DSU student Dejanae Carter-Montaque selected as Legislative Fellow

Staff Writer February 19, 2025Education, RSS-Education

DSU Legislative Fellow

Staff Writer

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Obamacare enrollment surges in Delaware, but rising health-care costs push premiums to new highs
Obamacare/Marketplace participation hits record levels — but skyrocketing medical costs, expiring subsidies, and insurer rate hikes threaten affordability; experts say it’s time to consider HSAs and price transparency WILMINGTON — Delaware is experiencing its highest Affordable Care Act enrollment since the program launched, but the celebration comes with a warning: the state’s health-care costs are rising so sharply that many residents may soon see their premiums double. More than 53,000 Delawareans are enrolled in the ACA marketplace for 2025 — up from about 23,000 in 2019 — representing a dramatic expansion of coverage and a significant shift in how individuals and families access insurance. Yet behind these record numbers lies a growing affordability crisis driven not by state policy, but by medical inflation, increased utilization of care and structural costs embedded in the health-care system. For many middle-income Delawareans, the math is simple and sobering: premiums that averaged around $700 a month last year could soon exceed $1,400 when enhanced federal subsidies expire in late 2025. And even with subsidies, Delaware’s underlying premium increases — among the steepest in the country — raise serious questions about whether the system is sustainable. Enrollment rises, but so do premiums Delaware’s ACA enrollment trajectory reflects impressive demand: 2019: 23,000 enrollees 2023: 40,000+ 2024: 45,000 (including 8,000 paying $10 or less thanks to subsidies) 2025: 53,000 But the same period also brought some of the largest premium hikes Delaware has ever seen. Insurers received approval for increases far above the national average: Highmark Blue Cross Blue Shield: +25% AmeriHealth Caritas: requested 46%, approved for +34.98% With inflation cooling in most sectors of the economy, many Delawareans are asking: why are health-care costs going in the opposite direction? And why is Delaware being hit harder than other states? Why Delaware’s health-care costs are climbing so fast Rate filings submitted to state regulators offer a candid picture of what insurers say is driving these increases. The pressures fall into several major categories: 1. Medical costs are rising faster than inflation Hospitals and physicians continue to raise prices, especially in high-cost specialties such as oncology, cardiology, emergency care and surgery. Specialty and biologic drugs — which now account for a significant share of total pharmacy spending — are increasing at double-digit rates. 2. More people are using more care Since the pandemic, Delawareans have returned to the health-care system in force. Elective procedures are up, chronic conditions are being treated more intensively and demand for mental-health services has surged. New diagnostic tools and technologies also improve care but come with higher price tags. 3. Labor shortages are driving up hospital expenses Hospitals across Delaware face workforce shortages, particularly among nurses, technicians and support staff. To maintain staffing, providers are resorting to overtime, bonuses and travel-nurse contracts — all of which significantly increase operating costs. Those costs are ultimately passed on in the form of higher premiums. 4. Delayed care is becoming more expensive care Thousands of Delaware residents postponed screenings and treatment during 2020–2021. They are now returning with more advanced conditions, raising average claims costs per patient. 5. Reinsurance and federal formulas are adding cost pressure Insurers must purchase reinsurance to protect against catastrophic claims — and those protections are becoming more expensive. Federal risk-adjustment formulas also shift money among insurers depending on the health status of their enrollees, adding unpredictability. 6. Medicaid “unwinding” is reshaping the risk pool As temporary pandemic rules end, many Delawareans are losing automatic Medicaid eligibility and moving back into private plans. This often brings sicker, higher-cost individuals into the marketplace. 7. The healthier you are, the more likely you are to leave As premiums rise, younger and healthier people disproportionately drop coverage. That leaves insurers with a smaller, sicker, and more expensive population, which forces rates up again — a cycle actuaries call a “death spiral.” Casscells: Delaware’s cost crisis reflects a deeper structural problem Retired orthopedic surgeon Dr. Chris Casscells, a policy adviser with A Better Delaware, argues these skyrocketing costs are symptoms of a system that gives patients almost no visibility into prices — and no incentive to shop. “The Affordable Care Act separated the patient from the actual cost of care,” Casscells says. “Nobody knows what anything costs. Hospitals inflate list prices because reimbursement formulas reward it. Insurers react by raising premiums. And patients are stuck in the middle with no ability to compare or negotiate.” Casscells believes Delaware’s cost crisis cannot be solved by subsidies alone because subsidies disguise, rather than reduce, the real price of medical care. “Delaware is drowning in complexity. We need reforms that give patients more control, not more layers of bureaucracy,” he said. Who really pays for Obamacare in Delaware? Although enrollment is administered at the state level, the federal government pays: 100% of ACA premium subsidies 90% of Medicaid expansion costs Delaware pays the remaining 10% of expansion and its regulatory overhead. This means Delawareans are not facing higher premiums because the state is charging more — but because the cost of care itself is rising far faster than insurers can absorb. A looming affordability cliff in 2026 The biggest threat on the horizon is the scheduled expiration of enhanced federal subsidies at the end of 2025. These subsidies temporarily discounted premiums for thousands of families. If Congress does not extend them, the impact could be dramatic: A family paying $600–$800/month today could face $1,400+/month in 2026 Thousands may drop coverage Delaware’s uninsured rate could rise for the first time in a decade The marketplace could destabilize as healthier enrollees exit For middle-income families — those earning too much for Medicaid but unable to afford unsubsidized coverage — the risk is significant. Is it time to rethink the model? HSAs and true price transparency While some lawmakers argue for new rounds of subsidies, Casscells and other center-right policy advocates say Delaware should strengthen consumer-driven health-care tools instead of expanding dependence on federal aid. Two strategies top the list: 1. Health Savings Accounts (HSAs) HSAs allow individuals to: Save tax-free […]
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Navigating Senior Care: What Adult Caregivers need to know before choosing senior living or in-home care
The Role of the Adult Caregiver and the Challenging Decisions about what is “best” WILMINGTON, Del. — An adult caregivers and caregiver, in the broadest sense, is anyone who invests time, money and energy to assist an older adult who needs help. In many families, it takes a village—relatives and friends, neighbors, nurses and aides, the person who handles the bills, the one who fixes the leaky sink, the cook who keeps meals coming. All of them are caregivers in their own unique ways. But the primary caregiver is different. The buck stops with that person. They make the hard decisions, explain changes to the family, and too often become the lightning rod for suspicion, grief and frustration when reality doesn’t match expectations. It is one of the most demanding roles a person can hold. A growing share of us are caregivers. Experts at Easterseals Delaware estimate that 30% or more of adults ages 45 and up are serving as caregivers, a share that is rising as people live longer with complex needs. For many, this season arrives suddenly and without a playbook, piling stress onto already full lives of work, children, and finances. The result is a simple, anxious question that starts the process: What do we do now? “Where do I start?”“When families call us, the first thing they say is, ‘Where do I start?’” said Lynn Paxson, a leading consultant to caregivers in Delaware and president of Oasis Care Advisors. “Overwhelm, guilt, and fear are common. The good news is that once options are clear, most people feel relief and empowerment.” A journey, not a single decisionThe path to care rarely begins with a moving truck or a signed home-care agreement. It starts with unease as small lapses turn into patterns. A doctor’s visit brings new instructions; a hospital discharge adds urgency. By then, the conversation has shifted from if help is needed to what kind of help will keep a loved one safest and most supported. Five stages families face Early concerns: Subtle signs—missed medications, skipped meals, isolation—raise the question: Is Mom safe at home? Health decline: Falls, ER visits or memory lapses push the discussion forward as safety becomes the priority. Care and housing decisions: Families compare staying at home with a caregiver versus moving to a senior living community, weighing the cost, care level, and lifestyle. Legal and financial planning: Power of attorney, advance directives, and budgets move to the front burner; families may explore VA Aid & Attendance or long-term care insurance. Transition and adjustment: Whether moving or starting home care, emotions run high; ongoing support helps the new routine stick. The turning point: choosing a care settingSenior living communities offer structure: staff on site around the clock, medication management, a built-in social life, and a predictable monthly bill that bundles housing with care. For older adults who are lonely, missing meals or struggling with routines, the daily rhythm—and the presence of peers—can be stabilizing. Why do many stay home?In-home care preserves the familiarity of the house and neighborhood. Care is scheduled by the hour or day and tailored to what the person needs, whether that’s help with bathing, transportation or specialized dementia support. The tradeoff is coverage: safety at home depends on how many hours a caregiver is present and how well those hours match the risks. What it costs—and what fits?Communities invoice monthly and adjust fees as care needs rise. Home care can begin modestly—just a few hours a week—but expenses climb quickly if nights, weekends or specialized skills are required. “Families often discover there is no single ‘cheap’ option,” Paxson said. “There’s the option that best matches risk, personality, and budget.” Paperwork with a purposeEven as families compare models, a second track of tasks arrives with its own clock. Power of attorney, advance directives and a workable budget are no longer paperwork for “someday”; they become essential tools to avoid crises. Some households qualify for help through long-term care insurance or VA benefits; others stitch together resources with savings and family support. Social workers and case managers can coordinate therapies, equipment and home-health orders that complement either path. The first weeks are emotionalOnce a decision is made, a new set of emotions takes center stage. Moves are rarely purely logistical; they are identity-shifting. Families who choose home care worry about finding the right fit; those who choose a community worry about how their loved one will adjust to a new routine. “That’s where coaching matters,” Paxson said. “We walk with families through the first weeks—touring, matching caregivers and checking in after move-in—so small problems don’t become big ones.” Vetting in-home care agenciesFor households opting to remain at home, ask whether the agency has caregivers available now in the right ZIP code and with the needed skills—mobility support, memory-care experience or chronic-disease know-how. Screening, training and a reliable backup plan for call-outs are nonnegotiable, as are transparent pricing and proper licensing. Touring communities the right wayVisit at mealtimes, observe an activity, and talk with residents and families, not just the marketing team. Note staffing visibility, response times and how teams interact with residents who need extra prompts or redirection. Avoid the pitfallsA few warning signs can help primary caregivers steer clear of costly detours and unsafe arrangements. Unverified call centers and vague online ads — They often sell your contact information instead of solving problems. “Too good to be true” offers — Beware of hidden fees, unlicensed operators or services that won’t meet your loved one’s needs. Pressure tactics without a full care assessment — Anyone rushing you to decide, especially without transparency, is a red flag.“Your loved one’s safety and dignity should always come first,” Paxson said. “Work with credentialed advisors, ask blunt questions and see the care up close—whether that’s in the living room or the dining room.” How to get started todayWrite down the specific worries—falls, medication mix-ups, loneliness—along with current diagnoses, medications and doctors. Identify a decision-maker who can speak for the family. Then schedule a […]
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Caregivers gather in New Castle for Alzheimers’ workshop focused on support, resources as part of Family Caregivers’ Month
Alzheimers’ Association workshop at Canaan Baptist Church brings families together for support, respite resources, and guidance during Family Caregivers’ Month. NEW CASTLE, Del. (Nov. 13, 2025) — More than 20 dementia caregivers spent Thursday morning learning strategies, sharing personal stories, and connecting with experts during a Family Caregivers Month workshop hosted by the Alzheimer’s Association Delaware Valley Chapter at Canaan Baptist Church. The half-day program, held from 10 a.m. to 12:30 p.m., brought together local clinicians, advocates, and caregivers for conversations about burnout, family dynamics, memory-care planning, and the growing network of support services across Delaware. “Caring for someone living with dementia brings a unique set of challenges and rewards,” said Erica Holmes, programs manager for the Alzheimer’s Association Delaware Valley Chapter. “No one should face dementia alone. Caregivers must have access to tools and best practices that can guide them on their journey.” A caregiver’s story sets the tone The workshop opened with a deeply personal reflection from Sonja Brown, a longtime caregiver who now mentors others navigating the emotional and practical demands of dementia. “My husband was diagnosed three years ago and I’m still learning every day,” Brown told attendees. “Who would have thought that my husband — a veteran, a deacon at our church, and a community leader — would struggle with Alzheimer’s? He was the strongest man I know.” Brown and her husband recently celebrated their 54th wedding anniversary. She said caregiving has become an act of partnership and perseverance. “I just want to help others find their way as caregivers,” she said. “If we can understand dementia in a way that helps our families, we can face this together.” Experts highlight respite care, dementia education, and support programs The workshop continued with presentations from medical professionals and community organizations: Jonathan Swartz of Easterseals offered guidance on respite care and accessibility programs that give caregivers short-term relief. Dr. Damali Thomas, who moderated a panel discussion, led a conversation about real-life caregiving challenges, communication struggles, and the emotional impact of the journey. Adrienne Holloway, Ph.D., of the ChristianaCare Swank Center for Memory Care presented information about the ChristianaCare GUIDE Program, which delivers coordinated dementia care — including caregiver training, respite services, personalized care plans, and 24/7 support — at no additional cost to Medicare patients. The GUIDE model, she said, is designed “to improve quality of life for families and help loved ones stay safely at home for as long as possible.” Building community during Family Caregivers Month Thursday’s program was one of several Delaware events held to recognize November as National Family Caregivers Month, an annual observance honoring the unpaid caregivers who support millions of Americans living with chronic or cognitive conditions. Attendees spent the morning comparing experiences, asking questions of experts, and gathering printed materials from resource tables. Organizers said the goal was simple: ensure caregivers feel seen, supported, and connected. “Caregiving is a journey,” Holmes said. “This workshop is about making sure nobody walks it alone.” Refreshments and one-on-one conversations rounded out the afternoon as the program concluded.
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Smart Tech for Caregivers: Delaware Leaders Blend Innovation and Compassion to Help Seniors Stay Independent
Smart Tech for Caregivers should empower seniors, provide peace of mind, help people stay safe and protect their privacy… and never overwhelm them. By George D. Rotsch, Editor and Publisher of Delaware LIVE WILMINGTON, Del. — Across Delaware, a new generation of caregiving leaders is using Smart Tech for Caregivers that combines compassion with innovation to help older adults live safely and comfortably at home. At Easterseals in New Castle, Nancy Ranalli gives caregivers hands-on access to assistive technology that promotes independence. At Griswold Home Care, Patrick Gray integrates AI-based systems that support safety and peace of mind. And through the Alzheimer’s Association, Kristina Fransel connects families with a powerful new mobile app that puts expert guidance right at their fingertips. Together, they represent a growing movement that blends human care and smart technology — giving families the tools to keep loved ones safe, connected, and independent, while supporting caregivers who shoulder the daily responsibility of care. “This is where independence and dignity meet technology,” said Ranalli, Director of Community Outreach & Assistive Technology for Easterseals Delaware & Maryland’s Eastern Shore. “These devices can help Mom or Dad be safer and more independent at home — and give the caregiver peace of mind.” A Hands-On Hub for Independence At Easterseals’ Caregivers Resource & Technology Center on Corporate Circle in New Castle, Ranalli leads tours that showcase more than 200 devices — everything from low-tech tools to AI-enabled systems that redefine caregiving. Visitors can see:• an inflatable bathtub for bed-bound care;• easy-grip toothbrush holders and plates designed for one-handed use;• mats that alert caregivers when someone gets out of bed;• sensors connected to refrigerators, microwaves, or doors that confirm when meals or medication have been taken;• a walker that converts to a wheelchair;• large-button phones and voice-activated smart speakers;• a robotic pet that mimics human interaction;• clothing with magnetic fasteners instead of buttons; and• gardening tools adapted for older hands. “These devices can enable the caregiver to help Mom or Dad be more independent, have dignity, and be safer at home — while giving the caregiver some peace of mind,” Ranalli said. She and her team also help families compare features, explain funding options, and learn how to integrate each tool into daily routines. Ranalli has expanded the program statewide, including a growing assistive-tech resource site at the Milford Wellness Village. “The right device can change a person’s daily life,” she added. “Something as simple as a smart light or automatic stove shut-off can prevent an accident. These aren’t luxuries — they’re lifelines.” AI Technology Extends the Reach of Care Across New Castle, Patrick Gray, owner and director of Griswold Home Care for New Castle County, is taking those same principles into clients’ homes — blending professional caregiving with AI and smart technology that reduce stress for families and staff alike. Gray, a Certified Dementia Practitioner with more than 15 years in senior-care leadership, is integrating technologies that complement human caregivers rather than replace them. “We use AI to help people stay connected and to help caregivers manage smarter,” Gray said. “The goal is always more personal time and less paperwork.” Among the innovations his agency employs or recommends: Remote care platforms that let families check schedules, communicate with aides, and receive real-time updates. AI companions, such as interactive voice assistants that engage clients with dementia, track mood, and notify caregivers of changes. Smart-home devices — fall detectors, medication dispensers, and emergency alert systems — coordinated through Griswold’s care dashboard. Predictive scheduling tools that use AI to match caregivers with clients, preventing burnout. TV-based virtual-visit systems that make telehealth simple for older adults. Newer AI-enabled systems can even “listen” for signs of trouble without using cameras — protecting privacy while improving safety. These devices can distinguish the sound of a television from a cry for help, or the clatter of a dropped dish from the crash of a broken window. They can tell the difference between a basket of laundry hitting the floor and a fall in the bathroom — and instantly alert a caregiver or neighbor. “Technology is evolving quickly, but the human need isn’t changing,” Gray said. “Seniors need technology to enable and protect them — not to rob them of privacy and dignity. At the same time, caregivers don’t need technology to replace human care; they need it to provide peace of mind — a little assurance that if they can’t be there, Mom is still going to be okay.” “These tools strengthen the human side of care,” he added. “They help us notice changes sooner and give families reassurance that Mom or Dad is doing well.” An App for Knowledge and Support While Ranalli and Gray focus on hands-on and in-home technology, Kristina Fransel, Executive Director of the Alzheimer’s Association Delaware Valley Chapter, highlights the importance of information access — and how the organization’s new My ALZ Journey app empowers caregivers in a different way. “This app is all about putting trusted guidance and resources directly into the hands of caregivers — anytime, anywhere,” Fransel said. The My ALZ Journey app offers: Personalized Support: Tailored content based on whether you’re a caregiver or someone living with dementia, your age, and your location. Step-by-Step Guidance: Tools to navigate early-stage planning, daily independence, and care routines. Local Resources: Connections to nearby Alzheimer’s Association chapters, support groups, and programs. Interactive Tools: Checklists, planning templates, and activities to stay engaged and organized. Privacy-First Design: No account required, no tracking — just easy access to help when it’s needed most. “Access to information about all kinds of challenges that caregivers face, right at your fingertips, can make the difference between protecting someone or improving the quality of life for a loved one,” Fransel said. The app complements the hands-on tech demonstrated at Easterseals and the in-home AI tools that Patrick Gray’s team uses — forming a trio of support for Delaware families navigating dementia and elder care. Partners in the Future of Aging Together, leaders like Ranalli, Gray, and Fransel […]
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Delaware Uniform Health-Care Decisions Act (UHCDA), Reshaping Decision-Making in Delaware
The Delaware Uniform Health-Care Decisions Act (DUHCDA) makes significant changes! WILMINGTON — The Delaware Uniform Health-Care Decisions Act (UHCDA) is a sweeping overhaul of Delaware’s medical decision-making law took effect Tuesday, September 30th, changing how families, health-care providers and patients handle treatment choices when someone lacks capacity to make their own decisions. At the heart of the law is the advance directive — a legal document that allows people to outline their wishes for medical care and designate someone to make health decisions if they cannot. An advance directive typically includes a living will describing what treatments a patient does or does not want, and a health-care power of attorney naming a trusted “Health Care Agent” to carry out those instructions. “An advance directive is your voice when you can’t speak for yourself,” said Catherine B. Read, Esquire, a Certified Elder Law Attorney with Estate & Elder Law Services in Greenville, Delaware and member of the Special Needs Alliance®. “It helps families avoid conflict in a crisis and gives doctors clear guidance about what you want. Without one, decisions can be left to people who may not know your wishes or to a system that defaults to who the law provides. The new law is intended to enable more people to prepare an advance directive, and to express priorities and wishes for quality of life that guide decision-making when unforeseen medical circumstances arise or expressed instructions don’t fit the situation.” The Delaware Uniform Health-Care Decisions Act (DUHCDA), effective Sept. 30, replaces the state’s previous Health-Care Decisions Act and makes the most significant changes to health-care directives and surrogate authority in decades. Lawmakers and advocates say the new rules are designed to give health-care providers more meaningful guidance, patients more autonomy, and families more clarity, and importantly, consider that family structures are much different today. However, legal experts caution that uncertainty remains over how the very new law will be applied. Major Changes in the Law Understanding the Implications of the UHCDA Capacity Presumed, With Exceptions An individual is presumed to have the capacity to make health-care decisions unless a court rules otherwise or they are found to lack capacity by a physician, psychologist, physician assistant, nurse practitioner, or licensed social worker. This expands the number of people who can make this determination, as under past law a physician was required to determine incapacity. The new law also allows these determinations to be challenged in the Court of Chancery under newly established rules. Optional Advance Directive Form Delaware adopted a new optional form that allows a person to specify priorities and wishes for care in addition to treatment instructions. An important change in the new law is that certain powers must be expressly stated in the advance directive. These powers include the ability of the agent to arrange for admission to a nursing home or for mental health treatment, have access to medical records, and have flexibility in making health-care decisions. Without this language, health-care agents may struggle to carry out a patient’s wishes for admission to a nursing home, mental health treatment, or specific medical procedures. The optional advanced directive form is required to protect the patient from abuse by ensuring that important decisions such as nursing home placement or psychiatric care are clearly defined in writing. Streamlined Execution The law eliminates the state Ombudsman’s office as a required witness for directives executed in nursing homes, a step intended to reduce formalities and make planning easier. Expanded List of Health-Care Agents The surrogate list has been broadened beyond those named in a power of attorney or a spouse to include adult children, parents, cohabitants, siblings and adult grandchildren. Supporters argue that this change better reflects modern families, which often do not conform to traditional forms. Advance Mental Health-Care Directives For the first time, Delawareans are expressly authorized to create directives specifically addressing mental health treatment. These allow individuals to authorize or exclude experimental treatments and even specify that a care plan created while healthy cannot later be revoked during a period of crisis. First-in-the-Nation Law The DUHCDA is the first State in the nation to adopt the Uniform Health-Care Decisions Act of 2023, meaning there is no precedent to guide attorneys, health-care workers or courts. The Delaware Court of Chancery only finalized its rules on the new law weeks ago, leaving uncertainty about how disputes will be handled in practice. “This law is intended to encourage people to plan ahead and make it easier for them to do so,” said William W. Erhart, Esquire, another Certified Elder Law Attorney at Estate & Elder Law Services. “But the law is new, and lawyers, health-care professionals, social workers, and those who serve vulnerable individuals in long-term care settings are still learning the details.” Read advises seniors and families to take three immediate steps: The first priority is to select a loving, trusted person as your health-care agent, clearly communicate your intentions, and maintain relationship with that agent so the agent will know how to advocate for you when you need it. Ask your estate planning attorney whether your current advance health-care planning documents comply with the new law. Make any adjustments needed to ensure your plan matches your wishes under the new law. Concerns and Issues Raised While the law passed without significant opposition, questions remain. Authority and Oversight: Some medical professionals worry that capacity determinations by non-medical professionals, such as social workers, could create inconsistent outcomes. Expanded Surrogate List: Elder Law attorneys note that including domestic partners, cohabitants and extended family may lead to disputes in high-stakes cases, potentially delaying urgent medical decisions. Advance Directive Safeguards: Simplified witnessing requirements could make directives easier to complete, but may also increase the risk of confusion or misuse. Mental Health Directives: Hospitals and psychiatric providers are awaiting detailed guidance on how to implement the new Advance Mental Health-Care Directive requirements, raising concerns about uneven adoption across facilities. Patient Protections: Disability rights advocates warn that the law’s definition of decision-making capacity could be misapplied, […]
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Delaware Faces an Alzheimer’s Surge—and a Growing Web of Challenges
The Economic, Workforce, Healthcare, Finance, and Public Safety Impact of Alzheimer’s and the immeasurable impact on the caregiver! WILMINGTON, Del. — Delaware’s fight against Alzheimer’s disease is entering a critical phase. New data show not only a rising number of residents living with Alzheimer’s, but a cascade of economic, workforce, and health system impacts that are already straining families, employers, and state budgets. “This is not just a health issue—it’s a statewide infrastructure issue,” said Linda Barba, Senior Manager, Marketing and Communications for the Alzheimer’s Association Delaware Valley Chapter, in an interview with Delaware LIVE. “As more Delawareans are diagnosed, every part of the care network—from hospitals to employers to family caregivers—feels the pressure.” A Rapid Rise in Cases According to the Alzheimer’s Association’s 2025 Facts and Figures report, approximately 23,000 Delaware residents over age 65 are living with Alzheimer’s, up from 22,300 in 2023. From 2000 to 2022, Alzheimer’s-related deaths in Delaware increased by nearly 300 percent, reflecting both a larger senior population and improved detection. “Age is the greatest known risk factor, and Delaware’s senior population is growing faster than the national average,” Barba said. “That combination means we are seeing more diagnoses, more hospitalizations, and more families needing support.” Economic and Workforce Strain The ripple effects extend well beyond the bedside. Medicaid Pressure: Alzheimer’s drives higher long-term care use and repeat hospitalizations, increasing costs for Delaware’s Medicaid program, which already allocates a large share to aged and disabled services. Direct Care Shortages: Memory care units, home health agencies, and adult day programs face chronic staffing gaps—particularly in Sussex and Kent counties—delaying hospital discharges and lengthening waitlists. Employer Impact: As spouses and adult children cut work hours or leave jobs to provide care, Delaware’s midsize employers—especially in health care, education, and state government—see higher absenteeism and turnover. Hidden Costs: Families frequently spend down savings on respite care, transportation, and home modifications to qualify for Medicaid coverage. “This is a disease that doesn’t just affect people living with the disease,” Barba said. “It affects the entire economic ecosystem of the state.” Pressure on Health and Long-Term Care Systems Hospitals, primary care practices, and long-term care facilities are struggling to keep pace. Hospital Throughput: ChristianaCare, Bayhealth, and Beebe report longer inpatient stays for people living with dementia due to delirium risks and complex discharge planning. Primary Care Load: Family doctors are conducting more cognitive screenings and coordinating care without enough dementia-trained navigators, stretching appointment capacity in New Castle and fast-growing Sussex. Memory Care Access: Demand for secured memory care beds and adult day slots outpaces supply, particularly in rural areas, where long drives and few programs intensify caregiver burnout. Determining the right care options and resources for a loved one is often one of the most emotionally taxing experiences families face. Lynn Paxson, president of Oasis Senior Advisors Delaware and Eastern Shore, noted that the shortage of a wide-ranging assortment of assisted living and memory care options makes the search increasingly difficult. “Families frequently reach out in crisis, only to discover that the type of options they want are not available,” Paxson explained. “Even before they call us, many caregivers are already stretched to the breaking point. And when there is availability, long waitlists for specific needs and preferences can be long and costs daunting.” Behavioral Health Overlap: Shortages in geriatric psychiatry and mobile crisis teams lead to more 911 calls and emergency department boarding when behavioral issues escalate. Caregiver and Community Impact For Delaware families, the burden is deeply personal. “Alzheimer’s care can last eight to eleven years on average,” Barba said. “That’s years of round-the-clock responsibility that takes a toll on physical health, finances, and mental well-being. “The impact on the caregiver is often overlooked; the caregiver can be easily overwhelmed with a new responsibility,” according to Nancy Ranalli, the Director of Community Outreach and Assisted Technology for Easterseals of Delaware. The caregiver faces new choices and can get isolated from friends and other family members. And because a person living with Alzheimer’s can be relatively healthy in other ways, they can live for a long time. With a growing number of seniors and seniors living with Alzheimer’s, this can have an immeasurable impact on thousands of people in our state.” Early-stage support can be just as overwhelming. Lori Smith, director of We Care at Milford Wellness Village, said families often struggle simply to figure out where to begin. “When a parent first starts showing signs of memory loss, it can feel like there’s no clear map,” Smith said. “Families are suddenly faced with a maze of programs, medical providers, and financial considerations. Our role is to help them sort through those options—whether it’s adult day programs, home care, or medical evaluations—so they can make informed choices before the situation becomes a crisis.” Finding affordable in-home care presents another major hurdle. Patrick Gray, director of Griswold Care, said many Delaware families want to keep loved ones at home but face rising costs and limited staffing. “The demand for in-home care is exploding, but affordability remains a serious barrier,” Gray said. “Families can be forced to patch together part-time aides or reduce hours because of cost. The hopeful side is that new technology—like remote monitoring, medication reminders, and fall detection—can help stretch care budgets and give families peace of mind when they can’t be there in person.” Caregivers in Delaware report higher rates of depression and chronic stress, and many struggle to navigate a patchwork of services such as state aging programs, veterans’ benefits, legal planning, and respite care. Black and Latino families in Wilmington, Dover, and Georgetown face later diagnoses and fewer culturally matched services, which can worsen disease severity by the time treatment begins. Public Safety and Social Services The disease’s reach extends into public safety and the courts: Wandering and Silver Alerts are increasing, requiring coordinated responses from state police and local EMS. Adult Protective Services sees more cases of self-neglect and caregiver burnout leading to emergency placements. Courts and Guardianship are handling more contested […]
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DSU student Dejanae Carter-Montaque selected as Legislative Fellow

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