Delaware assisted living facility license: DHCQ rules, staffing tiers and fees

Who needs this license, and what it is not

Delaware’s rule applies to any facility that provides assisted living to elderly people or adults with disabilities. It also protects the label itself: “assisted living” may not appear in a facility’s official name unless DHSS has licensed it as an ALF ⁠¹. Section 4.1 says no entity may hold itself out as an ALF without a license, and DHCQ issues each license, provisional or annual, for a set number of beds ⁠¹.

The statute places ALFs inside a broader category, the “long-term care facility”: a residential facility that provides shelter and food to more than one person who needs care because of a physical or mental condition and is not related within the second degree to the facility’s controlling person ⁠². An ALF is defined as a combination of housing, supportive services, supervision, personal help and health care for people who need help with activities of daily living. Its residents are medically stable adults who do not need the skilled nursing services of a nursing facility ⁠². Operating any long-term care facility without a license carries a civil penalty of up to $10,000 per violation ⁠².

Delaware sets no minimum size for an ALF. A 4-bed house that provides assisted living holds the same Chapter 3225 license as a 150-bed building, with lighter staffing rules (see below) ⁠¹. Neighboring licenses a founder might mix up:

• Family care home: beds and personal care for 2 or 3 residents in a family setting, under a separate rule. See the Delaware family care home guide.
• Adult day care facility: daytime services for 4 or more impaired adults, with no overnight stays. See the adult day care guide.
• Personal assistance services agency and skilled home health agency: care delivered in clients’ own homes. See the personal assistance services agency guide; skilled home health agencies are licensed separately.

You need a separate license for each location, even under the same management. Separate buildings run by the same management on the same grounds share one license ⁠¹.

Bed count decides your leadership structure

Before you pick a property, decide how many beds you will license. Section 16 of the rule ties the two key leadership roles to licensed beds, and the bed count is fixed on the license ⁠¹.

Scroll the table sideways to see every column.

An ALF that is part of a continuing care retirement community (CCRC), or part of a campus under the same ownership, may operate under one licensed NHA for the whole CCRC or campus ⁠¹. The NHA must comply with 24 Del.C. Ch. 52 and the rules of the nursing home administrators’ board ⁠¹.

For 4 beds or fewer, the director needs one of these: a bachelor’s degree in a health or social services field or business administration; an associate degree in those fields plus 2 years of full-time-equivalent experience; RN licensure with 4 years of combined education and related experience; 4 years of experience as an LPN; or 5 years of experience in a health or social services field or business administration ⁠¹. The house manager must have a high school diploma or equivalent, be a certified nursing assistant with at least 3 years of health care experience, complete CNA-rule orientation and receive at least 12 hours of in-service education a year ⁠¹.

There is one point to settle with DHCQ before you plan a 4-bed home. Section 1103(b) of the statute says an ALF must operate under the direction of a person “authorized or licensed to perform the functions of a nursing home administrator” under 24 Del.C. Ch. 52 ⁠². The rule’s director option for small facilities does not mention that statute. The sources do not say how the two fit together. Before you commit to a 4-bed home, ask DHCQ in writing whether a section 16.7 director satisfies §1103(b) or whether a licensed nursing home administrator is still required.

DHCQ’s public list of licensed ALFs showed 38 facilities on 2026-10-12. The smallest listing was 6 beds, and most were between 40 and 170 beds ⁠⁴.

What DHCQ looks at besides the building

The statutory application test goes beyond physical readiness. Along with the form and fee, you must show you can meet minimum standards of nursing or medical care, that you have the financial capability to operate, and that you can comply with other state and federal law ⁠². DHCQ considers the background of the applicant. It may also consider every partner, officer, director and managing employee, anyone who owns or controls the physical plant, and any controlling person ⁠².

You must file a sworn affidavit of satisfactory compliance history covering every state or jurisdiction where you operated a facility during the previous 5 years. DHCQ may also ask for 5 years of financial information ⁠². The license can be denied if anyone in that group has operated a long-term care facility without a license, or under a revoked or suspended one, in any jurisdiction. Other grounds include false statements in the application and a history of noncompliance ⁠².

Since 2026 the ownership picture is also public. Each long-term care facility must disclose its owners in the form DHCQ sets, including all controlling persons of any entity that is not publicly traded or nonprofit. “Facility owner” means anyone holding 5% or more, directly or indirectly. The disclosure must be updated within 30 calendar days of any change ⁠². DHSS publishes the disclosed owners online. The facility must post its current owners on its own website, and printed brochures used with prospective residents must point readers to both websites ⁠².

Assembling the application

DHCQ licenses long-term care facilities on a one-year term, and the state’s business portal points applicants to DHCQ for the application form ⁠⁵. Applications go to the Division on its forms, with the fee ⁠². The rule adds items that must accompany the application for licensure:

1. Menu cycle

   At least a 4-week menu cycle, with documentation from a dietitian or nutritionist that the menus are nutritionally adequate. You resubmit it at each renewal ⁠¹.

2. All-hazards emergency plan

   A plan for evacuation and sheltering in place, on the Division’s template, in digital form, sent to both the Division and the Delaware Emergency Management Agency (DEMA). It must address staffing shortages ⁠¹.

3. FEMA training certificates

   Proof that at least two active, full-time employees completed FEMA ICS-100 and NIMS-700a within the previous 24 months. Items 2 and 3 are required with the initial application and every annual renewal, though the Division may extend the deadline for good cause ⁠¹.

4. Ownership and compliance history

   The sworn 5-year compliance affidavit and the ownership disclosure described above ⁠².

5. Written policies

   The rule requires written policies and procedures covering resident rights, wandering prevention for residents with memory impairment, medication management, infection control, a staffing plan, the use of volunteers and a quality assurance program ⁠¹. It does not say DHCQ collects them with the application, so ask whether the surveyors expect to see them before the initial inspection.

The statute says DHSS “shall grant an initial license” to a newly established facility that meets these requirements, for a term of no more than 365 days ⁠². If you do not yet meet every requirement, DHCQ can issue a provisional license once the annual fee is paid. You then pay the application fee again for the re-inspection that comes before a full annual license ⁠².

Neither Chapter 3225 nor 16 Del.C. Ch. 11 describes architectural plan review or a pre-application meeting for a new ALF, and the state business portal does not either ⁠⁵. Ask DHCQ whether it reviews plans or meets with applicants before construction or conversion, and ask the State Fire Prevention Commission or your municipality about its own approvals.

Fees in the Delaware Code

Delaware sets ALF license fees by statute as maximums, not fixed amounts. As published on 2026-10-12, 16 Del.C. §1106 provides ⁠²:

The fee is due with every initial and renewal application ⁠². DHSS may also charge extra fees to recover its costs when it has to monitor or inspect beyond the standard inspection after substantiated violations ⁠². The statute sets only maximums, and the state business portal sends applicants to §1106 for fees ⁠⁵. No DHCQ fee schedule for ALFs was published online on 2026-10-12, so ask DHCQ for the exact amount, including the background examination fee, before you file.

Certificate of Public Review: probably not, but check

Delaware’s certificate-of-need program is the Certificate of Public Review (CPR), run by the Health Resources Board. You need a CPR to build, develop or establish a “health-care facility,” for capital spending over $5.8 million (adjusted for inflation), and for bed increases or relocations of more than 10 beds or 10% of licensed capacity, whichever is less, over 2 years. The section text is marked “effective until July 1, 2028” ⁠⁶. The definition names nursing homes and “continual care communities and any other nontraditional, long-term care facilities identified by” DHSS or the Delaware Health Care Commission. It does not name assisted living facilities ⁠⁶. So an ALF built inside a CCRC falls within the CPR definition, while a freestanding ALF depends on whether DHSS or the Commission has identified it. The sources do not list any such identification, so ask the Health Resources Board in writing whether your project needs a CPR before you buy or build.

Building, fire and space standards

The physical plant rules are short but specific ⁠¹:

• Federal law. Compliance with Section 504 of the Rehabilitation Act, the Fair Housing Act and the ADA.
• Bedroom size. For all new construction and conversions with more than 10 beds: at least 100 square feet per resident in a private bedroom and 80 square feet per resident in a shared one. Alcoves, closets and bathrooms are not counted. No bedroom may hold more than 2 residents.
• Bathrooms. At least 1 working toilet, sink and tub or shower for every 4 residents. Hot water at bathing and handwashing fixtures may not exceed 120°F.
• Emergency call. An intercom or other mechanical call system in bedrooms and all resident bathrooms. Memory care units are exempt if staff can communicate emergencies immediately.
• Kitchens. Residents must have access to a microwave or stove/oven, a refrigerator and a sink, either in their unit or in a nearby common kitchen.
• Temperature. Common areas kept between 71°F and 81°F.
• Privacy. Each resident has the right to a door that locks, consistent with their safety needs ⁠¹.
• Valuables. Locked storage for residents’ valuables.

For fire safety, the rule defers to the rules of the State Fire Prevention Commission, or of the municipality that has jurisdiction. Fire drills must be held at least quarterly on each shift, with written attendance records ⁠¹.

Hiring: background checks, drug screens and training

Delaware runs long-term care hiring through its Background Check Center. You may not employ anyone in a licensed facility until you have their criminal history, which DHSS compiles from the FBI and the State Bureau of Identification (SBI) ⁠³. You may hire someone conditionally for up to 60 days, but only after confirming they have been fingerprinted by the SBI. Failing to get the criminal history exposes the employer to a civil penalty of $1,000 to $5,000 per violation ⁠³. A pre-employment drug screen is also required, covering marijuana/cannabis, cocaine, opiates, PCP and amphetamines ⁠³. Each new employee also needs a baseline two-step tuberculin skin test or a single IGRA blood test ⁠¹.

Training and staffing requirements under section 16 ⁠¹:

• Resident assistants. Must be at least 18 and complete a facility-specific orientation. Topics include fire and disaster plans, infection control, food safety, first aid and the Heimlich maneuver, residents’ rights under 16 Del.C. Ch. 11, abuse reporting, the Ombudsman program and hospice. They then need at least 12 hours of in-service education every year and documented training in activities of daily living.
• Medication help. Anyone who assists with self-administration of medication must complete a Board of Nursing-approved AWSAM course (assistance with self-administration of medication) under 24 Del.C. Ch. 19. The facility files an annual AWSAM report with the Board of Nursing.
• Overnight coverage. At least one awake staff member must be on site 24 hours a day who is AWSAM-qualified and knows emergency procedures, first aid, CPR and the Heimlich maneuver.
• Agency temps. Temporary staff who have not worked at your facility within 6 months must be oriented before their first shift.
• Dementia training. If you serve residents with Alzheimer’s disease or other dementia, the health care staff who must take continuing education need dementia-specific training every year.

Personnel records for permanent employees are kept at least 5 years ⁠¹.

Who you can admit and keep

Admission starts with Delaware’s Uniform Assessment Instrument (UAI). An RN completes it within the 30 days before admission, and a physician completes a medical evaluation in the same window ⁠¹. The UAI is updated 30 days after admission, every year, and after any significant change. A signed service agreement based on the UAI is due no later than the day of admission and is revised within 10 days after each new assessment ⁠¹.

Section 5.9 lists people an ALF may not admit or keep ⁠¹. The list includes anyone who:

• needs more than intermittent nursing care
• has been bedridden for more than 14 days
• has stage 3 or 4 skin ulcers
• needs a ventilator
• needs more than contact isolation
• has an unstable tracheostomy, or a stable one less than 6 months old
• has an unstable PEG tube
• needs an IV or central line, except for a fully covered implanted port managed under strict conditions

Hospice patients are exempt if the licensed hospice gives written assurance that all their needs will be met ⁠¹. For a current resident whose condition is expected to improve within 90 days, you can request a resident-specific waiver with physician documentation. DHCQ must decide within 5 business days, and a waiver lasts no more than 90 days ⁠¹.

Medication rules include:

• a quarterly pharmacist review
• a drug reference guide no more than 2 years old
• locked storage, which may not be in a bathroom or laundry room
• an on-site RN review of each self-administering resident within 30 days of admission ⁠¹

Contracts Delaware requires

The resident contract has detailed required contents ⁠¹:

• Timing. The contract is signed within 3 business days after admission. It may not be signed before the assessment is complete and the service agreement is executed. Any pre-move-in deposit is fully refundable if you and the resident cannot agree on a service agreement.
• Notice periods. The contract must give at least 30 days’ notice of discharge and at least 60 days’ notice of any rate increase, unless the increase follows a change in the resident’s medical condition.
• Disclosures. It must list basic and optional services, including the availability of licensed nurses, and give a full statement of charges before signing.
• Negotiated risk. When a resident’s choice creates risk, a managed or negotiated risk agreement becomes part of the service agreement. It cannot be used to waive resident rights or to serve needs beyond what the facility can provide.

Memory care disclosure

Delaware has no separate memory care license. An ALF that offers specialized care for memory impairment must disclose its policies to DHCQ and to anyone seeking that care ⁠¹. The disclosure covers 11 areas: philosophy, resident population, admission and discharge criteria, assessment and care planning, staffing and training, physical environment and security, activities, family role, psychosocial services, nutrition and hydration, and program costs. Significant changes must be reported when they are made ⁠¹. Separately, the state keeps a voluntary registry of accredited ALFs, which marks facilities with a memory care certification from the Joint Commission or another approved accreditor. Proof goes to DHSS at least once a year and at least 90 days before license renewal ⁠².

Inspections, renewal and incident reporting

DHSS must inspect each long-term care facility within 15 months of the last day of its previous inspection, and the statewide average interval must be 12 months or less ⁠². Inspections are unannounced. DHSS staff may interview residents, families and staff, copy records and inspect any part of the building. At the end of each inspection, the Long-Term Care Ombudsperson’s office is invited to the exit interview ⁠². You have 10 working days from a written notice of violations to submit a plan of correction. The rule spells out the four points the plan must address ⁠¹. DHCQ posts each facility’s survey reports on its ALF page ⁠⁴.

You must post in a public area ⁠²:

• your license
• the complaint hotline sign
• your most recent survey report
• a notice that compliance-history materials are available at the facility and online, with the Division’s phone number
• a notice that the Division of Professional Regulation can provide information about the facility administrator

Reportable incidents go to DHCQ within 8 hours. They include abuse, neglect, financial exploitation, certain elopements, significant injuries and utility outages lasting more than 8 hours ⁠¹. To close a facility, you must give state agencies and residents at least 90 days’ notice ⁠¹.

Renewal is annual, with the fee, the updated menu cycle, the emergency plan and the FEMA certificates ⁠¹⁠². A license cannot be transferred. It ends when the facility passes to a new owner or controlling person, and the new owner needs a new license ⁠¹⁠².

Getting paid through Medicaid

Delaware delivers Medicaid long-term services through Diamond State Health Plan Plus (DSHP Plus), a mandatory managed care program for older adults and people with physical disabilities. Assisted living care is a listed DSHP Plus benefit ⁠⁷. How a facility contracts with the DSHP Plus managed care organizations is not described on the DMMA page.

What changed in 2026 and what starts in 2027

• Ownership disclosure (in effect). SS 1 for SB 196, signed July 23, 2026, added the owner disclosure and website posting duties in 16 Del.C. §1108 ⁠⁸⁠². It also added §1108A for changes of ownership. A proposed buyer must disclose the long-term care facilities it or its affiliates owned, operated or managed in the previous year, and any disciplinary actions for material risk to residents. The current owner must tell residents within 30 days after DHCQ approves the ownership paperwork. The new owner sends a second notice within 30 days after the new license is issued. Sales with binding agreements, and applications filed, before July 23, 2026 are exempt ⁠².
• Liability insurance (from February 27, 2027). New §1120 requires every “covered long-term care facility,” a term that includes ALFs, to carry at least $1 million per claim and $3 million aggregate in general liability, and the same in professional liability. Both policies must include abuse and molestation coverage ⁠². You must give DHCQ proof of coverage to hold a license and with each renewal. Insurers must notify DHCQ within 14 days of a lapse, and failing to maintain the limits results in license revocation ⁠². If you plan to open in 2027, include these premiums in your budget from the start.

For the other care licenses in the state, see the Delaware state page. For how assisted living is licensed elsewhere, see assisted living licenses.

Sources

1. 1
   Delaware Register of Regulations, 16 DE Admin. Code 3225, Assisted Living Facilities Checked 12 Oct 2026 · Back to text ↑
2. 2
   Delaware General Assembly, 16 Del.C. Chapter 11, Subchapter I (Licensing by the State) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Delaware General Assembly, 16 Del.C. Chapter 11, Subchapter IV (Criminal Background Checks; Mandatory Drug Screening) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Delaware Health and Social Services, Division of Health Care Quality, Licensed Assisted Living Facilities Checked 12 Oct 2026 · Back to text ↑
5. 5
   State of Delaware, Long Term Care Facilities (Business First Steps) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Delaware General Assembly, 16 Del.C. Chapter 93 (Delaware Health Resources Board, Certificate of Public Review) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Delaware Health and Social Services, Division of Medicaid and Medical Assistance, Diamond State Health Plan Plus Checked 12 Oct 2026 · Back to text ↑
8. 8
   Delaware General Assembly, SS 1 for Senate Bill 196 (long-term care facility ownership disclosure) Checked 12 Oct 2026 · Back to text ↑

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