Candace Esham is the founder of the Delaware Elder Care Advocacy Coalition. She is a resident of Middletown.
Last legislative session, the Delaware Elder Care Advocacy Coalition advocated for six bills related to long-term care quality. The long-term care facility laws passed last session were designed to ensure that facilities are surveyed on a regular basis, defined dementia care services, required sufficient staff in assisted living facilities (currently, there is no standard), instituted staff training for dementia care services and provided transparency around disclosure of dementia care services. Five of the six laws have not been implemented due to resources approved not being granted. All the bills that required Department of Health and Social Services staff resources also required fiscal notes. Additional meetings and approvals due to funding for each bill added to the obstacles to obtain the governor’s signature. We were constantly confronted by the supposed budget challenges to provide bare minimum oversight for long-term care facilities, which house our most vulnerable people.
We have discovered that not all bills that require DHSS resources require fiscal notes, and it is unclear how the decision is made for the department’s staff to absorb workload versus demand funding. Here are two examples: House Bill 140, aka the “assisted suicide bill,” recently passed the House of Representatives’ Health & Human Development Committee and House Bill 162, aka the “human composting bill,” was signed into law in 2024. Repeatedly, DHSS leadership states that its staff is overworked and under-resourced. If bill sponsors do not ask for funding for additional resources, the department implementing the regulations and oversight has to choose between new work and existing priorities. This likely means that other activities already assigned to staff and approved by legislators will not be completed. The long-term care laws signed by the governor last session had appropriate fiscal notes, received unanimous approval in the House and Senate, and are critical to the health and safety of our most vulnerable population. What responsibilities will DHSS have to stop doing to complete the tasks in these two bills? Why are there unclear standards for what tasks the department can supposedly absorb versus those that require new staff? The vision statement for DHSS is “Together we provide quality services as we create a better future for the people of Delaware.” A bill for composting human remains and one for assisted suicide were deemed to not need funding for oversight. Does this double standard align with that vision statement and how can an already overstretched department be expected to sufficiently support these bills?
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
