As a family member of an assisted living resident, it is important for you to understand the regulations that govern assisted living facilities, and the rights of residents.
In 1999, Maryland Senate Bill 545 brought major changes to the licensing and regulation of assisted living programs. Formerly, these programs were licensed and monitored by several different government agencies, with several sets of regulations. The 1999 legislation brought all assisted living facilities under one set of standards.
The Maryland Department of Health and Mental Hygiene (DHMH) was named the lead agency for the licensing and monitoring of all assisted living facilities. DHMH assumed the following responsibilities:
- To be the single point of entry for licensing of assisted living programs
- To develop and enforce a single set of regulations regardless of facility size or number of beds
- To review medication management at the facilities
- To license facilities and admit residents according to levels of care.
- To impose civil or criminal penalties for serious infractions of the regulations
- To suspend or revoke facilities' licenses in cases of the most serious violations.
Under this legislation, an assisted living program is defined as: A residence or facility-based provider that provides housing and supportive services, supervision, personalized assistance, health-related services, or a combination of these services to meet the needs of residents who are unable to perform, or need assistance in performing, the activities of daily living or instrumental activities of daily living, in a way that promotes optimum dignity and independence for residents.
The regulations of greatest interest to consumers are summarized below.
- COMAR 10.07.14.04 Licenses Required: This section discusses the license required to operate an assisted living program.
- COMAR 10.07.14.05 Levels of Care: This section describes the requirement that each home be licensed to provide specific level(s) of care for residents. Levels of care are defined.
- COMAR 10.07.14.21 Pre-admission Requirements: The required preadmission forms are listed and described here.
- COMAR 10.07.14.23 Admission Requirements: Information is provided here on the disclosure statement that the facilities are required to give to potential residents or other interested parties.
- COMAR 10.07.14.24 Resident Agreements: This section describes the provisions that must be included in this contract and the requirement that it be signed prior to occupancy.
- COMAR 10.07.14.14 Staff Levels: This section outlines the plan that each facility is required to prepare for 24-hour staff coverage sufficient to meet resident needs. There is no specific, required staff-to-resident ratio.
- COMAR 10.07.14.26 Service Plan: This section outlines the requirement that a service plan is developed for each resident within 30 days of admission. The service plan must include specific information about who will provide the services, how they will be provided, and how often.
- COMAR 10.07.14.28 Services: This section outlines the services that an assisted living program is required to provide, including meals, monitoring, personal care, laundry and housekeeping services, access to health care and social services, social and spiritual activities.
- COMAR 10.07.14.29 Medication Management: The responsibilities of the facility for medication management are outlined in this section.
- COMAR 10.07.14.33 Relocation and Discharges:
This section describes the facility's responsibilities when a resident is discharged or relocated.
- COMAR 10.07.14.36 Abuse, Neglect, and Exploitation: This section describes the requirement that all assisted living programs have policies and procedures prohibiting abuse, neglect, and abuse of residents. It also describes the responsibilities of facilities to report and investigate allegations of abuse, neglect or financial exploitation.
- COMAR 10.07.14.49 Resident Rooms and Furnishings: This section lists the requirements for residents' rooms, including the amount of floor space, furnishings and other features. It states that no more than two residents may share a room.
- COMAR 10.07.14.12 Compliance Monitoring: The requirements for state monitoring of facilities are outlined in this section. Generally, the state must perform on-site inspections at least once a year.
In 2006 a new regulation was enacted which requires that all Maryland Assisted Living programs include a Disclosure Statement in their marketing materials to consumers and to make it available to consumers upon request. The Disclosure Statement outlines the services and policies of the assisted living program. Each facility uses the same standardized form, which allows consumers to more easily compare facilities, and choose the one that best meets their needs. Read the 2006 regulation.
Licensed assisted living facilities are inspected or “surveyed” on a regular basis by the Department of Health and Mental Hygiene to ensure that they are in compliance with state regulations. Assisted living providers are required to post the survey reports. Ask the manager for a copy of the survey, or contact the Office of Health Care Quality at DHMH at 410-402-8000 to obtain a copy.