations. Example: Of the 499 residents moving into New Castle County assisted living facilities were prior residents of New Castle County, 414 already resided in New Caste County, five were prior residents of Kent County, eight moved in from Sussex County, etc. Delaware Assisted Living Move-ins by Prior Geographic Location Moved New Kent Sussex MD NJ PA Other Total To Castle Moved To New Castle 414 5 8 9 10 29 24 499 Kent 6 64 2 1 0 2 2 77 Sussex 7 7 94 6 3 2 14 133 Statewide 427 76 104 16 13 33 40 709 *The three states listed have boundaries shared with Delaware. The category “other” refers to any location not mentioned. Percent of Delaware Assisted Living Residents Moving into Facilities Within the County of Theor Prior Residence New Castle 97% Kent 84% Sussex 90% REST RESIDENTIAL Of the fifty six rest residential move-ins fifty five were previously residing in New Castle and the remaining one resident was from Pennsylvania. MOVE-INS BY PRIOR RESIDENCY TYPE ASSISTED LIVING The chart below states the actual number of resident move-ins by county and the type of residence they resided in prior to moving into a Delaware assisted living facility. Example: Of the 499 people moving into an assisted living facility in New Castle Count 298 previously lived in a private home, 93 from nursing homes, 35 from hospitals, etc. Number of Delaware Assisted Living Residents by Prior Residency Type Private Nursing Other AL County Home Home Hospital Facility Unknown Total New Castle 298 93 35 33 40 499 Kent 55 6 7 4 5 77 Sussex 79 21 3 12 18 133 Statewide Total 432 120 45 49 63 709 Statewide Percent of Delaware Assisted Living Move-In by Prior Residency Type Private Home 61% Nursing Home 17% Hospital 6% Other AL Facility 7% Unknown 9% REST RESIDENTIAL Percent of Delaware Rest Residential Move-Ins by Prior Residency Type Private Home 46% Nursing Home 4% Hospital 21% Unknown 29% All rest residential facilities are located in New Castle County MOVE-INS BY GENDER ASSISTED LIVING Percent of Delaware Assisted Living Move-Ins by Gender County Female Male New Castle 71% 29% Kent 74% 26% Sussex 83% 17% Statewide 73% 27% REST RESIDENTIAL Percent of Delaware Rest Residential Move-Ins by Gender Female 73% Male 27% All Rest residential move-ins were from New Castle County. MOVE-INS BY RACE, AGE AND COUNTY 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 white male move-ins less than 65 years of age, 2% moved into facilities located in New Castle, less than 1 % in Kent, and 5% in Sussex County. Statewide, 2% of all white male resident move-ins were less than 65 years of age. Percent of Delaware Male Assisted Living Move-Ins by Age and Race White Black Other White Black Other White Black Other White Black Other County <65 <65 <65 65- 65- 65- 75- 75- 75- 85+ 85+ 85+ New Castle 2% 1% 0% 9% 1% 0% 38% 2% 1% 46% 1% 0% Kent 0% 0% 0% 16% 0% 0% 42% 11% 0% 32% 0% 0% Sussex 5% 0% 0% 18% 5% 0% 45% 0% 0% 27% 0% 0% Statewide 2% 0% 0% 11% 1% 0% 39% 2% 0% 43% 0% 0% * Any percent equaling less than one appears as zero 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 white female move-ins less than 65 years of age, 3% moved into facilities located in New Castle, 2% in Kent, and 1% in Sussex County. Statewide, 2% of all white female resident move-ins were less than 65 years of age. Percent of Delaware Female Assisted Living Move-Ins by Age and Race White Black Other White Black Other White Black Other White Black Other County <65 <65 <65 65- 65- 65- 75- 75- 75- 85+ 85+ 85+ New Castle 3% 0% 0% 6% 0% 0% 31% 1% 0% 58% 2% 0% Kent 2% 0% 0% 9% 4% 0% 41% 4% 0% 39% 2% 0% Sussex 1% 0% 0% 4% 0% 0% 34% 0% 0% 61% 0% 0% Statewide 2% 0% 0% 6% 0% 0% 33% 1% 0% 57% 1% 0% * Any percent equaling less than one appears as zero. REST RESIDENTIAL MALE The graph below shows that less than 1 % of all male rest residential move-ins were non-white and all male rest residential move-ins were white and 75 years of age or older. Percent of Delaware Male Rest Residential Move-Ins by Age and Race <65 65-74 75-84 85+ Black 0% 0% 0% 0% White 0% 0% 20% 80% Other 0% 0% 0% 0% REST RESIDENTIAL FEMALE The graph below shows that of all female move-ins under 75 years of age, less than 1 % were non-white and 2.4 % were white between the ages of 65 and 74. Percent of Delaware Female Rest Residential Move-Ins by Age and Race <65 65-74 75-84 85+ Black 0.0% 0.0% 2.4% 2.4% White 0.0% 2.4% 12.2% 80.5% Other 0.0% 0.0% 0.0% 0.0% RESIDENT MOVE-OUTS BY CRITERIA RESIDENT MOVE-OUTS BY GENDER ASSISTED LIVING This graph shows a greater percent of all rest residential move-outs resident move-outs are female and the balance between male and female remain consistent throughout the state. Percent of Delaware Assisted Living Resident Move-Outs by Gender Female Male New Castle 75% 25% Kent 74% 26% Sussex 74% 26% Statewide 74% 26% REST RESIDENTIAL Percent of Delaware Rest Residential Move-Outs by Gender Male 35% Female 65% All rest resident move-outs were from New Castle County. RESIDENT MOVE-OUTS BY RACE, AGE AND COUNTY ASSISTED LIVING MALE The graph below identifies the comparison of male resident move-outs by age, race and county. The chart below the graph clarifies the percentage of move outs for the specific age group and race by county and statewide. (Example: Of the white male resident move-outs less than 65 years of age, 4% were from New Castle County, 5% were from Kent County and 6% from Sussex County. Statewide, 4% of all male resident move-outs were less than 65 years of age.) Percent of Delaware Male Assisted Living Move-Outs by Race, Age and County 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 4% 0% 0% 6% 0% 0% 30% 1% 0% 59% 1% 0% Kent 5% 0% 0% 0% 0% 0% 42% 11% 0% 42% 0% 0% Sussex 6% 0% 0% 8% 3% 0% 36% 6% 0% 42% 1% 0% Statewide 4% 0% 0% 5% 1% 0% 33% 3% 0% 53% 1% 0% *Any percents equaling less than one appear as zero. ASSISTED LIVING FEMALE The graph below shows the comparison of female resident move-outs by age, race, county and statewide. (Example: Of all white female resident move-outs less than 65 years of age, 2% were from New Castle County, 2% were from Kent County and 2% from Sussex County. Statewide, 2% of all female resident move-outs were less than 65 years of age.) Percent of Delaware Female Assisted Living Move-Outs by Race, Age and County 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% 7% 0% 0% 26% 1% 0% 63% 1% 0% Kent 2% 0% 0% 6% 4% 0% 25% 2% 2% 55% 6% 0% Sussex 2% 0% 0% 3% 0% 0% 26% 2% 0% 67% 0% 0% Statewide 2% 0% 0% 6% 0% 0% 26% 1% 0% 63% 1% 0% * Any percent equaling less than one appears as zero. REST RESIDENTIAL MALE The graph below shows the comparison of male rest residential move-outs by age and race. Percent of Delaware Male Rest Residential Move-Outs by Race and Age 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+ 5% 0% 0% 0% 0% 0% 16% 0% 0% 79% 0% 0% REST RESIDENTIAL FEMALE The graph below shows the comparison of female rest residential move-outs by age and race. Percent of Delaware Female Rest Residential Move-Outs by Race and Age 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+ 0% 0% 0% 3% 0% 0% 17% 0% 0% 80% 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 facilities 18 percent returned home, 30 % went to nursing homes, and 14 % went into hospitals, etc.) Percent of Delaware Assisted Living Move-Outs by Destination Return Nursing Other County Home Home Hospital Assisted Death Unknown New Castle 18% 30% 14% 7% 17% 14% Kent 25% 35% 21% 6% 13% 1% Sussex 27% 36% 1% 9% 24% 3% Statewide 21% 32% 12% 7% 18% 10% REST RESIDENTIAL The graph below identifies the comparison of resident move-outs by destination resident type. Percent of Rest Residential Move-Outs by Destination Return Nursing Other Home Home Hospital Assisted Death Unknown 15% 11% 31% 2% 4% 37% CONCLUSION: This concludes the Delaware State Assisted Living and Rest Residential Utilization Statistical report for the calendar year 2005. The State of Delaware Administrative Code, Title 16, Ch 11, 3225 Delaware Health and Social Services Delaware Assisted Living & Rest Residential Division of Public Health Utilization Statistics Bureau of Health Planning and Resources Management Calendar Year 2005 Doc # 35-05-20/08/03/14