Maryland assisted living rules: what you must document about each resident

Who these rules cover

Maryland uses one license category for this setting, the assisted living program. COMAR defines it as a residential or facility-based program for two or more residents that provides housing and supportive services, supervision, personalized assistance and health-related services to people who need help with activities of daily living. That covers everything from small group homes to large campuses. Each program is licensed for the levels of care the Department has approved, and the Resident Assessment Tool decides which level a resident needs.⁴

The licensing and survey agency is the Office of Health Care Quality (OHCQ) within the Maryland Department of Health. OHCQ also developed the Resident Assessment Tool itself, formally "Maryland's Assisted Living Resident Assessment and Level of Care Scoring Tool," which COMAR describes as the tool used "to assess the current health, physical, and psychosocial status" of prospective and current residents.

The assessment: the Resident Assessment Tool

Maryland's assessment happens before the resident moves in. Under COMAR 10.07.14.22, the manager or designee, working with the delegating nurse, decides whether the program can admit the person and meet their needs:

Within 30 days before admission, the assisted living manager or designee shall determine admission eligibilities described in §A(1) of this regulation based on completion of a resident assessment using the Resident Assessment ToolCOMAR 10.07.14.22A(2)

The tool sets the level of care, decides whether awake overnight staff are needed, and "forms the basis for development of the resident's service plan." Its health section is based on an examination by a physician, nurse practitioner, registered nurse or physician assistant and covers medical history, diagnoses, medications, allergies, nutrition and similar items.

Then comes the functional assessment, also collected on the tool within 30 days before admission. Alongside ADLs, symptoms, decision-making capacity and behaviors, it must record:

(6) Social factors, including: (a) Significant problems with family circumstances and personal relationships; (b) Spiritual status and needs; and (c) Ability to participate in structured and group activities, and the resident’s current involvement in these activities.COMAR 10.07.14.22D(6)

That is the extent of Maryland's explicit requirement on the personal side. It asks about relationships, faith and current activity involvement. It does not ask for a life history, former occupation, hobbies, daily routines or what brings comfort. Those are good things to learn, but they are beyond the rule's minimum.

The service plan

COMAR 10.07.14.28 ties the plan directly to the assessment:

The resident’s service plan shall be based on an assessment of the resident’s health, function, behavioral, and psychosocial status using the Resident Assessment Tool and the nursing assessment.COMAR 10.07.14.28B(1)

The plan must be developed "in a manner that enhances the principles of dignity, privacy, resident choice, resident capabilities, individuality, and independence." The resident is invited to take part in every plan, and at the resident's request a representative, family member or other person is invited to all service plan meetings. The program should accommodate participants' schedules when possible.

At a minimum the written plan states the services to be provided based on the assessment, when and how often, and how and by whom. It is due within 30 calendar days of admission and is reviewed at least every six months. One detail matters for anyone tracking preferences:

The service plan is reviewed by staff at least every 6 months, and updated, if needed, unless a resident’s condition or preferences significantly changeCOMAR 10.07.14.28D(3)

In that case the plan has to be reviewed and updated sooner. A change in what the resident wants, not only a change in health, can trigger an early review. COMAR 10.07.14.29C adds that programs need policies so that information about a resident's "condition or preferences" is documented in the record and shared with the resident, their representative and the staff who carry out the plan.

Activities and spiritual life

COMAR 10.07.14.30 lists the services every program provides. Section H covers social and recreational activities: staff must encourage participation in line with the service plan, arrange transportation, and help residents with communication and social skills.

The assisted living manager shall provide or arrange appropriate opportunities for socialization, social interaction, and leisure activities that reflect the resident’s preferences and promote the physical and mental well-being of each resident.COMAR 10.07.14.30H(2)

Section I requires access to "spiritual and religious activities consistent with the preferences and beliefs of the resident," with transportation arranged per the service plan. Meals must also give "specific attention" to each resident's preferences. None of these sections prescribe a calendar, a number of hours or an activity director credential, so the evidence that activities reflect preferences is mostly what you recorded about the resident and how the program responds to it.

Alzheimer's Special Care Units

A program must get written OHCQ approval before operating or marketing an Alzheimer's Special Care Unit, under COMAR 10.07.14.32. It must submit and disclose a written description of the unit, including its philosophy, how its services differ from the rest of the program, admission and discharge criteria, staffing, fees and the physical environment. Two items in the description touch this topic directly:

• The "assessment and service planning protocol," including what triggers a reassessment before the usual six-month review.
• A description of activities, including frequency and type and how they meet the needs of residents with dementia.

The description must also cover at least six hours of advanced cognitive impairment training for care staff, including "2 hours related to making activities meaningful." The regulation does not add a separate social-history requirement for the unit. What you promise in the description, though, is what OHCQ can hold you to, since the rule says it must "accurately reflect the current operation of the unit."

What surveyors tend to look for

This is based only on what the rule text says to document, not on citation data. From the text, a reviewer can check:

• A completed Resident Assessment Tool dated within 30 days before admission, with the social factors section filled in.
• Six-month reviews signed off by the delegating nurse and manager, and new assessments annually and after significant changes.
• A service plan within 30 days of admission that follows from the assessment and shows the resident was invited to take part.
• Evidence that activities and spiritual access reflect the resident's recorded preferences, and that the plan was updated when those preferences changed.
• For special care units, that daily practice matches the approved written description.

Gathering preferences and life history well

Because the tool is done before move-in, the first weeks after admission are when you actually get to know the person. A few habits help:

• Ask open questions in the first two weeks. "Tell me about the work you did." "What did Saturdays look like when your kids were young?" "Where did you go to worship?" These fill in the social factors section with something staff can use.
• Bring family in, if the resident wants that. COMAR already lets the resident invite family to service plan meetings. Relatives often know the routines, favorite foods and old friendships.
• Write down what brings comfort and what to avoid. A hymn, a morning walk, a sports team, or a subject that upsets them. Put it where direct care staff will see it.
• Treat preference changes as plan changes. The rule does. When a resident stops enjoying a group or asks for something new, note it and update the plan.
• Revisit at every six-month review. Ask the questions again rather than carrying forward last round's answers.

How Porchlight can help

Porchlight gives residents an easy way to tell their story in their own voice. A resident taps one large button on a tablet, a life question is read aloud and shown in large type, and the spoken answer is recorded and transcribed. There are 800+ human-written questions organized by life chapter. The resident or staff can pick a topic, any question can be skipped, and nothing is scored. Staff can add profile facts, including topics to avoid, and family get a private page to listen, leave voice replies, and add their own questions and photos.

Staff receive a "Know Your Resident" briefing with conversation starters, story highlights and a printable life-story biography, plus a weekly Monday email digest. It helps you gather and keep the preferences, routines and life-story material your assessment and service plan draw on, in the resident's own words. The Resident Assessment Tool and compliance remain your team's responsibility.

Frequently asked questions

When is the Resident Assessment Tool due in Maryland?

Within 30 days before admission. The assisted living manager or designee completes it with the delegating nurse, and it determines the level of care and forms the basis for the service plan. For an emergency admission by a local department of social services, it is due within 14 calendar days.

When must a Maryland assisted living program complete the service plan?

Within 30 calendar days of admission, under COMAR 10.07.14.28D. It must be reviewed at least every 6 months, and sooner if the resident's condition or preferences significantly change.

Does Maryland require a social history or life history?

Not by that name. The functional assessment on the Resident Assessment Tool must record social factors: significant problems with family circumstances and personal relationships, spiritual status and needs, and the resident's ability to participate in and current involvement in activities.

What does COMAR say about activities?

The assisted living manager must provide or arrange opportunities for socialization, social interaction, and leisure activities that reflect the resident's preferences, and facilitate access to spiritual and religious activities consistent with the resident's preferences and beliefs.

Are there extra rules for memory care in Maryland?

Yes. An Alzheimer's Special Care Unit needs written OHCQ approval and a written description that covers its assessment and service planning protocol, its activities for residents with dementia, staffing, and staff training, including 2 hours on making activities meaningful.