Assisted Living in Maryland

Assisted living is a residential program that provides housing, supervision, personal care services, health related services, or a combination of these to residents who are unable to perform activities of daily living or who need help performing them. As an assisted living resident, Maryland law provides you with certain rights.

Assisted Living

Assisted living is a residential program that provides housing, supervision, personal care services, health related services, or a combination of these to residents who need help performing activities of daily living. The activities of daily living include bathing, dressing, eating, and toileting. The goal of assisted living is to provide the care needed in a way that promotes dignity, independence, and choice in a home-like setting.

Assisted living is not the same thing as nursing home care. Nursing home facilities care for residents who need rehabilitation, health-related services above the level of room and board, or skilled nursing services. Learn more about nursing home care.

Read the Law: Md. Code, Health - General § 19-1801

Read the Regulation: Code of Md. Regulations 10.07.14.02

Pre-placement Counseling - Deciding to enter a long-term care facility is a major life decision and requires careful planning. Pre-placement counseling is available for seniors and their families. Review and discuss how to select a facility, types of facilities available, current facility surveys by state licensing agencies, and financial considerations. Contact your Department of Aging local area agency for more information.

Consider Alternatives - Depending on your needs, there may be alternatives to assisted living that work better for your situation, including home care, home aide services, medical adult day care centers, meal services, and in-home nursing and therapy services. Contact your local Center for Independent Living for more information about alternatives.

NOTE: If you choose to hire someone to help with the caregiving tasks, decide whether to hire an individual or an agency. If you hire an individual, you may have to pay Social Security and Medicare taxes and withhold income taxes. The Internal Revenue Service (IRS) Publication 926 – Household Employer’s Tax Guide provides detailed information.

Financial Considerations - Assisted Living in Maryland can cost anywhere from $1,000/month to over $5,000/month. The facilities that cost $1,000 per month tend to be small homes owned by people who decide to have 1 or 2 people move in with them. The residents pay the homeowner in exchange for a room, personal care services, and meals. Larger facilities tend to be more expensive. Most assisted living facilities charge a daily rate and bill you monthly.

Generally, people pay privately for assisted living care using their income and assets. There are limited subsidies through the Department of Aging’s Senior Assisted Living Subsidy Program that help pay for assisted living in some counties. Contact your local Area Agency on Aging for more information.

There are also assisted living beds paid for by Medical Assistance under the "Home and Community Based Options Waiver,” but there are limited subsidies, a waiting list, and level of care standards that must be met before one is eligible. Contact your local department of social services for more information.

Levels of Care - Assisted Living Facilities are licensed by the level of they provide. Level one facilities provide low level of care. Level two facilities are for moderate care. Level three facilities are for people requiring high level of care. Most facilities are licensed for all levels of care. The cost of assisted living will depend on your level.

Read the Regulation: Code of Md. Regulations 10.07.14.05

Resident Rights

Resident rights include the right to:

be treated with consideration and respect, with full recognition of your human dignity and individuality;
sign an Resident Agreement, which explains what types of services you will receive and the cost;
make choices about care;
privacy and confidentiality;
refuse treatment;
access your medical records;
be free of abuse, neglect, and exploitation;
handle your own finances;
privacy with visitors of your choice; and
to make complaints and get timely responses to your complaints.

This is just a short list. Your rights are more detailed and expansive.

Read the Regulations: Code of Md. Regulations 10.07.14.35

Treatment and Care - Your treatment, care, and services must be adequate, appropriate, and promote your social, emotional, physical, and spiritual health. For example, you have a right to a service plan based on an assessment of your needs. you also have a right to three meals and additional snacks each day.

Your treatment must be free of verbal, mental, physical, and sexual abuse, involuntary seclusion, neglect, and exploitation. Physical and/or chemical restraints can only be used if your doctor has ordered them as appropriate for treatment of your medical symptoms or conditions.

You have the right to refuse treatment after the consequences of refusing treatment have been explained to you. NOTE: It is possible that if you choose to refuse treatment, the provider may decide to terminate your contract and discharge you.

Read the Regulations: Code of Md. Regulations 10.07.14.35; 10.07.14.26; 10.04.14.28; 10.07.14.36; 10.07.14.37

Sufficient Staffing - You and the other residents of the assisted living facility have the right to have enough staff members in the facility to meet your needs. There should always be a staff person in the facility when a resident is there.

Read the Regulation: Code of Md. Regulations 10.07.14.14

Privacy and Confidentiality - You have the right to have privacy when you make telephone calls or have visitors, and staff must knock on your door before entering (unless they know you are asleep).

You can meet privately with anyone you choose, according to reasonable visiting hours and visiting areas, which must be posted by the assisted living manager.
You have the right to send and receive mail without delay, and without your mail being opened, censored, controlled, or restricted. You must have access to writing instruments, stationery, and postage. Only you or your legal representative can request any modifications or restrictions in how you send and receive your mail.
Unless otherwise provided by law, your health care records should not be given to anyone not directly involved in your care. (An example of when the law provides that your records may be shared is if the provider needs to transfer you to another facility, such as a hospital.) Also, any discussions about your health, medical diagnosis and treatment should be held in private.

Read the Regulations: Code of Md. Regulations Code of Md. Regulations 10.07.14.35; 10.07.14.32

Self-Determination and Personal Choice - You have the right to participate in developing your own care plan and medical treatment.

You or someone of your choice may manage your personal financial affairs.
You have the right to have a lawyer and to meet with him/her in private.
You have the right to practice the religion of your choice. You can choose whether you want to attend religious services or receive visits from members of the clergy.
You can decide what clothing to wear, how to wear your hair, and what personal effects to keep in your own area – as space and safety permit. The assisted living program must have a reasonable security policy for the protection of your personal property.
If you share a room, to the extent possible, you should have input into the choice of a roommate, including the right to share a room with your spouse. You also have the right to receive notice before there is a change in roommates.

Read the Regulations: Code of Md. Regulations Code of Md. Regulations 10.07.14.35; 10.07.14.38; 10.07.14.49

Safety and Livability of the Home - The facility building should be clean and in good repair and heated to at least 70 degrees in cold weather and cooled to at least 80 degrees in hot weather. The program must provide or arrange for indoor multipurpose space as well as outside activity space.

Read the Regulation: Code of Md. Regulations 10.07.14.41; 10.07.14.48; 10.07.14.52

Suggestions, Complaints and Grievances - You (or your representative) have the right to make suggestions or complaints and to present grievances on your own behalf or on behalf of others without threat or fear of retaliation. Learn more about protecting your rights in long-term care facilities.

Relocation and Discharge – You cannot be relocated within the facility except in accordance with your Resident Agreement. The Assisted Living Program must notify you and your representative at least 5 days before a nonemergency relocation within the facility and get you or your representative’s consent.

For involuntary discharges (i.e., the facility wants to discharge you against your will), you have a right to 30 days’ notice. In a health care emergency, it can move you immediately to a safe and proper setting. In case of a medical health care emergency, neither you nor the facility must give 30 days’ notice. You have the right to immediately remove yourself from the facility in a health care emergency.

Your Resident Agreement with the assisted living provider should clearly state under what circumstances or conditions you might be involuntarily discharged from the facility.

Read the Regulation: Code of Md. Regulations 10.07.14.33; 10.07.14.24

Source

Legal Aid Bureau/Tamara Catchpole; Assisted Living in Maryland: What You Need to Know, updated by Anne Hurley, Esq.; edited by Mary Jo Broussard Speier, Esq., Maryland State Bar Association, Section on Elder Law and Disability Rights; updated by PLL Contributors