Delaware Adult Day Services: DHCQ License, 1:8 Ratio, DSHP Plus

Adult Day Care in Delaware

In short: One adult day care license from DHCQ covers all centers serving 4 or more adults; 2 staff minimum, then 1:8 above 16 participants.

Delaware adult day services at a glance

License or certification	Yes. A DHCQ adult day care facility license for programs serving 4 or more functionally impaired adults, any payer.
Who licenses or certifies	Delaware Department of Health and Social Services (DHSS), Division of Health Care Quality (DHCQ)
Adult day care vs adult day health	One license type. Delaware has no separate adult day health care license; nursing services are optional.
Strictest staffing ratio	At least 2 staff at all times, then 1 staff per 8 participants above 16 (DHCQ licensing)
Dementia ratio	No dementia-specific ratio. 1:4 for programs serving mainly participants with severe cognitive or physical disabilities.
Medicaid programs	Diamond State Health Plan Plus (DSHP Plus) LTSS, through managed care plans
Medicaid billing unit	Not published by the state. One DSHP Plus plan lists S5100 (15 minutes) and S5101 (half day).
Licensed centers	10 (DHCQ list, checked October 21, 2026)

Last verified against state sources: 2026-10-21.

How is adult day care regulated in Delaware?

Delaware has one license for adult day care, the adult day care facility license, issued by the DHSS Division of Health Care Quality (DHCQ). There is no separate adult day health care license. Nursing services are optional, but a center that serves participants who need nursing care must keep a nurse on site. Delaware Medicaid pays for adult day services through its managed long-term care program, DSHP Plus.

Three layers of rules can apply to a Delaware center, and each comes from a different agency:

Licensing (DHCQ). The Regulations for Adult Day Care Facilities, 16 Del. Admin. Code 3360 (formerly numbered 4402), adopted under 16 Del.C. 122(3)(s). These rules cover the license, staffing, space, services, participant records and policies for every center, whatever the payer.
Medicaid (DMMA). The DHSS Division of Medicaid and Medical Assistance runs Diamond State Health Plan Plus (DSHP Plus), a mandatory managed care program for residents who are elderly or physically disabled. Adult day services are one of its long-term services and supports (LTSS) benefits, delivered through contracted managed care plans under the Diamond State Health Plan section 1115 demonstration.
Other funding (DSAAPD). The DHSS Division of Services for Aging and Adults with Physical Disabilities contracts with adult day providers using Older Americans Act, Social Services Block Grant and state funds, under its own service specifications.

The licensing rules apply to any program that gives health, social and related support services to four or more functionally impaired adults who live in the community, for less than 12 hours a day, outside the participant's or operator's home (3360, section 1.0). Programs mainly for people with developmental disabilities or mental illness are outside this rule. We did not find a separate dementia license or certification.

Where the layers overlap, DHCQ licensing sets the operating standards. Medicaid adds eligibility and plan authorization, and one plan's policy adds an enhanced rate level for participants with weekly behavioral needs, but no separate center model.

Do you need a license to open an adult day center in Delaware?

Yes, if your program will serve four or more functionally impaired adults. No one may establish, run or maintain an adult day care facility in Delaware without a license from DHSS, whether participants pay privately or through Medicaid (3360, section 3.1). A new center starts with a provisional license and then moves to a 12-month license.

What to submit. Under 3360, sections 3.4, 5.1 and 5.2, the application includes:

Ownership details, including officers, partners and anyone owning 5 percent or more.
Disclosure of anyone involved who has a felony record.
The name of the director responsible for the center.
The center's policy and procedure manuals.

Site and building. DHSS must approve the site in advance, construction plans need written approval before work starts, and DHSS inspects before the space is occupied. Every license and renewal application must include a letter from the fire marshal with jurisdiction certifying that the center meets State Fire Prevention Commission rules. The center must also meet local and state building codes, and its water and sewage systems need approval.

Fees. State law sets a $100 application fee for a new license and a $50 annual renewal fee (16 Del.C. 122(3)(s)(2)).

Provisional license. A new center, or a center after a change of ownership, gets a provisional license for less than a year while DHCQ completes an on-site survey within the first 90 days. A full license then lasts 12 months.

Certificate of need. We did not find a certificate of need requirement or a moratorium for adult day care in Delaware. Confirm with DHCQ before you sign a lease.

One license per site. Each separate location needs its own license. Separate buildings on the same grounds under the same management do not. The license must be posted where it can be seen.

Buying a center. A license cannot be transferred to another person or location, and a center under new ownership receives a provisional license pending a new survey. We did not find a required advance notice period for a change of ownership, so contact DHCQ early in any purchase. A center must also tell DHSS in writing within 15 days when its director or administrator changes.

Renewal and inspections. Renewal applications are due at least 30 days before the license expires. DHCQ inspects licensed centers periodically, with regular inspections at least once every three years.

Application forms. We did not find a current DHCQ application form online, and the published renewal form link no longer works. Ask DHCQ for the current forms.

What are the staffing rules for adult day centers in Delaware?

Delaware licensing rules require at least two staff on duty whenever participants are present. Above 16 participants, a center needs at least one adult staff member for every eight participants, with no rounding down. Programs serving mainly participants with severe cognitive or physical disabilities must staff at 1:4.

The ratios are in 16 Del. Admin. Code 3360, section 12:

Licensing (DHCQ): 2 staff minimum at all times. Above 16 participants, 1:8 overall, so 17 to 24 participants need 3 staff and 25 to 32 need 4. The ratio must go up as the number or care needs of impaired participants rise. Each separate section of a facility must meet the staffing rules on its own.
Higher needs (DHCQ): 1:4 for all severely disabled participants in programs serving mainly participants with severe cognitive or physical disabilities. This is not a general dementia ratio.
Medicaid (DSHP Plus): no ratio specified in the DMMA pages or plan policy we reviewed.
Other funding (DSAAPD): we could not read the DSAAPD adult day service specifications, because the published document no longer loads. Ask DSAAPD whether its contracts add staffing rules.

Who must be on site. The director or a designee must be present and in charge whenever participants are there, and at least one employee certified in CPR must be on site. If the center serves participants who need nursing services, an RN or LPN must be on the premises at all times when participants are present.

Who counts toward the ratio. Volunteers and employees who have not finished orientation do not count toward minimum staffing.

Director. The director needs one of three backgrounds: a bachelor's degree in health, social services or a related field plus one year of supervisory experience; comparable training with shown management experience; or an RN license with two years of supervisory experience. The activities coordinator must meet the degree, certification or experience options set out in the rule.

Aides. Aides complete an orientation of at least 40 hours of instruction and supervised practice, and must also be a CNA, have one year of health care experience, or be a nursing student who has finished a medical surgical practicum. They must pass a competency evaluation before giving care without supervision.

Training. Direct care staff complete at least 12 hours of staff development each year. Centers serving people with dementia give yearly dementia-specific training to health care staff who take continuing education. All staff receive infection control orientation and yearly in-service training.

Background checks. Centers follow Delaware's health care employment background check law (19 Del.C. 708 and 11 Del.C. 8563) and check the adult abuse registry (11 Del.C. 8564). Staff must be at least 18, and anyone convicted of a crime against a person may not be employed.

Health screening. Staff need a physical exam and TB testing before hire, and TB testing each year after that following CDC recommendations. The 2022 infection control rule also calls for COVID-19 testing of new and current staff, vendors and volunteers in line with Division of Public Health guidance. The rule does not require vaccination.

What does an adult day center in Delaware have to provide?

Every licensed Delaware center provides supervision and help with daily activities such as eating and toileting, planned activities for at least 65 percent of its open hours, and meals and snacks. Nursing, therapy and transportation are optional, but each comes with rules if you offer it. Centers must also meet space, restroom and safety minimums.

Care and activities. Aides or licensed nurses supervise participants and help with activities of daily living as needed. Therapies, if offered, need a physician's order and qualified therapists. Planned activities must fill at least 65 percent of open hours, with a written schedule at least monthly, the current month posted, and 12 months of schedules kept (3360, sections 9 and 10).

Meals. Participants present four or more hours get at least one meal a day meeting one third of the recommended dietary allowances. Centers also serve a morning snack, an afternoon snack for anyone staying more than three hours after lunch, and an evening meal if open in the evening. Menus prepared on site follow a two-week cycle approved by a dietitian, a dietitian must be available for consultation, and the dated weekly menu is posted.

Medications. Medications are given only on a prescriber's written order, administered under the Nurse Practice Act for participants who cannot take them on their own, logged for each dose, and stored locked. Schedule II drugs are double locked and counted with the family.

Transportation. Transportation is not required. A center that provides it, directly or by contract, must meet rules on vehicles, securement, supervision, drivers trained in first aid, and two-way communication, and must help participants from the ground floor of their home to the center.

Space and capacity. Under 3360, sections 5 and 6:

At least 100 square feet of program space for each of the first five participants and 60 square feet for each participant after that. Offices, bathrooms, storage, the exam room and the dining room (unless also used for activities) do not count.
At least one toilet per 12 participants and one hand-washing sink per two toilets, with signaling devices in bathrooms.
A separate rest area with a bed, cot or recliner for privacy and for participants who become ill, and a dining area that seats everyone.
A center in a building with other services needs its own identifiable space, at least two separate marked exits, and a fenced or bounded outdoor area to prevent wandering.

DHCQ sets a licensed capacity for each center, shown on its list, but the rule gives no formula for it beyond the space minimums.

Hours. By definition a program runs less than 12 hours a day. We did not find a minimum number of days or hours a center must be open.

Written policies. The rules require written policies on participant rights and responsibilities; incidents, accidents, medical emergencies and preventing wandering; a complaint procedure approved by DHSS; admission and discharge criteria; maintenance, cleaning, toxic materials and soiled linen; preventing drug diversion; self-administered over-the-counter products; personnel; and infection prevention and control, including COVID-19 work exclusion and outbreak staffing plans.

Quality and safety. Centers run a documented quality improvement program that tracks performance measures, reviews goals at least yearly, reviews complaints and monitors participant or family satisfaction. Fire evacuation drills are held and documented at least every quarter.

What rules protect participants in Delaware adult day centers?

Delaware rules require a physical exam and TB screening before enrollment, a signed written agreement, a nursing and social assessment, and a care plan within 30 days. Discharge is allowed only for listed reasons and with at least two weeks notice. Centers must keep attendance records and keep records for at least five years.

Who can enroll. Participants must be 18 or older and functionally impaired. Before admission the record needs a history and physical done by or under a physician within the prior 6 months, and a TB screening within the prior year showing no active infectious TB (3360, sections 7 and 15). For Medicaid members, DMMA checks DSHP Plus eligibility and the member's plan authorizes services.

Written agreement. The agreement states the services, scheduled days, financial arrangements, transportation, emergency procedures, and conditions for discharge and appeal. It is signed by the participant (if able), the representative and the center, and updated when services or finances change.

Assessment and care plan.

A written assessment of physical condition (by a licensed nurse), social situation and mental status within 30 days before admission, updated at least yearly.
A preliminary care plan before admission.
A full care plan within 30 calendar days of the first day.
Care plan review at least every 6 months, with an update each year.

Discharge. A center may discharge a participant only when it cannot meet the person's needs, for medical reasons, for non-participation or not following the agreement, for the welfare of the participant or others, or for nonpayment of justified charges. At least two weeks notice is required. Notice can be waived only for a sudden change that needs a higher level of care, and the center must then help with placement.

Records. Each participant record includes attendance and service records, admission data, assessments, care plans, medication and treatment notes, monthly progress notes on health, function and psychosocial status, advance directive status, and the signed agreement. Records are kept at least five years and protected from loss, damage and unauthorized use.

Incidents. Centers must have policies for handling and documenting incidents, accidents and medical emergencies and keep the reports on file. The adult day rule does not set a deadline for reporting incidents to DHCQ. We did not review Delaware's adult abuse reporting law, so ask DHCQ what must be reported and when.

Rights and complaints. Participants have written rights, including being told about services and charges when accepted and voicing grievances without reprisal. The center's complaint procedure must include the right to report to DHSS.

How does Medicaid pay for adult day in Delaware?

Delaware Medicaid pays for adult day services through Diamond State Health Plan Plus (DSHP Plus), the managed long-term services and supports program for residents who are elderly or physically disabled. Services are authorized and paid through the member's managed care plan, not billed directly to the state. We did not find a state-published adult day rate or fee schedule.

Important: The billing codes below come from one plan's clinical policy, not from a state fee schedule. We did not find codes, units or rates for the other DSHP Plus plans. Ask each plan you contract with how it pays for adult day before you set your prices or budget.

DSHP Plus. DMMA lists adult day services as a DSHP Plus benefit that the base Diamond State Health Plan does not include (DMMA DSHP Plus page). The program runs under the Diamond State Health Plan section 1115 demonstration, and DMMA checks member eligibility.

Billing codes and units: Delaware First Health's clinical policy (DE.CP.MP.02) lists S5100 per 15 minutes and S5101 per half day.
Enhanced rate: the same policy treats adult day at an enhanced rate as medically necessary when staff time is needed for ongoing behavioral patterns that need extra prompting or intervention at least weekly.
Day habilitation: the plan covers day habilitation as a separate LTSS service for members with cognitive, social or behavioral needs, such as from a brain injury.
Rates: we did not find a published adult day rate.

Transportation. We did not find whether DSHP Plus plans pay for transportation to adult day separately. Ask each plan.

Attendance documentation. The licensing rules require attendance and service records in each participant's file but do not specify sign-in and sign-out times or electronic tracking. We did not find a Medicaid or plan rule that spells out the attendance records needed for adult day claims, so ask each plan you bill what it expects.

DSAAPD contracts. DSAAPD also pays contracted adult day providers with non-Medicaid funds (see the next section). Its service specifications, which would set the unit of service and documentation, could not be read online.

Can a private-pay adult day center operate in Delaware without Medicaid?

Yes, a center can be fully private pay, but it still needs a DHCQ license if it serves four or more functionally impaired adults. Delaware's licensing rule has no payer exception. A program serving fewer than four adults, or one mainly for people with developmental disabilities or mental illness, falls outside the rule.

What the rule does not say. The rule defines its scope by the number and type of participants. It does not list services an unlicensed program may not provide, and we did not find a rule barring discrimination by payment source. Ask DHCQ before you open any small or specialized program without a license.

Protections for private-pay participants. Participants must be told about available services and related charges when accepted, must have a written agreement that covers financial arrangements, and may voice grievances without reprisal (3360, sections 7.5 and 11).

Other funding. DSAAPD funds contracted services through the Older Americans Act, the Social Services Block Grant and state funds, and asks providers to review its service specifications before bidding. DSAAPD says adult day programs in Delaware are not state operated, are available in all three counties, and serve people 18 or older with a functional impairment or a diagnosis such as dementia. Families can call the Aging and Disability Resource Center (ADRC) at 1-800-223-9074 for help finding a program (DSAAPD Community-Based Day Programs). We did not find a VA adult day health care program in Delaware.

The market. The DHCQ list of adult day care centers names 10 licensed centers in Georgetown, Dover, New Castle, Newark, Smyrna and Wilmington, three of them Easter Seals sites. Licensed capacities range from 24 to 77 participants. We did not find a Delaware adult day services association.

What is changing next for adult day in Delaware?

As of our last check on October 21, 2026, we did not find an upcoming change to Delaware's adult day licensing rules, Medicaid adult day coverage or adult day payment. The licensing rule was last amended effective February 2022 (25 DE Reg. 776), when infection control and COVID-19 testing provisions were added.

Two housekeeping changes affect anyone who used older references:

Rule number. The adult day rule moved from 16 Del. Admin. Code 4402 to 16 Del. Admin. Code 3360 under the Division of Health Care Quality.
Web addresses. After the DHSS website moved, the current DHCQ adult day page is the Adult Day Care Centers page, and some older links to DHCQ forms and DSAAPD documents no longer work.

If you are planning around Medicaid payment, check with DMMA and your DSHP Plus plans for any rate or policy updates.

Get notified when Delaware adult day rules change

Leave your email and we will let you know when Delaware changes its adult day licensing, staffing or Medicaid rules. No newsletter, only changes for this state.

Who to ask about adult day rules in Delaware

Questions about Delaware adult day rules are best put to the state. Start with DHCQ Adult Day Care Centers. The state lists this contact: DHSS General Information 302-255-9040; dhssinfo@delaware.gov.

Delaware adult day sources

Other states that license or certify every adult day center

California, Florida, Georgia, Hawaii, Iowa, Kansas, Maine, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Wyoming. See every state on the adult day services map.

Page history

October 21, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.

Questions about Adult Day Care?

There's a lot to learn about Adult Day Care and the opportunity that it presents both for entrepreneurs, and for families. Below are some frequently asked questions, but you are also welcome to learn more by filling out the form on the right.

Delaware adult day questions

Do I need a license to open an adult day center in Delaware?

Yes, if the program serves four or more functionally impaired adults, whoever pays. The DHSS Division of Health Care Quality issues the license under 16 Del. Admin. Code 3360, starting with a provisional license and an on-site survey within 90 days. State law sets a $100 application fee and a $50 annual renewal fee.

What staffing ratio does Delaware require in adult day care?

At least two staff must be on duty whenever participants are present. Above 16 participants, centers need one staff member per eight participants with no rounding down, so 17 to 24 participants need three staff. Volunteers and staff who have not finished orientation do not count toward the minimum.

Does Delaware license adult day health care separately from adult day care?

No. Delaware has one adult day care facility license. Nursing services are optional, but a center serving participants who need nursing services must have an RN or LPN on site whenever participants are present.

Are there special staffing rules for dementia care in Delaware adult day centers?

There is no dementia-specific ratio. Programs serving mainly participants with severe cognitive or physical disabilities must staff at least 1:4 for those participants. Centers serving people with dementia must give health care staff yearly dementia-specific training and have policies to prevent wandering.

Does Delaware Medicaid pay for adult day services?

Yes. Adult day services are a benefit of Diamond State Health Plan Plus, the managed long-term services and supports program for residents who are elderly or physically disabled. Services are authorized and paid through the member's managed care plan, and the state does not publish an adult day rate, so ask each plan how it pays.

Can I run a private-pay adult day center in Delaware without a license?

Not if you serve four or more functionally impaired adults, because the license requirement has no payer exception. Programs serving fewer than four adults, or mainly people with developmental disabilities or mental illness, fall outside the adult day rule. Check with the Division of Health Care Quality before opening without a license.

How much notice must a Delaware adult day center give before discharge?

At least two weeks. The notice can be waived only when a sudden change in care needs requires a higher level of care, and the center must then help find a suitable placement. Discharge is allowed only for the reasons listed in the rule, such as needs the center cannot meet or nonpayment of justified charges.

How many licensed adult day centers are there in Delaware?

The Division of Health Care Quality lists 10 licensed adult day care centers, in Georgetown, Dover, New Castle, Newark, Smyrna and Wilmington. Licensed capacities range from 24 to 77 participants.

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