A
SSISTED
L
IVING
IN
M
ARYLAND
WHAT YOU NEED TO KNOW
A cooperative effort of:
The Legal Aid Bureau, Inc.
- Assisted Living Project
Maryland Attorney General’s Office
Maryland Department of Aging
Maryland Department of Health
and Mental Hygiene
Maryland Department
of Human Resources
Maryland State Bar Association
University of Maryland School of Law
- Law and Health Care Program
Assisted Living in Maryland: What You Need to Know - 3
ASSISTED LIVING IN MARYLAND:
W
HAT YOU NEED TO KNOW
A cooperative effort of:
The Legal Aid Bureau, Inc.
- Assisted Living Project
Maryland Attorney General’s Office
Maryland Department of Aging
Maryland Department of Health and Mental Hygiene
Maryland Department of Human Resources
Maryland State Bar Association
University of Maryland School of Law
- Law and Health Care Program
4 - Assisted Living in Maryland: What You Need to Know
Copyright 2002
University of Maryland School of Law
TABLE OF CONTENTS
Chapter 1 An Introduction to Assisted Living ............................................... 3
Chapter 2 Choosing an Assisted Living Provider ........................................ 11
Chapter 3 What Will It Cost and How to Pay for Assisted
Living Services .......................................................................... 21
Chapter 4 Before You Sign a Contract . . . Read This ................................. 27
Chapter 5 Your Rights Under the Law ........................................................ 33
Chapter 6 How to Complain When Quality of Care Is
Lacking ..................................................................................... 37
Chapter 7 Enabling Others to Make Health Care and Financial
Decisions for You ...................................................................... 39
Chapter 8 Alternatives to Assisted Living ................................................... 47
Chapter 9 Where to Get Help .................................................................... 53
Assisted Living in Maryland: What You Need to Know - 5
ASSISTED LIVING IN MARYLAND:
WHAT YOU NEED TO KNOW
COMMITTEE MEMBERS
Joan L. O’Sullivan, Committee Chair
University of Maryland School of Law
515 W. Lombard Street
Baltimore, MD 21201
Denise Adams
Senior Assisted Living Program Manager
Maryland Department of Aging
301 W. Preston Street, Room 1007
Baltimore, MD 21201
Elizabeth Binckes
Department of Health and Human Services
Aging and Disability Services
410 Hungerford Drive, 3
rd
floor
Rockville, MD 20850
Rachel Cohen
Assistant Attorney General
Maryland State Retirement & Pension System
120 E. Baltimore Street
Baltimore, MD 21202
Stephanie Edelstein
ABA Commission on Legal Problems of the
Elderly
740 15
th
Street NW
Washington, DC 20005-1022
Morris Klein, Esq.
4550 Montgomery Avenue, Suite 601N
Bethesda, MD 20814
William Dorrill
Office of Health Care Quality
Department of Health and Mental Hygiene
Spring Grove Hospital
Bland Bryant Building
55 Wade Avenue
Catonsville, MD 21228
April Seitz
Department of Human Resources
311 W. Saratoga Street, Room 259
Baltimore, MD 21201
Kevin Simpson
Office of the Attorney General
Health Education and Advocacy Unit
200 St. Paul Place
Baltimore, MD 21202-2022
Susan Shubin
Chief Attorney
Nursing Home and Assisted Living Program
29 W. Susquehanna Avenue
Towson, MD 21204
Tamara Z. Catchpole
Assistant Attorney General
Maryland Department of Aging
301 W. Preston Street, Room 1007
Baltimore, MD 21201
6 - Assisted Living in Maryland: What You Need to Know
CHAPTER 1
AN INTRODUCTION
TO
ASSISTED LIVING
If any of the following scenarios seem
familiar to you, assisted living may be
an option to explore. Your arthritis
prevents you from cooking, and some
days it is so bad that you cannot even
feed or bathe yourself. You cannot keep
your medications straight even with the
pill reminder system your daughter
bought you. Or perhaps you
cannot get around anymore on
your own, even with a walker,
and there is no family around
to help you regularly. In short,
it is getting harder to manage
on your own, and you, your
friends, or your family are
beginning to worry.
Deciding whether assisted living
is the best solution for you is not
easy. To arrive at the best answer you
should:
1. Read the rest of this booklet;
2. Explore options other than assisted
living;
3. Think about your abilities, your
needs, and your finances; and
4. Visit some assisted living facilities.
This booklet explains the role and
function of assisted living providers,
but does not take the place of applicable
laws and regulations. It also discusses
other options available, legal protec-
tions for residents, and area resources
where you can get more information. In
addition, there are tips to assist you in
the following areas: deciding if assisted
living is for you, electing an assisted
living provider, entering into a
contract for care, and paying for
care.
What Is Assisted Living?
Assisted living is a way to
provide care to people who are
having difficulty living inde-
pendently, but do not need the
daily nursing services provided
in a nursing home. Assisted
living providers furnish a place to live,
meals, and assistance with daily activi-
ties, such as dressing, bathing, eating,
and managing medications. People
who live in assisted living facilities
generally have less complicated medical
problems than people in nursing homes.
Assisted living facilities also tend to
have a less institutional look than
nursing homes. However, these facili-
ties are not as highly regulated by the
government as nursing homes.
Assisted Living in Maryland: What You Need to Know - 7
In Maryland, an assisted living provider is defined as:
If a person is mentally
A residential or facility-based provider that provides
sharp, only takes medica-
housing and supportive services, supervision, person-
tion for arthritis pain, and
alized assistance, health-related services, or a combi-
only needs assistance with
nation of these services to meet the needs of residents
dressing and bathing he or
who are unable to perform, or who need assistance in
she would be classified as
performing, the activities of daily living or instrumen-
needing a low level of
tal activities of daily living, in a way that promotes
care. A person would need
optimum dignity and independence for the residents.
a high level of care if he or
Code of Maryland Regulations 10.07.14.02B(10).
There is a wide variety of assisted living
providers in Maryland. They range from
large, corporate-managed facilities where
hundreds of people live in their own
apartments to small, private homes in
which the owners provide services to two
residents who may share a bedroom.
What all of these providers have in com-
mon, however, is they all offer their
residents some level of assistance with
their daily activities, like dressing, bathing
and eating.
Levels of Care
Assisted living facilities in Maryland
are licensed to provide up to three
levels of care.
The levels correspond with how much
assistance residents need. Licensure at
level one means the provider is autho-
rized to take care of residents with low
care needs. A level two license means
the provider can also take care of
residents with moderate care needs, and
a level three license allows a provider
to care for residents with high-level
care needs (as well as residents with
low or moderate needs).
she is mentally confused
by dementia, has a compli-
cated list of powerful
medicines that must be given
at different times each day,
WAYS IN WHICH ASSISTED
LIVING PROVIDERS DIFFER:
❖ Facility size;
❖ Staff qualifications;
❖ Location;
❖ Fees, what is included in the monthly
fee varies widely;
❖ Sponsorship: non-profit vs. for profit
vs. religious affiliation;
❖ Free standing facility vs. a campus
type setting;
❖ Experience and reputation of pro-
vider;
❖ Private room vs. semi-private room;
❖ Private bathroom vs. common bath-
room;
❖ Provider participation in Medical
Assistance;
❖ Ability to age in place: levels of care,
potential for level of care
waivers;
❖ Visiting hours; bedtimes; wake-up
times; mealtimes.
8 - Assisted Living in Maryland: What You Need to Know
and requires assistance with bathing, Functional Assessment
eating, walking, dressing, and toileting.
Such a person could only be accepted by
a provider with a level three
license.
Most providers are licensed at
level three, which means they
can accept residents with low,
moderate, or high care needs.
If you have a progressive
condition and do not want to
have to move repeatedly, you
should look for a provider
with a level three license
even if you only need a low
level of care now.
Assessment and Service Plan
Before you move into an assisted living
facility, the assisted living manager
must assess the level of care you require
and whether you qualify for admission
under the provider's license. For
example, if you need a moderate or
high level of care and the provider is
only licensed to provide a low level of
care, the provider will not be able to
admit you. There are two parts to an
assessment: the Resident Assessment
and the Functional Assessment.
Resident Assessment
A resident assessment is based on a
physical examination made by a medi-
cal professional. It records a lot of
basic medical information.
The assisted living manager must
conduct a functional assessment. A
functional assessment measures
and records various kinds of
information, such as your
ability to take care of your
daily needs and how much
help you need from others.
It also records current
symptoms you have that
would have to be moni-
tored by an assisted living
provider. In addition to
your physical needs, the
functional assessment also
looks at things like your ability
and desire to participate in group
activities.
Service Plan
The manager must also develop a plan
for your care based on the overall
assessment. This plan is called the
“service plan.” A service plan must
state what services you are to be pro-
vided, when they are to be provided,
and who will provide them. You are
entitled to participate in the develop-
ment of your service plan. Moreover, a
service plan must be updated every six
months or more frequently, if there are
changes in your needs. Your service
plan is very important because it speci-
fies precisely what services you will
get, when you will get them, and how.
Each assisted living manager must
Assisted Living in Maryland: What You Need to Know - 9
make sure that every resident is monitored Laundry and Housekeeping
daily to see that a resident’s care is
provided in accordance with the service
plan.
Activities of Daily Living and Other
Required Services
Activities of Daily Living
A large part of what assisted living
providers do is provide assistance with
"activities of daily living,” which
include:
❖ Eating;
❖ Grooming, bathing, oral hygiene,
shaving, and combing hair;
❖ Walking or getting around, with or
without assistive devices;
❖ Toileting; and
❖ Dressing in clean, weather-appro-
priate clothing.
Often this type of assistance is called
“personal care” or “personal care
service.”
Other services that assisted living
providers in Maryland are required to
deliver include:
Meals
Meals must be served in a common
dining area three times a day seven days
a week. Snacks also must be
offered at intervals each day.
While every assisted living
provider must try to accom-
modate special diets, a
provider does not have to
provide a special diet that is
beyond its capabilities.
Housekeeping and laundry services are
required services that must be offered
by every provider. Typically a certain
amount of these services are covered by
the basic monthly fee. What that
amount is varies greatly from provider
to provider.
Facilitating Access to Healthcare and
Social Services
While a few assisted living providers
may employ part time nurses, most
providers do not supply the kind of
medical care offered by licensed health
care professionals. However, every
assisted living manager is “responsible
for facilitating access to appropriate
health care and social services,” such as
physicians, nurses, social workers,
dentists, hospice care, etc. “Facilitat-
ing access” is a flexible phrase so
different providers implement this
requirement in widely different ways.
Some providers only provide help with
scheduling appointments, and you will
have to arrange for your own transpor-
tation. Others will arrange appoint-
ments and provide transportation, while
some providers go so far as to arrange
for services to be delivered at the
facility. You will want to ask providers
how they facilitate access to health care
and social services.
10 - Assisted Living in Maryland: What You Need to Know
Social and Spiritual Activities Medication Management
The manager of each provider must
provide or arrange opportunities for
activities that will promote the physical
and mental health of each resident.
This includes facilitating access to
spiritual and religious activities. Typi-
cally providers satisfy this requirement
by conducting activities in the facility
and by arranging transportation to
activities outside the facility. Card
games, bingo, and sing-alongs are the
kind of activities you will find in many
facilities. Typical activities outside a
facility may include trips to the mall,
grocery store, and local worship ser-
vices. Transportation charges may
apply, and when they do, they can vary
widely.
During the initial assessment process
the assisted living manager must deter-
mine if: (1) you can handle your own
medications, (2) you need assistance
with your medications or reminders to
take them, or (3) need someone to
administer your medications for you. If
you need assistance
with your medications
or need someone to
administer them for
you, the provider must
have specially trained
staff to supply that help
to you.
Assisted Living in Maryland: What You Need to Know - 11
12 - Assisted Living in Maryland: What You Need to Know
CHAPTER 2
CHOOSING AN ASSISTED
LIVING PROGRAM
Choosing a high quality assisted living
provider that meets your needs and your
lifestyle can be quite a challenge.
Assisted living providers in Maryland
range in size from small, family-style
homes with two people sharing a
bedroom, to large apartment complexes
housing several hundred residents. The
services they offer can be just as varied.
Getting Started
living guides and other publi- discharge policies. Chapter 4
cations. The resources listed contains detailed information
in Chapter 9 will help. If
To find out what facilities exist in the
area you are interested in, ask your
friends and other acquaintances, check
with your local agency on aging, and
look at newspapers, retirement
❖ What types of living units are
available?
❖ If none, do you have a waiting list?
❖ What is your monthly fee?
❖ Do you require a deposit?
❖ What services do you provide?
❖ What services are included in the
monthly fees?
❖ What services are extra?
Request a brochure, a price list, and a
copy of the Resident Agreement (con-
tract) so that you can review those
items before you visit. Do not rely on
what the brochure says. Read the
contract closely, paying special atten-
tion to costs, services provided, and
on what to look for in a Resi-
possible, try to choose a dent Agreement.
facility that is near your
family or friends. Also, request a copy of the
assisted living provider's Disclo-
Once you have a general sure Statement. This disclosure state-
idea of what setting, services, and price
range you prefer, call several facilities
in the location you are considering.
Ask the manager or administrator the
following preliminary questions to help
you narrow your search:
❖ What is the size of your facility?
❖ What level of care are you licensed
to provide?
ment must include information about
other facilities operated by the same
organization, the organization's reli-
gious or charitable affiliations, the
name of the manager, and a description
of special programs offered. There is
no cost for this document.
Assisted Living in Maryland: What You Need to Know - 13
Before you make any decisions, visit as Visits can be exhausting. After a while
many facilities as you can. Take a tour, the different providers and their facilities
talk to residents and to may start to blend
staff, and ask a lot of in your memory.
WHEN YOU VISIT
questions. Have a The checklist on
friend or family mem- pages 14 - 19 will
❖ Ask the manager to show
ber go with you to be help you organize
you around the building and
another set of eyes and your visit, ask the
grounds.
ears. You can com- right questions, and
❖ Consider the overall atmo-
pare notes later. record your obser-
sphere of the facility.
If you need help vations. The
❖ Talk to members of the staff:
selecting a facility, you checklist is lengthy
are they friendly and help-
may want to hire a so you must review
ful?
geriatric care manager. it before you go
❖ Chat with residents, their
Geriatric care managers and highlight or
friends, and families.
are professionals who mark the questions
❖ Observe how the staff
specialize in assessing a that are the most
interacts with residents.
person’s needs and important to you.
❖ Eat a meal. (There may be a
arranging housing and Make as many
charge for the meal.)
services to meet those copies of the
needs. See Chapter 9 checklist as you
for the telephone like. You should
number of the National Association of
Professional Geriatric Care Managers,
which can refer you to a local care man-
DOCUMENTS TO GET
ager.
AND
READ
Visiting Facilities
If you do not already have them by the
time you visit, be sure to get a copy
Once you have decided which facilities to
of the:
visit, call to make an appointment. Try to
visit each facility more than once, to get
❖ Resident Agreement (contract),
a better sense of what life is like for
❖ List of services offered,
residents. Plan your first visit for a week-
❖ Notice of resident's rights,
day, during late morning or at midday if
❖ List of costs,
possible, and another on a weekend or in
❖ Disclosure statement, and
the evening. Make the second visit
❖ Any other documents that resi-
unannounced. Be concerned if the
dents must sign at admission.
provider will not allow you to make an
unscheduled visit. You may even want to
Carefully review these documents
ask about spending the night to get a sense
and read Chapter 4 before signing
of how the facility is run during off-peak
any papers!
hours.
14 - Assisted Living in Maryland: What You Need to Know
use one copy for each facility you visit.
Use a notebook for additional information
and questions. The answers to the
checklist questions can be used to com-
pare facilities once you have visited them.
If you are not able to get all the questions
answered during one
visit, visit again or
call on the telephone
to get the answers.
Judging Quality
You will learn a great
deal by visiting a facility, asking
questions, reviewing the Resident Agree-
ment, and reviewing other written materi-
als. But you will also want to consider the
quality of the services and care provided.
You can go to see or request copies of
inspection results and plans of correction
from the Office of Health Care Quality.
(There may be a charge for copies and it
may take as long as 30 days to get them.)
See Chapter 9 for the address. You will
want to find out:
❖ How recently was the provider
inspected?
❖ Were any violations found?
❖ What were the violations?
❖ Have the problems been corrected?
Remember to focus on the seriousness of
any violations, not just the number of
them.
Your local Long-Term Care Ombudsman
Program may also have information about
a particular service provider, including
whether the provider has received com-
plaints, and how those complaints were
resolved. See Chapter 9 for the number
for your local Long Term Care Ombuds-
man.
You can also ask an assisted living
provider you are considering for a
copy of its most recent inspection
report. The law requires providers
to make copies available.
Certain factors contribute to quality
care. They include:
❖ Consistent and responsive ownership;
❖ Stable, well-trained staff;
❖ The number of residents per staff
member;
❖ Interaction with the community;
❖ A provider philosophy that empha-
sizes residents’ dignity and indi-
vidual needs;
❖ A mission to eliminate restraints, or
to use them only when no individu-
alized care plan works.
❖ Teamwork between management
and staff; and
❖ Respect and advocacy for residents'
rights.
Keep these factors in mind during your
visits and while reviewing any inspec-
tion reports.
Assisted Living in Maryland: What You Need to Know - 15
Checklist for Selecting an Assisted
Living Facility
1
The complete checklist that follows is
organized into eleven sections:
1. Costs & Contracts
2. Personal Care
3. Health Care
4. Transportation
5. Activities & Socializing
6. Meals
7. Housekeeping & Laundry
8. Safety/Choice
9. Facility Initiated Discharge
10. Licensure
11. Special Care/Dementia Units.
1. Costs and Resident Agreement
(Contract)
The Resident Agreement is a legal
contract, obligating you to potentially
pay very large sums of money for care.
Ideally, you will have gotten a copy of
the Resident Agreement and reviewed it
before you visit. Chapter 4 explains
what to look for in a Resident Agree-
ment.
If you have not gotten a copy before
you visit, make sure you get a copy and
during the visit ask any of the following
questions that are important to you.
Later review the Resident Agreement
carefully with Chapter 4 in hand before
you agree to sign.
❖ Is the print large enough for you to
read? (If not ask for a copy that is.)
❖ What services are provided for the
basic (usually monthly) fee?
❖ What is the current amount of the
basic (usually monthly)
fee?
❖ What services are
available for an addi-
tional charge?
❖ What is the amount of
each additional
charge?
❖ Is there a refund policy in
cases of transfers, discharges,
changes in ownership, or an
assisted living facility closing?
❖ When will any refunds be paid?
❖ What behaviors, conditions, or other
circumstances can result in termination
of services?
❖ What type of living unit will I have?
❖ What are the rights of residents?
❖ What is the provider’s grievance
procedure; and what alternatives are
there if I am not satisfied with the
results of the procedure?
❖ What, if any, initial payments are
required?
❖ If any are required, how much are
they and what are they for?
❖ What happens if my funds run out?
❖ What is the provider’s policy on
relocating residents in the facility?
❖ If I am away from the facility for a
period of time, (e.g., visiting family, in
a hospital, or temporarily in a nursing
home) what fees stop?
❖ Is there a charge to hold a bed during
an absence?
❖ If there is a charge, when does it
begin?
❖ How long will you hold a bed for me?
❖ When, how often, and why can the
fees be changed?
❖ When fees are changed, who is
informed, and how?
16 - Assisted Living in Maryland: What You Need to Know
❖ How much advance warning is pro-
vided of fee changes?
2
❖ Does the provider
participate in the
Medicaid waiver
program?
2. Personal Care
Take into consideration
that you may need more
care in the future than you need now. If
you do not want to move again, ask
questions about care that you do not
need now, but may in the future. In any
event, you will want to ask the ques-
tions below.
Meeting Individual Needs
❖ How often will my level of care be
reassessed?
❖ How many residents are you li-
censed to serve?
❖ What level of care are you licensed
to provide?
❖ How will the provider meet my
current care needs (e.g., inconti-
nence, insulin shots, etc.)?
❖ What happens if my needs change -
I need more help, become inconti-
nent, become confused?
❖ How does the provider tailor sched-
ules for preferences of residents
(like bathing and waking times)?
❖ How does the provider help resi-
dents maintain their abilities to
toilet, dress, and eat?
❖ Is there a schedule for staff to check
on each resident's whereabouts and
well being?
❖ What resources does the provider
have to address difficult behavior?
❖ Are bedrooms, hallways, doorways,
bathrooms, and common areas fully
accessible to people with walkers or
wheelchairs?
❖ If rooms are shared, what does the
provider do if there are problems
between roommates?
Written Service Plan
❖ What professionals/staff will be
involved in the development of my
written service plan?
❖ How often is the plan revised?
❖ How will my family and I be in-
volved?
❖ What involvement does a confused
resident have?
❖ What happens if I do not agree with
the service plan?
Staffing
❖ How many staff are there for each
shift?
❖ What are their responsibilities?
❖ What is the training/certification of
the people who care for residents?
❖ What other duties do direct care
staff have?
❖ Which direct care staff on each shift
is fluent in my native language?
❖ Is there special training for staff
about dementia and Alzheimer's
disease?
❖ How is staff trained to deal with
aggressive individuals?
❖ How is staff trained to deal with
wanderers?
❖ What if I do not like the staff person
assigned to me?
❖ What is the staff turnover rate?
3. Health Care
While most assisted living providers are
not designed to provide medical care, a
Assisted Living in Maryland: What You Need to Know - 17
provider must make sure residents have
access to health care either on or off
site. It is important to evaluate the
provider’s capacity to manage or coor-
dinate health care needs because you
may need more help in the future.
Provision and Monitoring of Health
Care
❖ What kinds of health monitoring
checks are available (e.g. weight
change, glucose levels, etc.)?
❖ If a nurse is not on staff, are there
regularly scheduled visits by a nurse
or other health provider?
❖ If so, what medical services do they
provide?
❖ How will the provider facilitate my
access to health care and social
services?
❖ Will the provider schedule routine
medical appointments for me?
❖ Will the provider schedule transpor-
tation to and from medical appoint-
ments?
❖ What health services are available
on site: e.g. nursing care, lab work,
physical therapy, wound care,
hospice, social work, podiatrist,
etc.?
❖ What health services does the
provider furnish, and what does it
arrange for outside agencies to
provide?
❖ Under what circum-
stances and when will
the provider call my
family?
❖ Under what circum-
stances and when will
the provider call my doctor?
Medication Management
❖ What safeguards are in place to
ensure that I get the appropriate
medications on time and in the correct
dosage?
❖ Who is responsible for having pre-
scriptions filled?
❖ Must I use the provider’s pharmacy,
even if it costs more than my phar-
macy?
❖ Who gives out medications?
❖ If not a nurse, how are staff trained
and supervised about medications?
❖ If I am able, will I be allowed to take
care of my medications on my own?
4. Transportation
Questions to ask about transportation
include the following:
❖ Is any trans-
portation
provided?
❖ If so, how often
(daily, weekly,
evenings, weekends)?
❖ To where is transportation provided
(grocery stores, shopping malls,
medical appointments)?
❖ Will the provider call and arrange for
transportation it does not provide?
❖ Is transportation available if I want to
go to an event by myself or with a
friend?
❖ Are there fees for using the provider’s
transportation or transportation
arranged by the provider?
❖ Is transportation wheelchair acces-
sible?
18 - Assisted Living in Maryland: What You Need to Know
5. Activities and Social-
izing
When looking at the
activities a facility offers,
think about your prefer-
ences. Some people enjoy
scheduled activities, such as
current events discussions, crafts, bingo,
card games, etc. Others have never been
“activities people” and will not care to
participate. They would rather read a
book. You may want to go on trips and
outings. Look at a monthly activity
schedule to see if the activities appeal to
you. Inquire about the following:
❖ How often are activities in the
community sched-
uled?
❖ Will staff attend with
me?
❖ Are there protected
or enclosed walking
areas for residents?
❖ How are resident’s
religious or spiritual
needs met?
❖ Who develops and supervises recre-
ational activities?
❖ How do residents have input into
the activities offered?
❖ What is the provider’s policy on
pets?
❖ What is the policy on visitors?
6. Meals
Meals are important to residents of
assisted living because they are usually
dependent on the food provided by the
provider. So sample a meal on your
visit to see how it tastes. Questions to
ask include the following:
❖ What times are meals served?
❖ What happens if I am late, miss a
meal, or refuse a meal?
❖ How will any special dietary needs I
have be met?
❖ When can I have a tray delivered to
my room?
❖ Is there an additional charge for tray
service?
❖ If I do not like a meal, what are the
alternatives?
❖ When are snacks available?
❖ May I see the printed menu for the
past month?
❖ How do you make sure each resi-
dent is taking in adequate nutrition?
7. Housekeeping and Laundry
❖ How often will my room be
cleaned?
❖ How often will my linens be
changed?
❖ Will the provider do my personal
laundry?
❖ Are washing machines available for
me to use at the facility?
❖ If so, is there any cost to use them?
❖ What extra charges, if any, are there
for additional housekeeping or
laundry services?
8. Safety and Choice
Assisted living providers should em-
phasize independence and choice. They
also have rules and procedures designed
to protect residents from harm. It is
important to match your ability with the
extent of choices and opportunities
offered by a provider, as well as the
limitations it will impose upon you.
Assisted Living in Maryland: What You Need to Know - 19
Questions to ask include:
Safety
❖ What safety measures are in place to
protect resident's personal property
from being stolen?
❖ What safety measures are in place to
protect residents from wandering
away?
❖ Are exit doors alarmed?
❖ Are there call bells in each room and
bathroom?
❖ Are the floor coverings made of
nonskid material?
❖ Is there a fire emergency plan?
❖ What are the safety arrangements for
people in wheelchairs to escape in
case of fire?
❖ How often are there fire drills?
❖ How do residents with limited mobility
participate in fire drills?
❖ Are emergency plans publicly dis-
played?
Emergencies
❖ What kind of emer-
gencies are staff
expected to handle
and how are they
trained for them?
❖ Who decides whether to call
911?
❖ May I have a copy of any written
policies about how that decision is
made?
❖ Will my family be notified immediately
if 911 is called?
Choice
❖ How much of my own furniture and
personal possessions may I bring?
❖ What if I want an exception to a
policy, e.g. signing in and out, smok-
ing, or eating foods that are not on a
prescribed diet?
❖ What is the
provider’s policy on
smoking?
❖ Will the provider
require that I partici-
pate in any particular activity or
program?
9. Facility Initiated Discharges
Answers to these questions will help you
clarify a provider’s ability to care for
people with health and behavior conditions
that can be difficult to manage. It will also
help you determine if you have recourse if
you are asked to leave.
❖ What are the possible reasons for
discharge?
❖ Is there an internal appeal process?
❖ What is it?
❖ How many days notice is given and to
whom?
3
❖ How does the facility assist you if it
proceeds with discharge?
❖ Is there a refund if there is a dis-
charge?
10. Licensure
❖ When was the provider last inspected
by State licensing authorities?
❖ What, if any, violations have been
cited by the authorities in the past two
years?
❖ Did the provider submit a plan of
correction?
❖ May I have a copy of the inspection
results and any plans of correction?
20 - Assisted Living in Maryland: What You Need to Know
_________________________________________________________________
11. Special Care or Dementia Units
This section is directed to family members
or other interested persons, because it
would be unusual for the person who
needs a special care unit to be asking
these questions.
❖ Is there a separate
area specifically for
people with demen-
tia?
❖ How do services in
the special care unit
differ from services
in the rest of the
facility?
❖ What is the differ-
ence in staff train-
ing?
❖ What is the staff-to-
resident ratio?
❖ Is there a special out door area for
residents with dementia to use?
❖ What techniques do you use to
ensure that the resident is getting
proper nutrition?
❖ Do you offer decaffeinated drinks
throughout the day?
❖ Does the calendar of activities look
appropriate for the resident?
❖ What is the provider’s policy on
restraints, both chemical and physi-
cal?
❖ How much space is there to walk
around on the unit?
❖ Are the room’s private or semipri-
vate?
❖ When rooms are shared, what does
the provider do if there are prob-
lems between roommates?
❖ What is the cost difference between
special care and regular units?
1
Copyright © 2001 Consumer Consortium on
Assisted Living. The Consumer Consortium on
Assisted Living (CCAL) originally developed
this questionnaire with assistance from the
Arlington Area Agency on Aging and the
Northern Virginia Long Term Care Ombuds-
man Provider. Other professionals and
potential consumers reviewed it as well. It
has been significantly modified for use in
Maryland.
2
By Maryland law at least 45 days notice is
required.
3
By Maryland law, at least 30 days notice of a
discharge is required except in emergencies.
Assisted Living in Maryland: What You Need to Know - 21
22 - Assisted Living in Maryland: What You Need to Know
CHAPTER 3
WHAT WILL IT COST AND HOW TO PAY
FOR
ASSISTED LIVING
What Will It Cost fee,” “community fee,” “deposit,” “activity
fee,” or any other of a number of names.
While assisted living is usually more Depending on the contract, you may
affordable than a nursing home, assisted recover all, part, or none of an initial or
living can be very expensive. The cost monthly fee when you leave.
of assisted living varies greatly, ranging
from under $1,000 to over $5,000 per Most facilities base their fee on how
month. The average cost for a month is much care you need. The facility
about $2,000. The variation is based on evaluates you at the time of admission,
many factors, including: and conducts re-evaluations regularly
while you continue to live there. The
❖ The kind of and number of services more care that you need, the higher the
offered; fee. A facility may have several "levels
❖ The size, design, and amenities of of care" for which it charges. These
the facility; “levels” are not always identical to the
❖ Whether your room is private or is three levels of care the State uses to
shared; and license and regulate assisted living
❖ The geographic location. facilities. When they are not identical,
confusion can result so make sure to
Most assisted living facilities charge a ask enough questions to make sure you
daily rate and bill you monthly. Provid- understand.
ing care is labor intensive, and rates
usually go up each year
due to increases in
operating costs and
labor.
While most assisted
living facilities charge a
monthly fee, some may
also require an addi-
tional fee before or
shortly after you move
in. These initial fees
may be called “entrance
Read the Resident Agreement or
contract carefully to learn if you
will receive a refund of any initial
fees or monthly fees you have paid
should you decide to leave the
facility. Any refund policy must be
described in the Resident Agreement. It
should state, if, how, and when you can
obtain a refund should you decide to
leave the facility. Consider having an
attorney look at it.
Assisted Living in Maryland: What You Need to Know - 23
In addition to the basic monthly fee for
each “level of care,” an assisted living
facility may charge you for what it
considers to be additional or extra
services that are not included in the
monthly charge. No standard exists for
what is an “extra” service, and each
facility sets its own policy. Such
“extras” may include:
❖ Nursing service;
❖ Incontinence care;
❖ Extra assistance with daily tasks not
covered by the basic fee;
❖ Medication administration;
❖ Special diets, snacks, and room
service meals;
❖ Maid service;
❖ Laundry;
❖ Cable television;
❖ Private telephone line and
utility services;
❖ Personal services like
barber or beauty parlor
services; and
❖ Transportation.
The cost of assisted living
care may very well exhaust
your savings. Assisted living
facilities are not obligated to continue
to keep you if you cannot pay for
services. Nonpayment will be a ground
for discharging you. It is important for
you to consider what would happen if
your money ran out while you lived in
assisted living, and to have a plan for
that possibility.
How To Pay For Assisted Living
Except in the few situations mentioned
below, very few government programs
pay for assisted living. Almost all
assisted living services are paid for by
residents (or their families) out of their
personal funds. Long term care insur-
ance generally will pay for assisted
living, but the insurance must be pur-
chased in advance and paid for from
personal funds.
Health Insurance, Medicare, and
Medicaid
Many people think Medicare or private
health insurance help pay for assisted
living and other long-term care ser-
vices. This is wrong. Medicare
and private health insurance
usually will not pay for
the costs of assisted
living.
If you have limited
resources, Medicaid may
provide financial assis-
tance under certain
limited circumstances.
Ordinarily, Medicaid is available for
long-term care only if you reside in a
nursing home. However, Maryland has
a new Medicaid program that can pay
for assisted living services if you meet
its strict eligibility requirements. The
new program is called the Medicaid
Home and Community Based Waiver
Services for Older Adults (“Medicaid
Waiver Program”). It serves a limited
number of people. If all the openings
are filled, Medicaid will not be able to
pay for your assisted living services.
24 - Assisted Living in Maryland: What You Need to Know
To qualify for the Medicaid Waiver Senior Assisted Living Group Home
Program, you must be at least 50 years
old and meet both the medical and
financial eligibility standards. To
satisfy the medical standard, you must
require enough care to qualify to live in
a nursing home (even though you plan
to live in assisted living).
The financial eligibility standards are an
income test and asset test. You must
have limited income and assets to be
eligible. The financial eligibility rules
are complex, but basically, your assets
have to be less than $2,500 or $2,000,
depending on eligibility category, and
your monthly income cannot exceed
three times the SSI amount for a single
person. This number is adjusted annu-
ally for inflation and is $1,635 in 2002.
Medicaid will not count as assets, your or
your spouses’s, cars or pre-arranged
funerals. Also, under certain circum-
stances, your spouse can keep up to half
of your joint assets.
The eligibility standards are too
Subsidy Program
The Maryland Department of Aging has
a limited subsidy program that you may
be eligible for if you are elderly and live
in an assisted living facility that partici-
pates in the subsidy program. Only
facilities that have between four and
sixteen beds participate in this program.
There are often waiting lists for the
program.
To be eligible you have to have limited
assets and income. While the numbers
change from year to year, in order to be
eligible at the time this booklet was
printed in 2002 your monthly income
would have to be less than $1,945 and
your assets less than $11,000. To apply,
or for more information, contact your
local agency on aging. See Chapter 9
for the agency on aging closest to you.
Long-Term Care Insurance
Long-term care insurance can
complex to be summarized in pay for assisted living. The
this booklet so for more cost of long-term care insur-
information on eligibility ance varies greatly, depending
for the Medicaid Waiver on the options you select and
Program call the Legal Aid
Bureau’s Assisted Living Project or
your local agency on aging. You can
also get an application from your local
agency on aging. See Chapter 9 for the
agency on aging closest to you and the
contact information for the Legal Aid
Bureau. You can also get information
from the Legal Aid Bureau’s website at
www.mdlab.org.
your medical condition. If
you already need assisted living ser-
vices, you probably will not be able to
purchase a policy. If you are over age
85, even if you are in good health, you
may also have a hard time finding a
policy.
Assisted Living in Maryland: What You Need to Know - 25
The older a person is when a policy is
purchased, the more expensive the
policy will be. However, even if it is
too late for one spouse to purchase
coverage, it may not be too late for the
other spouse to buy a policy.
Annual premiums can range from a few
hundred dollars for a healthy 40-year
old to thousands of dollars for a 70-year
old. Most policies offer premiums that
are "level," that is, the rates do not
change as you age. However, an insur-
ance company typically can raise rates
for a group of policyholders if it can
show the rates are too low.
Long-term care insurance policies are
offered in many different options. It is
very important for you to understand
what a particular policy covers, as well
as the rules affecting when the policy
goes into effect.
What services are covered
Make sure the insurance policy includes
assisted living care. It is a good idea to
buy a policy that covers all types of
long-term care: home care, day care,
assisted living, and nursing home
services. Long-term care insurance
may not necessarily include assisted
living services, although most policies
written in the last few years will. Older
policies may be limited to nursing home
care or at-home care. The “assisted
living” concept was not common until
recently so many older policies do not
mention it or cover it.
Tax Deductions
Long-term care insurance premiums
may be deducted from your federal
income taxes. The deduction is based
on the age of the person insured. The
deduction covers only a small part of
the actual insurance policy cost, ranging
from about $220 for persons age 40 or
less to about $2,700 for persons over
age 70, but it should not be overlooked.
Maryland offers a one-time state in-
come tax credit of up to $500 for your
purchase of long-term care insurance.
A credit is different from a deduction in
that the full amount is taken directly out
of the amount of taxes owed to the
State.
For More Information
For more information about long-term
care insurance, contact the United
Seniors Health Cooperative, 409 3rd
Street SW, Suite 200, Washington, D.C.
20024, telephone (202) 479-6678; the
Maryland Insurance Administration at
(410) 468-2000 or 1-800-492-6116; or
your local Senior Health Insurance
Assistance Program. See Chap-
ter 9 for information on your
local Senior Health Insurance
Assistance Program.
Reverse Mortgages
Reverse mortgages enable you
to convert the equity in your
home to cash. The cash can be
spent to pay for assisted living.
However, in most cases, to
qualify for a reverse mortgage, there
must be one borrower living in the
26 - Assisted Living in Maryland: What You Need to Know
home. So, if you are single, a reverse
mortgage probably will not help with
assisted living expenses.
A reverse mortgage is based on your
age, the value of your home, and inter-
est rates. Reverse mortgages are avail-
able to you if you are at least 62 years
of age. The value of the home will be
less after you take out a reverse mort-
gage. This means that your heirs will
receive less money than they would if
there was no reverse mortgage on your
home.
Banks, mortgage firms, and financial
service companies offer reverse mort-
gages. You should do a lot of research
to make sure you find a reputable
reverse mortgage lender. There have
been unscrupulous people using the
reverse mortgage idea to scam seniors.
You should also shop around to com-
pare options. For more information,
contact the National Center for Home
Equity Conversions at (651) 222-6775
or visit their website at
www.reverse.org. Reverse mortgages
can have substantial financial ramifica-
tions so you should contact a financial
planner, accountant, or attorney before
entering into one.
Tax Deductions and
Credits
If you are paying out of
your own pocket, some or
all of the cost for assisted
living may be tax deductible as a
medical expense. To get the deduction,
a resident must be “chronically ill” and
receive care prescribed by a doctor or
another health care provider. See IRS
Publication 502 for more information.
To be considered “chronically ill” your
doctor or other licensed health care
practitioner must determine that you are
unable to perform at least two activities
of daily living for at least 90 days
without substantial assistance from
another or that you have a severe
cognitive impairment (such as
Alzheimer's disease) and need substan-
tial supervision to be protected from
threats to your health and safety.
You can only deduct medical expenses
that are more than 7.5% of your ad-
justed gross income. Thus, you can
only have a deduction for assisted
living costs if your total medical ex-
penses, including your assisted living
costs, exceed 7.5 % of your adjusted
gross income.
Consult your tax advisor for more
information about the tax deductibility
of assisted living services.
Assisted Living in Maryland: What You Need to Know - 27
28 - Assisted Living in Maryland: What You Need to Know
CHAPTER 4
BEFORE YOU SIGN A
CONTRACT . . . READ THIS
Before you move into an assisted living
facility, you and the provider must sign
a contract, called an assisted living
Resident Agreement.
It is very important that you read the
Resident Agreement carefully and
understand it before you sign. The
contract—not the facility's salespeople
or brochures—will determine what
services you will receive, and at what
cost. In most cases, an assisted living
provider is only legally required to
supply what is stated in the Resident
Agreement. What the sales brochure or
sales person said seldom counts.
Read the Resident Agreement carefully.
Is the print large enough for you to
read? If not ask for a copy that is. If
you can, before you sign the Agree-
ment, have it reviewed by a lawyer who
is familiar with assisted living. You
may obtain help finding such a lawyer
by calling the local bar association for
your county or city or by viewing the
roster of the Maryland State Bar
Association’s Elder Law Section on the
internet at www.msba.org/sec_comm/
elder/roster.htm. The Legal Aid office
will review the contract at no cost if
you are eligible.
Chapter 2 contains an extensive list of
questions designed to help you choose
an assisted living provider. You should
use that same list as you review the
Resident Agreement.
Start by reading the Agreement straight
through once. Then go back and reread
it with the checklist questions in hand.
The only section of the checklist ques-
tions in Chapter 2 that will not be
helpful are those in Part 10, “Licen-
sure.” If the answer to a question in
Chapter 2 is important to you and you
want the provider to be bound by its
answer, then the answer needs to be
somewhere in the Resident Agreement.
If it is not, you will need to add lan-
guage to the Agreement to make your
understanding with the provider clear.
If you add or delete language to or from
a preprinted Resident Agreement be
sure that both you and the facility
representative write your initials and the
date in the margin
next to each change.
Responsible Party
A provider may ask
you to have a family
member or friend
sign the Resident
Agreement as an
“agent,” “responsible party,” or other
similar name. Your family member or
friend should not sign the Agreement
Assisted Living in Maryland: What You Need to Know - 29
without understanding completely what
that means. What the word or phrase
means should be clear from the lan-
guage of the Agreement. If a represen-
tative of the provider has to tell you
what the word or phrase means, either
(1) do not sign the Agreement or (2)
strike out the word or phrase before
signing. The Agreement should make
completely clear whether the person
signing as “agent,” “responsible party,”
“representative,” etc. is required:
1. To pay for your care using only your
funds; or
2. To pay for your care using his or
her own funds.
Needless to say, there is a big differ-
ence! People’s lives have been seri-
ously affected by a few slippery words
in this area, so be very careful!
Many sons and daughters have been
surprised to learn that an assisted living
provider maintains that the Resident
Agreement obligates them to pay for their
parent’s assisted living care out of their
own personal funds. Make sure the
Agreement is completely clear about the
financial obligations of anyone signing
the Agreement as an “agent,” “personal
representative,” or other similar phrase.
The Rest of This Chapter
The rest of this chapter sets forth a
number of questions to ask yourself as
you review the Agreement. Many of
the questions in this Chapter deal with
the same issues as the Checklist Ques-
tions in Chapter 2. You should read this
Chapter anyway because doing so will
emphasize the issues that a Resident
Agreement should cover.
What to Check For - Generally
Check carefully for the following:
❖ What are there extra fees for:
To remind the resident to take
medication?
Incontinence care?
Assisting with bathing?
Laundry?
Anything else?
❖ What if you run out of money to
pay the monthly fee? How much
time does the facility give you
before it discharges you? (A study
of people leaving assisted living
reported that one in ten left because
they had run out of money.)
❖ What happens if your health prob-
lems become more serious? Will
the facility keep you on with private
nurses in attendance or will they
require you to move to a more
intensive health setting?
30 - Assisted Living in Maryland: What You Need to Know
√√
√√
Does the resident agreement clearly
describe:
❖ What services are provided for the
basic (usually monthly) fee?
❖ What services are available for an
additional charge?
❖ The amount of each additional
charge?
❖ Whether there is a charge to hold a
bed during an absence?
❖ A refund policy in cases of trans-
fers, discharges, changes in owner-
ship, or closing?
❖ Behaviors, conditions, or other
circumstances that may result in
termination of services’?
❖ The type of living unit you will
have?
❖ Rights of residents?
❖ A grievance procedure; and alterna-
tives if you are not satisfied with the
results of a grievance?
❖ What, if any, initial payments are
required (e.g. entrance fee, deposit,
move in fee, community fee, activ-
ity fee, security deposit, etc.)?
❖ What happens if your funds run
out?
❖ Internal relocation policy?
❖ When any refunds will be paid?
❖ What happens if you have to leave
the assisted living facility for a
medical emergency? Do you get
your money back?
If after reading the Resident Agreement
carefully the answer to any of the above
questions is “No,” be wary. Raise your
concern with the provider’s manager
and make sure the Residence Agree-
ment is clarified in writing to your
satisfaction.
What to Check For - Services
Levels of Care
As explained more
fully in Chapter
One, assisted living
facilities may be
licensed to provide
up to three levels of
care to their resi-
dents: a low level of
care, a moderate level of care, or a high
level of care. Levels of care are set
based on an assessment of what ser-
vices a resident needs. The Agreement
must explain what levels of care the
facility is licensed to provide. If you
move into a facility licensed to provide
low or moderate levels of care, and you
later require a high level of care, the
facility may no longer be able to pro-
vide you care. The Agreement should
explain how your level of care will be
determined, how often your level of
care is reviewed and by whom, and who
can change your level of care.
Assistance with Activities of Daily
Living
You should be informed of exactly what
services are available, what level of
assistance will be provided, and at what
cost. The Agreement should at least
promise assistance with the following
activities if you need them: eating,
bathing and grooming (including
brushing teeth, shaving, and combing
√
Assisted Living in Maryland: What You Need to Know - 31
hair), dressing, toileting, and mobility.
Often, facilities will provide different
levels of assistance depending on your
level of care, and charge different rates
for each level. Some facilities may
charge a separate fee for additional help
with some activities.
Health/Medical
Care
The Agreement
should explain what
type of assistance
with medications is available, such as
verbal reminders or hands-on assis-
tance. The Resident Agreement should
also explain whether doctors and other
health care professionals come to the
facility or whether the facility will help
you arrange transportation for your
doctor visits.
Meals
Meals should be
available three
times a day,
seven days a
week, and there
should be additional snacks each day.
The Agreement should explain how you
are charged for meals. Usually they are
included in the basic monthly fee. The
Agreement should also state whether
meals are provided in the dining area
only or whether you may be served in
your room in certain circumstances.
Are there designated meal times, or can
you eat at another time if you wish?
Will your dietary preferences be consid-
ered? What about medically required
special diets?
Laundry/Housekeeping
The Agreement should explain how
often laundry and housekeeping is
provided, and whether these services
are included in the basic monthly fee.
Does the provider provide linen service
only, or will it handle your personal
laundry? Are washing machines avail-
able on the premises? Are the machines
coin-operated?
Transportation
The Agreement should discuss transpor-
tation services. Do transportation
services cost extra? How often is
transportation provided (daily, weekly,
evenings, or weekend), and to where
(grocery stores, shopping malls, indi-
vidual medical appointments)?
What to Check For—Fees
and Payment
Monthly Fees
Most facilities charge a basic monthly
fee which covers your room and some
services. The challenge is to make sure
you understand which services are
covered by the basic monthly fee and
which are not. The Resident Agreement
should explain exactly what services
are included in the monthly fee, and
whether you pay extra for services, such
as personal laundry, housekeeping, or
transportation. Are utilities, such as
telephone, cable television, water, gas,
and electricity included?
Are different fees charged depending on
your level of care? In other words, will
your basic monthly fee go up if you
32 - Assisted Living in Maryland: What You Need to Know
change from a level one to a level two
classification? With most assisted living
providers, your monthly fee will be higher
if you start receiving a higher level of care.
“Fee for Service,” Prepaid Fees, and
Other Fees
A Resident Agreement must explain all
fees that you may be charged for
services that are not included in
the monthly fee. It must
also explain whether
there are any other
costs or initial fees,
such as “entrance fees,”
“security deposits,” “wait-
ing deposits,” or “mainte-
nance or repair fees.” If there
are refundable fees, check to see
if there are any hidden costs or
restrictions to terminating the con-
tract that would limit the amount of, or
prevent you from getting, your refund.
Rate Changes
The Agreement must explain whether fees
may be increased over time, and under
what circumstances. Maryland law
requires that you be given at least 45 days
written notice before any rate increase. If
the cost of your care increases because
you need a higher level of care, that is not
considered a rate increase.
What to Check For—Termination
and Discharge
If You Want to Terminate the Contract
The Resident Agreement should explain
the termination requirements, for example
that you must give the provider not less
then 30 days notice if you decide to move.
The Agreement must also explain whether
any portion of a fee may be refunded, and
under what circumstances.
If the Facility Decides to Terminate the
Contract
The Resident Agreement must explain
the circumstances under which a
facility may discharge you. One such
reason is if you require a higher
level of care than the facility is
licensed to provide. At times,
a provider may obtain a
waiver from the State to
keep you in its facility, if
you need a higher level of
care than the level for which the
provider is licensed and you do not
want to move.
If a provider decides to discharge you
without your consent, it must give you at
least 30 days notice, except in a health
emergency or if there is a substantial risk
to the health or safety of other residents or
staff. The Resident Agreement should
clearly explain the procedures the facility
will follow if it decides to discharge you or
terminate your Agreement. Is there an
internal appeal process? If the facility is
discharging you because you need more
care (such as nursing care), will it help you
arrange for care at another facility? Will
there be any refund of any fees?
Assisted Living in Maryland: What You Need to Know - 33
BEFORE YOU SIGN A RESIDENT
AGREEMENT, YOU SHOULD—
1. Get a copy of the Resident Agreement ahead of time and read it in the privacy of your own
home. If the facility will not give you a copy, ask why not. You should reconsider whether
you want to live at such a facility.
2. Ask a lawyer to review the Agreement with you or get advice from any of the agencies listed
in this booklet in Chapter 9. You may also be eligible because of age or income to get free or
reduced fee legal information or assistance. Contact the Maryland Senior Legal Hotline at
(800) 999-8904 for more information.
3. Ask the assisted living facility about any part of the Agreement you find confusing or unfair.
If you change the terms, be sure that both you and the facility representative write your
initials and the date in the margin next to each change.
4. Make sure that there are no blank spaces and that the contract is complete and correct at the
time you sign it.
AFTER YOU SIGN AN AGREEMENT, YOU SHOULD—
Get an original signed copy (or a photocopy) of the contract after it has been filled in and signed
by both you and the facility representative.
The Office of Health Care Quality does
not require that a provider obtain the
Office’s approval before the provider
begins to use a Resident Agreement.
However, if you believe that a Resident
Agreement includes illegal terms, or
that it does not meet all legal require-
ments, call the Office of Health Care
Quality at (410) 402-8217 or toll free at
1-877-402-8220.
34 - Assisted Living in Maryland: What You Need to Know
CHAPTER 5
YOUR RIGHTS UNDER
THE
LAW
It is important that you and your family
understand what you are entitled to
once you enter a facility. This chapter
highlights some of your most important
rights.
Refusing Treatment
You have the right to refuse treatment,
and the consequences of refusing
treatment must be fully explained to
you. However, refusal of treatment
may lead to situations that result in the
provider being able to terminate your
contract and discharge you.
QUALITY OF CARE
You have a right to receive treatment, care
and services that are adequate and appropri-
ate. You have the right to participate in your
service plan, which defines the type of care
you will receive. Your service plan should be
developed within 30 days of move in and be reviewed at least every 6
months. You have the right to care that promotes your physical,
emotional, spiritual and social well being.
Your Belongings
You have the right to keep and use
your own clothing and other personal
belongings as space, safety, and
security permits.
Spouses
If it is feasible to do so, you have the
right to share a room with your spouse.
Legal Counsel
You have the right to have a lawyer and
to meet with your lawyer in private.
Roommate
You have the right to receive
notice before your roommate is
changed and, to the extent pos-
sible, have input into the choice of
a roommate.
Mail
You have the right to have access
to writing instruments, stationary,
and postage. You have the right to
send and receive correspondence,
and to have this correspondence
remain private.
Confidentiality
You have the right to confidentiality.
Any discussion about your treatment or
medical diagnosis should be in private.
Assisted Living in Maryland: What You Need to Know - 35
Your health care records should not be
available to anybody who is not directly
involved in your care, except as other-
wise allowed by law.
Religion
You have the right to practice the
religion of your choice, and to attend or
not attend religious services. You have
the right to receive visits from members
of the clergy.
Restraints
You have the right to be free from
physical and chemical restraints, unless
they are ordered by your doctor to treat
your symptoms or medical conditions.
A physical restraint is a device that
keeps you from moving freely or having
access to your body such as a restraining
vest or bed rail. Chemical restraints are
medications such as drugs for depression,
tranquilizers, or sedatives. They should
never be used for the convenience of the
staff or to discipline a resident.
Dignity
You have the right to be treated with
consideration, respect, and full recognition
of your human dignity and individuality.
Part of being treated with dignity is having
the right to self-determination, including
the right to determine dress, hairstyle, or
other personal effects according to indi-
vidual preference.
Privacy
You have the right to privacy, including the
right to have a staff member knock on
your door before entering (unless
the staff member knows you are
asleep). You have the right to
have visitors and phone calls in
private. You have the right to
have visitors of your choice
subject to the reasonable rules of
the provider.
Freedom From Abuse and
Neglect
You have the right to be free
from mental abuse, verbal abuse,
sexual abuse, neglect, involun-
tary seclusion, and exploitation.
You have a right to call the
DISCHARGE
RIGHTS
You have a right to 30 days notice, if the
facility plans to discharge you against
your will. In a health care emergency, it
can move you immediately to a safe and
proper setting. You have the right to
immediately remove yourself from the
facility in a health care emergency. Your
Resident Agreement (contract) with the
provider should clearly state what actions,
circumstances, or conditions would allow
it to involuntary discharge you from the
facility.
36 - Assisted Living in Maryland: What You Need to Know
Ombudsman, Adult Protective Services, assisted living provider may, but does not
and Office Of Health Care Quality to
report neglect or abuse. See Chapter 9
for telephone numbers. You have the right
to use the phone in private to call any of
these entities.
Staffing
You have the right to have a sufficient
number of staff in the facility to meet your
needs and the needs of the other
have to, assist you with your financial
affairs.
Grievances and Complaints
You have a right to make suggestions or
complaints or present grievances to the
assisted living manager. You have the right
to receive a prompt response to any
concern or complaint. Your provider
should have an established internal com-
residents. A staff member plaint procedure. See Chapter 6 for
should always be present information about external grievances.
when you are in the
facility. The full text of resident’s rights can be
found in the Code of Maryland Regula-
Managing Your Money tions at COMAR 14.07.14.26. You can
You have the right to handle find the regulations in your local public
your own financial affairs or to library or on the internet at, https://
appoint a representative of your choice constmail.gov.state.md.us/comar/
to manage your financial affairs. An dsd_web/default.htm .
Assisted Living in Maryland: What You Need to Know - 37
38 - Assisted Living in Maryland: What You Need to Know
CHAPTER 6
HOW TO COMPLAIN WHEN
QUALITY CARE IS LACKING
You may have heard stories in the
media about incidents of poor care in
nursing homes. Sometimes problems
arise with care in assisted
living, as well. Com-
plaints range from
staffing and medication
concerns to disputes
about charges and
payment. This chap-
ter describes how to
address the more
typical kinds of com-
plaints.
If you are unhappy with
the quality of care that you
or a family member is
receiving in an assisted
living facility, you have the right to
complain to the manager of the facility.
Your facility is required to have an
established complaint procedure. The
assisted living facility should give you a
prompt response to your complaint.
The complaint procedure is required to
be outlined in the Resident Agreement.
If the manager does not resolve the
problem to your satisfaction, or if you
are afraid to complain to the manager,
contact the Office of Health Care
Quality, at 410-402-8217 or toll free at
1-877-402-8220. The address is Office
of Health Care Quality, Department of
Health and Mental Hygiene, Spring
Grove Hospital Center, Bland Bryant
Center, 55 Wade Avenue, Catonsville,
MD 21228. You may make your
complaint anonymously, but if you do
so, you will not receive a written report
of the investigation.
You can also contact the Long-Term
Care Ombudsman for your county. See
Chapter 9 for telephone numbers. The
local ombudsmen are employees of the
local agency on aging. Ombudsmen
investigate complaints about assisted
living facilities and nursing homes.
Contractual Disputes
Some complaints about ‘quality of care’
actually have to do with what level of
services you agreed to pay for in your
Agreement. It may be that the facility is
providing the services you paid for, but
you thought you would be getting more.
For example, you may have thought
that laundry service was included in the
package of services in your Agreement,
but it actually states there is an extra
charge for doing laundry. Or a family
member may think that the facility will
take the resident to medical appoint-
ments, but the facility did not agree to
do that.
Assisted Living in Maryland: What You Need to Know - 39
Usually, the Office of Health Care refusal to provide the resident adequate
Quality and your local ombudsman
cannot assist you in these kinds of
contractual disputes. Generally, the
State cannot enforce private contracts
for other parties or intervene in private
contractual disputes.
The Legal Aid Bureau, Inc. may be able
to provide some legal assistance
through its Assisted Living Project to
clients who meet the Bureau’s financial
eligibility requirements. It offers free
legal assistance to residents, family
members, anyone helping a resident, or
anyone pursuing assisted living options.
Examples of problems with which it
may be able to help include reviewing
admission agreement contracts, invol-
untary discharges and transfers, quality
of care, and billing disputes. See
Chapter 9 for the telephone numbers.
In addition, the Health Education and
Advocacy Unit of the Office of the
Attorney General may be able to medi-
ate a contractual dispute with an as-
sisted living facility if all parties to the
dispute voluntarily agree to participate.
See Chapter 9 for the telephone num-
ber.
Abuse or Neglect
Abuse includes things like hitting,
pushing, sexual assault, verbal abuse,
the improper use of physical or chemi-
cal restraints, involuntary seclusion, and
misuse of funds. Neglect includes the
food, clothing, toileting, medical
treatment, supervision, or other neces-
sary help with the resident’s needs.
Unfortunately, there have been cases of
abuse and neglect in assisted living
facilities. When abuse or neglect is
suspected, you or your family or friends
should immediately notify the Adult
Protective Services of the local Depart-
ment of Social Services. The Long
Term Care Ombudsman, local police, or
the Office of Health Care Quality may
also be called. See Chapter 9 for the
telephone numbers.
Assisted living facilities are required by
law to thoroughly investigate all allega-
tions of abuse or neglect. They must
take appropriate action to prevent
further incidents while the investigation
is in progress.
WHAT FAMILY AND
FRIENDS CAN DO TO
ENSURE QUALITY CARE
Family members and friends can con-
tribute to the quality of care at an
assisted living facility by visiting often.
By visiting frequently, they can monitor
the quality of care their loved one
receives. Staff at the facility may pay
more attention to a resident who has
attentive visitors than to those whose
family and friends visit less frequently.
40 - Assisted Living in Maryland: What You Need to Know
CHAPTER 7
ENABLING OTHERS TO MAKE HEALTH
CARE AND FINANCIAL DECISIONS FOR YOU
While you are planning where you will There are two areas to consider:
live for the next several years, you ❖ who might handle your money and
should also think about your financial property if you are unable to do so
and health care decisions. If you take (Arranging Assistance with Finan-
some steps now, it will assist those who cial Decisions); and
love you to make medical decisions for ❖ who might make medical decisions
you and to administer your property if for you if you are unable to do so
you become unable to do so yourself. (Arranging Assistance with Health
Care Decisions).
Arranging Assistance with
DURABLE POWERS OF
Financial Decisions
ATTORNEY
There are five typical methods you
A “power of attorney” is a legal document
can use to arrange for someone
used to appoint another person to act on
else to handle your money and
your behalf. It is very helpful if you become
property in the event you become
unable to handle your own money and need
unable to do so:
someone else to do it for you.
1. Durable Power of Attorney;
You must be competent to sign a power of attorney.
2. Representative Payee;
You are the “principal.”
3. Banking Services;
The person you appoint to represent you is your “agent.”
4. Personal Money Managers; and
5. Trusts.
In a durable power of attorney, you, the principal, name an
agent to act for you, as if you were acting yourself.
If you make arrangements in
advance, you may avoid the
"Durable" means that the power of attorney will stay in effect
possibility of your loved ones
even if you, the principal, become incapacitated and cannot act
having to go to court to seek a
for yourself.
guardianship over your financial
affairs.
You may still act for yourself as long as you are able even if you
have appointed an agent.
Assisted Living in Maryland: What You Need to Know - 41
You must think very carefully about
who you would choose as your agent,
for agents often have unlimited discre-
tion to act in your name. Think about
the person you would trust the most to
handle your affairs for you. Does this
person have an unblemished record of
honesty? Do you trust this person to
disregard his or her own interests and to
act only in your best interest? If not,
you should not use a power of attorney
to appoint an agent.
We have heard many sad stories of an
elder appointing an agent who then
cleaned out the elder’s bank account or
put a mortgage on the elder’s home.
A power of attorney must
be written when the princi-
pal is competent. For some
persons with dementia, it the authority given the
may be too late to write a agent.
power of attorney. People
in the early stages of You may create a power of
Alzheimer's Disease, still attorney as part of your
may be competent to say
whom they trust to handle their money
for them. This may also be true for
some people with mental retardation,
and for those with mental illness as
well.
To be competent, a principal must be
able to understand:
1. What property he or she owns,
2. The consequences of appointing an
agent, and
3. Who he or she wants to handle his
or her money.
If a power of attorney is signed by you
when you are in an early state of de-
mentia, it will be helpful to have your
signing witnessed by people who can
confirm that you understood these
points when you signed.
Durable powers of attorney usually
state that the agent has unlimited
discretion to:
1. Collect moneys due the principal,
2. Deposit funds for the benefit of the
principal, and,
3. Write checks to pay bills.
The agent may also have the authority
to make investments and to buy and sell
property and stock. How-
ever, a power of attorney
also can be written to limit
estate plan. For anyone
who has property in his or her name
alone, regardless of age, it is important
to have a power of attorney. Anyone
may suffer a sudden illness or accident
that leaves him or her unable to act on
his or her own behalf.
It is not necessary to have a lawyer
write a power of attorney, although if
you have substantial assets and invest-
ments, it is a good idea to discuss a
power of attorney with an attorney. If
you have few assets, it is possible to
42 - Assisted Living in Maryland: What You Need to Know
write a power of attorney using forms
from an office supply store or from a
computer disk.
You should think about whether you
want to give the agent the power to
make gifts to him or herself. You may
also write the power of attorney so that
it only becomes effective when two
doctors have certified you as not being
able to handle your own finances. This
is called a "springing" power of attor-
ney.
Be very sure that you understand the
meaning of the document and sign it
willingly and knowingly. Have people
who can verify your competency wit-
ness your signing
The person who wants to be your
representative payee applies by filling
out the agency’s application form.
There is no need to go to court, as the
agency makes its decision based on
your doctor’s opinion that you are
unable to handle your money. Arrang-
ing for a representative payee is much
easier and cheaper than having to go to
court to have a guardian appointed.
Moreover, there is no court finding of
incapacity so you maintain most of your
independence and autonomy. Repre-
sentative payees are only authorized to
handle checks from the agency that
appoints them. They are not authorized
to handle any of your other property.
Representative payees
because a power of are usually family
attorney can be chal- members or friends,
lenged just like a will. but assisted living
facilities, public
Representative Payees agencies, and volun-
If your income is from teer organizations can
Social Security or the serve as representative
Veterans Administra- payees. The agency
tion and there comes a paying the benefits
time when you can no requires the represen-
longer manage these
funds yourself, the government agen-
cies involved may appoint someone
else as your representative payee. The
representative payee can collect your
monthly income and use it to pay your
bills. Some pension plans also allow
for representative payees.
tative payee to file an
annual report verifying how the money
was spent on your needs.
Banking Services
Some banks can manage funds for you
if you are not able to do so or arrange
other services that may be of assistance.
It is possible to arrange for the follow-
ing services.
Assisted Living in Maryland: What You Need to Know - 43
❖ Direct Deposit
Your monthly income can be di-
rectly deposited in your bank
account, saving you a trip to the
bank.
❖ Direct payments
Some bills can be paid electroni-
cally by the bank. These are usually
routine bills such as your mortgage,
rent, utility and assisted living bills.
When the bank pays these bills
electronically, you do not have to
remember to write a check each
month.
❖ “Power of Attorney” or Conve-
nience Account
Banks can set up a power of attor-
ney or convenience account for you.
You tell the bank who you would
like to handle your account for you
and the bank adds them to the
account as your agent. It is like a
power of attorney, but only for that
account (hence the name “power of
attorney account”) without the
formality of having a power of
attorney created. If you have a
formal power of attorney document
you do not need a “power of attor-
ney” or convenience accountant.
❖ Joint Ownership of Bank Accounts
You may want to establish joint
accounts with your children or other
trusted relatives to make sure that
the funds in the account go to the
other person when the first one dies.
Joint accounts also make it easier
for someone else to write checks on
an account and to pay your bills.
However, beware! Joint Accounts
are dangerous to both parties and
easily used to financially exploit
the original owner! A joint ac-
count gives the other person and
their creditors full access to all of
your funds in the joint account.
There is no need to
have a joint account
with someone who is
not your spouse. If
you want a child, relative, or trusted
friend to have the funds in the account
when you die, have the bank make it a
“payable on death” account. The bank
will make clear on the account docu-
ments that the funds in the account will
be paid at your death to whoever you
designate without having to go through
probate. In other words, you can have
who you want get the money directly
with a “P.O.D.” account, without the
dangers of a joint account.
Similarly, there is no reason to add a
person’s name to your account as a joint
account holder just so they can help you
with your bills. Go to the bank and
have the bank make it a convenience or
“power of attorney” account.
44 - Assisted Living in Maryland: What You Need to Know
A joint account can also create prob-
lems for you if you apply for Medicaid.
Medicaid may consider all funds in a
joint account as yours. This may
disqualify you from some of the Medi-
cal Assistance waiver funds described
in Chapter 3.
Contact your bank to ask about the
alternatives described above.
Personal money managers
If you have substantial assets, you can
hire a personal money manager to
collect funds and pay bills each month.
While agents usually have authority to
do things like sell your property, per-
sonal money managers act more like a
bookkeeper. They do not have author-
ity to sell or give away your money or
property. To locate a personal money
manager call the Senior Information
and Assistance Program in your local
area agency on aging (see Chapter 9 for
the telephone number) or call the
American Association of Daily Money
Managers at 301-593-5462. Before
hiring a personal money manager,
carefully check his or her references
and status with the bonding
usually only used if there are substan-
tial assets because the trustee charges
a fee.
The trust instrument usually describes
how the money should be spent on the
beneficiary. You should see a lawyer to
set up a trust. Trusts are complicated
and flexible and they must be precisely
written to reflect your wishes. It is
important to set up the trust so that it
does not jeopardize the person's public
benefits, such as Medicaid.
Special Needs Trusts
When you are receiving government
benefits such as Medical Assistance, a
special-needs trust can be established
for your benefit. The trust funds would
be used to pay for items that Medical
Assistance cannot pay for, such as a
motorized wheelchair. See a lawyer to
set up a special needs trust. If the
beneficiary dies, any funds in the
special needs trust will be turned over
to the State to repay the State for pro-
viding Medical Assistance benefits.
Arranging Assistance with Health
Care Decisions
company.
Maryland's Health Care Decisions
Trusts Act allows you, if you are compe-
A trust is a legal tent, to write an advance directive
arrangement by (also known as a living will or a
which you, the health care durable power of attorney).
grantor, gives An advance directive is a legal instru-
property to ment in which you can state what kind
another, the trustee, to of medical care you would want and
hold for the benefit of a third who you would want to make medical
person, the beneficiary. A trust is decisions for you, if you were not able
to make decisions for yourself.
Assisted Living in Maryland: What You Need to Know - 45
If you do not have an
advance directive, the
statute allows your
closest relatives or
friends to make health
care decisions for you
in the event you are
unable to do so.
Advance Directives
An advance directive
must be made when
you are competent to
understand what it
says. It usually has
two parts:
AFTER YOU WRITE AN
ADVANCE DIRECTIVE
After you have written an advance
directive, you should make several
copies. Give one to your agent, one
to each of your doctors, and keep
one in an easily accessible place
where your relatives or friends
know where to find it. If you go to
an assisted living facility, a copy of
your advance directive must be
placed with your records.
Appointment of a
health care agent
An advance
directive is similar
to a power of
attorney. You, the
principal, name
an agent to act for
you if you cannot
make medical
decisions for
yourself. Unless
you specify
otherwise, the
agent's power
becomes effective
when two doctors certify that you
❖ one to appoint someone to make
cannot make medical decisions your-
medical decisions if you are not
self.
able to do so yourself; and
❖ a second part to state what type of
Health care instructions
medical care you would want if you
You may also state what kind of care
cannot act for yourself.
you would want if you cannot act for
yourself. This may refer to end-of-life
An advance directive may be made
care, or you may state that you would
orally or in writing. If you make an oral
not want a particular procedure (for
advance directive, your doctor and
example, kidney dialysis).
another witness must hear what you say.
The doctor then notes what you want in
Be aware that if you appoint a health
your medical chart and he and the other
care agent and give instructions about
witness sign the notes.
specific care decisions in an advance
directive, the health care agent will be
If you write an advance directive, it
bound by your decisions. Some people
must be witnessed by two persons. At
want to limit their agent’s discretion in
least one of the witnesses must be
this way. Others prefer just to tell the
someone who would not benefit from
agent about their general health care
your death. That is, someone who
preferences and leave the ultimate
would not receive insurance benefits or
decision to be made in a future situation
an inheritance if you die.
up to the agent.
46 - Assisted Living in Maryland: What You Need to Know
Surrogate Decision Making
If you do not have an advance directive,
the Health Care Decisions Act allows
your closest relatives or friends to make
health care decisions for you. Maryland
law encourages family members and
friends to make medical decisions if
you are not able to act yourself. If you
are mentally incapacitated because of
LIST OF PRIORITY FOR
SURROGATES
A surrogate is someone who acts for
the patient. The surrogate will make
decisions about what care the patient
will receive. Surrogates are called
upon in the following order:
❖ legally appointed guardian;
❖ spouse;
❖ adult children;
❖ parents;
❖ adult siblings; and
❖ other relatives or friends.
illness, disease, mental illness, or a
developmental disability, they may
make medical decisions for you without
going to court to get a guardianship
over you.
After two doctors certify that you
cannot make an informed choice about
medical care, the doctors will ask if you
have a written advance directive. If you
have done this, the doctors will look to
the agent named to make medical
decisions. If there is no advance direc-
tive, the doctors will look to the closest
relatives or friend to make medical
decisions.
Standard for Surrogate Decisions
The surrogate(s) will make all medical
decisions for you, including day-to-day
care as well as end-of-life decisions, if
you are in a terminal or end-stage
condition or in a permanent coma. The
surrogate(s) will consult with your
doctors and should make decisions
based on what you would have wanted.
This is called the substitute judgment
test.
In considering what you would want if
you could make the decision, the
surrogate(s) will consider your:
❖ current diagnosis and prognosis;
❖ expressed preference regarding the
treatment being considered;
❖ attitude toward similar treatment for
another person;
❖ behavior and attitude toward medi-
cal treatment in general;
❖ expressed concerns about the effects
of your illness and treatment on
other family members and friends;
and
❖ religious beliefs and moral beliefs.
If it is not possible to know what you
would have wanted, the surrogate(s)
will follow the best interest test and
consider:
❖ the treatment's effects on your
physical, emotional, and mental
functions;
Assisted Living in Maryland: What You Need to Know - 47
❖ the treatment's risks, benefits, and
side effects;
❖ the physical pain you would suffer
with and without treatment;
❖ the effect of the treatment on your
life expectancy and your potential
for recovery;
❖ the humiliation, loss of dignity and
dependency you are suffering; and
❖ your religious beliefs and values.
Surrogate(s) may not authorize treat-
ment in the following circumstances:
❖ if you actively refuse the treatment;
or
❖ the treatment is for a mental disor-
der or sterilization.
In these circumstances, it may be
necessary to file for guardianship of the
person and get the permission of the
court to authorize treatment.
Liability
A surrogate is not liable for any of
the patient’s medical costs just be-
cause the surrogate is authorizing
treatment. A surrogate is not liable for
any medical decisions he or she makes
in accordance with the Health Care
Decisions Act. The law also protects
surrogates from errors in judgment.
48 - Assisted Living in Maryland: What You Need to Know
CHAPTER 8
ALTERNATIVES TO
ASSISTED LIVING
If you are thinking about moving to
assisted living you may want to con-
sider what options may suit your par-
ticular circumstances. Other options can
include home health care, adult day
care, continuing care retirement com-
munities, nursing homes, and senior
communities. Each of these alterna-
tives is described briefly in this
Chapter. However,
before you read about
these alternatives it is
important for you to
know about two
resources that can help
you choose the right
solution for you: (1)
Adult Evaluation and
Review Services and (2)
Geriatric Care Managers.
Adult Evaluation and Review
Services (AERS)
AERS’s purpose is to help you remain
in the community while functioning at
the highest possible level of indepen-
dence and personal well being. An
AERS team consists of professional
nurses, social workers, and doctors, if
needed. Your team will develop a plan
of care that recommends any services
needed to help you remain at home. If
you cannot remain at home, the plan
will recommend the most appropriate
services for your situation.
AERS teams are part of your local
county or city health department and
their evaluation services are free. See
Chapter 9 for the AERS team closest to
you.
Geriatric Care Managers
Geriatric care managers are profession-
als who are trained in gerontology,
social services, psychology, nursing, or
counseling. They help you and your
family manage the daily decisions
which may keep you in your own home,
or help decide when to make a change
to a more protected setting.
Geriatric care managers can assess your
health, emotions, and ability to handle
the activities of daily living. Geriatric
care managers can help find home
health care providers, monitor how a
provider is working, and make recom-
mendations to you or your family about
public benefit programs that can make
life easier. They can provide crisis
counseling and help find the best place
to move if you decide to move to a
more protected setting. Some geriatric
care managers also provide money
management, individual therapy, and
Assisted Living in Maryland: What You Need to Know - 49
guardianship services. Geriatric care
managers charge an hourly fee for their
services, which usually range from $60
to $125 per hour.
There is a national association that
certifies geriatric care managers. To
find a certified geriatric care manager
near you, call the National Association
of Professional Geriatric Care Manag-
ers, 655 N. Alvernon, Suite 108, Tuc-
son, AZ 85711, at 520-881-8008. You
may also visit them on the internet at
www.caremanager.com .
You may also find local geriatric care
managers by calling your local area
agency on aging. See Chapter 9 for
telephone numbers.
Home Health Care Services
Home health care services are designed
to promote, maintain, or
restore health, or to
minimize the effects of
illness or injury on your
ability to cope with
activities of daily living,
while living at home.
Home health care can
include skilled nursing care and home
support services.
Skilled nursing care services are pre-
scribed by a physician. You receive the
skilled nursing services from a regis-
tered nurse after your doctor has pre-
scribed them. Registered nurses and
licensed practical nurses monitor your
medicines, help with catheters, admin-
ister wound care, teach you and your
family members how to perform certain
medical services, and provide other
skilled services. Some specialized
therapists may perform physical,
speech, occupational, and respiratory
therapy to you at home.
Support services include personal care
to you, such as bathing, dressing,
eating, and exercising; some home-
maker services, such as meal prepara-
tion, laundry, light housekeeping, and
shopping; and companion services.
Usually, these services are performed
by home health aides.
Home health agencies may be private or
public. You may also hire someone
privately to provide care. Some public
agencies are the local agencies on
aging, Departments of Social Services,
and Health Departments. See Chapter 9
for the telephone numbers of these
agencies.
Under a new Maryland program, Med-
icaid may pay for some home health
care. To apply for this benefit, go to
your local area agency on aging. See
Chapter 9 for telephone numbers for
agencies on aging. Staff will help you
get what you need to establish your
medical condition, and will help you fill
out the application. If you are denied
Medicaid home health care, you can
appeal the decision. The Legal Aid
Bureau may be able to help you. See
Chapter 9 for your local Legal Aid
Bureau office.
50 - Assisted Living in Maryland: What You Need to Know
Medicare may pay for home health care
after you come home from the hospital.
Medicare covers a limited number of
home health visits and some support
care as well. Some Medigap insurance
policies also cover home health visits.
However, in most cases, home health
care has to be paid for
Veterans and some for low income
people, but usually costs are paid
privately by you or your family.
Call your local area agency on aging
for a list of adult day care providers in
your area. See Chapter 9 for the ad-
dress and telephone number
entirely from a person's of your local area agency on
personal income. aging.
Adult Day Care Senior Communities
Adult day care provides a Senior communities are for
place for you if you active older adults who do not
cannot stay alone at home
during the day. Adult day care usually
provides transportation to and from the
center, as well as meals, medications,
and some nursing and social services.
One of the biggest benefits of adult day
care is the activities. You can mingle
with others in a safe environment.
When considering adult day care, you
should visit the center and determine
whether the center is clean and well
kept, whether it meets fire and safety
regulations, and whether it is comfort-
able. Observe the staff in action. Are
they friendly and encouraging? Is the
staff courteous and respectful, and do
they treat the participants as adults?
Ask about the activities. Watch to see if
people are encouraged to join in.
Read the contract carefully and decide if
the center is right for you. Also con-
sider the cost of adult day care; there are
some subsidy programs, some for
want the worries of caring for
a house and grounds. They include
apartment complexes, condominium
communities, and single family devel-
opments. They screen prospective
residents for age. They also may
provide more security than other
complexes. Independent living and
senior apartment communities may
offer various activities: cultural activi-
ties, shopping trips, and longer outings.
They may offer transportation, and
many have sport centers. Most inde-
pendent living communities do not
offer healthcare services, but do offer
meals in a community dining room.
If you are planning to move to a senior
community, consider the services you
think you will need, and their cost. You
usually pay a flat monthly charge to
cover basic services to residents, with
additional services available for an
added fee.
Assisted Living in Maryland: What You Need to Know - 51
Some public housing apartments are
available for elders and those with
disabilities. In addition, many counties
have some subsidies for senior housing
and for those with disabilities. Call
your local agency on aging to ask if
there is a subsidy and if there is a
waiting list. See Chapter 9 for your
local agency on aging and its telephone
number.
Continuing Care Retirement
Communities (CCRCs)
Continuing care retirement communi-
ties are a special type of senior commu-
nity. They offer a variety of living
arrangements, from independent living
in apartments, to assisted living, to
nursing home care. The idea behind
continuing care retirement communities
is that once you go to live at the CCRC,
you will not have to leave the commu-
nity, even if your health declines. Most
CCRCs offer assisted living and nurs-
ing care on-site.
CCRCs generally charge a hefty en-
trance fee, from $100,000 to $300,000
depending on the type of contract one
signs. There is also a monthly fee, and
there are often additional fees for
optional services.
CCRCs screen the age, health, and
cognitive status of prospective residents
to determine whether residents are able
to live alone when they enter the facil-
ity. Most CCRCs want their residents
to be able to live independently for
some period of time when they first
enter the facility. There are approxi-
mately thirty CCRCs in Maryland,
offering a different range of facilities
and services. They are owned and
managed by a variety of non-profit and
for-profit businesses.
Three Basic Contracts
There are three basic CCRC contract
models:
Type A—"Life care" or “Extensive”
contract
Although many CCRCs promote and
advertise themselves as "life care
communi-
ties," only
about one-
third offer
this type of
contract.
Under this
plan, the
anticipated
costs of your
future health
care needs
are built into
the entrance
fee and
monthly fees.
The finances
of the com-
munity are
structured so
the monthly
fee remains
relatively
constant
whether you are in an independent
living apartment, an assisted living unit,
or nursing home bed. The fees are
periodically adjusted to cover changing
WHEN CONSIDERING
A
CCRC
Call the Maryland Department of Aging at
410-767-1118 and ask for a CCRC
Consumer Package. In addition, be sure
to request the following papers from each
CCRC you are considering: its continuing
care agreement, its annual disclosure
statement, and its most recent annual
audited financial statement. Read the
agreement carefully. You should have an
attorney look over the agreement. You
may also want to speak with
a qualified financial advisor
to determine if your per-
sonal financial situation
fits the financial structure
of the CCRC.
52 - Assisted Living in Maryland: What You Need to Know
operating costs and inflation. Most
facilities also offer optional services
(such as meals, housekeeping, laundry,
and beauty and barber services) on a
fee-for-service basis.
Type B—“Modified” contract
Under a “modified contract” the en-
trance fee and monthly fees cover
shelter and various resident services
and amenities. Assisted living and
nursing care are provided at no in-
creased fee, but only for a specified
period of time (such as 90 days). In a
Type A or Extensive Contract there is
no time limit. If you need more as-
sisted living or nursing home care than
the number of days provided for in a
Type B agreement, you have to pay
whatever the prevailing daily rate is at
the time you receive the service. Op-
tional services are provided on a fee-
for-service basis.
Type C—"Fee for Service” contract
Many CCRCs in Maryland offer a fee-
for-service contract. Under this plan,
the entrance fee and monthly fees only
cover shelter and some basic services
that are not related to health care. If
you need assisted living services,
nursing care, or any other optional
service, you have to pay whatever the
prevailing rate is when you
receive the service. The monthly
rates for assisted living and
nursing home care are substan-
tially more expensive than they
are for independent living.
Refunds
Many communities now advertise
"refundable entrance fees” which are
refunded to the resident when the
resident leaves. You should read the
contract carefully to determine whether
the entrance fee is:
❖ non-refundable;
❖ refundable on a declining basis over
time; or
❖ partially refundable on a percentage
basis.
There are no truly 100% refundable
agreements in Maryland as of 2002.
While some CCRCs advertise a fully
refundable entrance fee, there is always
some refurbishing or other fees they
assess before paying the refund. You
should also determine when a refund
will be paid. A common clause in most
CCRC contracts requires you to wait
until a new resident moves into your
space before you receive a refund.
The American Association of Homes
and Services for the Aging (AAHSA)
publishes a directory on CCRCs. The
Continuing Care Accreditation Com-
mittee of AAHSA has accredited many
CCRCs in several states. You can call
AAHSA at (202) 783-2242 and ask for
Assisted Living in Maryland: What You Need to Know - 53
the booklet. The address of AAHSA is
901 E Street NW, Suite 5000, Washing-
ton, DC 20004-2837 or look on the
internet at www.aahsa.org.
You can also call the Maryland Depart-
ment of Aging at 410-767-1118 to get a
consumer guide to CCRC’s. This
packet of information includes a list of
all CCRCs in Maryland.
Nursing Homes and
Rehabilitation Centers
Nursing homes and
rehabilitation centers
provide nursing care
around the clock to you
if you do not need the
services of an acute care
hospital. Nursing professionals provide
care under the direction of a physician.
Some nursing homes also offer short-
term care if you are recovering from an
injury or an illness or need rehabilita-
tion therapy after an accident or stroke.
If considering a nursing home call your
local agency on aging to get a copy of
“Nursing Homes: What You Need to
Know,” which is a publication similar
to this one, but geared to nursing
homes. You can also get it from Mary-
land Attorney General’s internet web
page at www.oag.state.md.us/consumer/
nurshome.htm.
How to Pay for Alternatives
Some of the ways to pay for assisted
living described in Chapter 3 may also
help pay for the alternatives described
in this Chapter. For example long
term care insurance and the
Maryland Medcaid Waiver for
Older Adults will pay for personal
care in your home in certain
circumstances. A reverse mort-
gage might enable you to convert
the equity in your home to cash,
which you could use to pay for
home health services that would
allow you to stay in your home.
If you need help figuring out how you
can pay for a particular alternative,
contact your local area agency on aging.
The address and phone number for your
local agency is in Chapter 9. The
agency may have staff who can help
you directly or it may refer you to some
financial planners or elder law attorneys
who can advise you on your financial
options.
54 - Assisted Living in Maryland: What You Need to Know
CHAPTER 9
WHERE TO GET HELP
This Chapter is organized geographi-
cally. National resources are listed first,
State resources second, and local (i.e.
county and Baltimore City) resources
are listed third.
National Resources
American Association of Retired
Persons (AARP)
601 E. St., NW
Washington, DC 20049
(800) 424-3410
Internet at http://www.aarp.org
American Association of Homes and
Services for the Aging (AAHSA)
2519 Connecticut Ave., NW
Washington, DC 20008-1520
(202) 783-2242
Internet at http://www.aahsa.org
Assisted Living Federation of America
(ALFA)
10300 Eaton Place, Suite 400
Fairfax, VA22030
(703) 691-8100
Internet at http://www.alfa.org
Consumer Consortium on Assisted Living
P.O. Box 3375
Arlington, VA 22203
(703) 533-8121
Internet at http://www.ccal.org
Organization of consumers, caregivers,
regulators, researchers, educators,
advocates and providers who examine
issues in assisted living.
National Citizens’ Coalition for Nurs-
ing Home Reform
1424 16
th
St., NW, Suite 202
Washington, DC 20036
(202) 332-2275
Internet at http://www.nccnhr.org
National Elder Care Locator
1-800-677-1116
Refers consumers to local area agencies
on aging by zip code anywhere in the
United States.
National Association of Professional
Geriatric Care Managers
655 N. Alvernon, Suite 108
Tucson, AZ 85711
(520) 881-8008.
Internet at: http://www.caremanager.com.
Assisted Living in Maryland: What You Need to Know - 55
National Center for Home Equity Conver-
sions
(651) 222-6775
Internet at: www.reverse.org.
United Seniors Health Cooperative
409 Third Street, SW, #200
Washington, DC 20024
(202) 479-6678.
Call United Seniors Health Cooperative
to ask for information on buying long-
term care insurance.
National Websites
www.elderweb.com
Elder web
www.webofcare.com
Web of Care
www.nsclc.org
National Senior Citizens Law Center
www.aahsa.org
American Association of Homes and
Services for the Aging
www.aarp.org
American Association of Retired
Persons
www.ccal.org
Consumer Consortium on Assisted
Living
www.ncal.org
National Center for Assisted Living
www.abanet.org
American Bar Association, Commis-
sion on Legal Problems of the Elderly
Maryland Resources
Office of Health Care Quality
Department of Health and Mental
Hygiene
Spring Grove Hospital Center
Bland Bryant Center
55 Wade Avenue
Catonsville, MD 21228
(410) 402-8217
http://www.dhmh.state.md.us/ohcq
Call this office to complain about care
at an assisted living facility. The office
is responsible for licensing assisted
living facilities.
Maryland Department of Aging
301 West Preston Street, Suite 1007
Baltimore, Maryland 21201
410-767-1100
(800) AGE-DIAL
http://www.mdoa.state.md.us
Health Education and Advocacy Unit
Office of the Attorney General
200 St. Paul Place
Baltimore, MD 21202
Toll-free number: 1-877-261-8807
http://www.oag.state.md.us
Legal Aid Bureau
Assisted Living Division
29 W. Susquehanna Avenue
Suite 305
Towson, MD 21204
(410) 296-6705 Baltimore metropolitan
area and (800) 367-7563 toll free in
Maryland.
56 - Assisted Living in Maryland: What You Need to Know
Guide to Retirement Living
This is a free guide which lists a variety
of housing options for older adults in
the Maryland, DC and Virginia areas. It
lists assisted living facilities, adult day
care centers, nursing homes, home
health agencies, geriatric care manage-
ment services, senior communities, and
continuing care retirement communi-
ties. Call (800) 394-9990 to get your free
copy.
Maryland Websites
www.dhmh.state.md.us/ohcq
Maryland Office of Health Care Quality
www.md.lab.org
People’s Law Library
www.manpha.org
Mid-Atlantic Non-Profit Health and
Housing Association
www.mala_md.org
Maryland Assisted Living Association
http://www.oag.state.md.us
Office of the Attorney General
http://www.mdoa.state.md.us
Maryland Department of Aging
http://www.dhmh.state.md.us/ohcq
Office of Health Care Quality
County and Baltimore
City Resources
Allegany County
Adult Evaluation and Review Services
P. O. Box 1745
12500 Willowbrook Road
Cumberland MD 21502
(301) 777-5665
Department of Social Services
1 Frederick Street
P.O. Box 1420
Cumberland, MD 21501
(301) 784-7000
Legal Aid Bureau, Inc.
110 Greene Street
Cumberland, MD 21502
(301)777-7474 (Allegany Co.)
(301) 334-8832 (Garrett Co.)
(301) 777-1563 (fax)
Area Agency on Aging
Human Resources Development Com-
mission
Area Agency on Aging
19 Frederick Street
Cumberland, MD 21502
(301) 777-5970
(301) 722-0937 (fax)
Medicaid Waiver Provider Information
and Assistance
(301) 777-5970 X107
Senior Health Insurance Assistance
Program (SHIP)
(301) 777-5970 X 136
Assisted Living in Maryland: What You Need to Know - 57
Senior Information and Assistance Central
Offices
(301) 777-5970
Ombudsman Program
(301) 777-5970
Anne Arundel County
Adult Evaluation and Review Services
Anne Arundel County Health Dept.
Geriatric Health Services
2666 Riva Road, Suite 400
Annapolis, MD 21401
(410) 222-4366-7
Department of Social Services
80 West Street
Westgate Building, 2
nd
floor
Annapolis, MD 21401
(410) 269-4500
TDD: (410-974-8590
Department of Social Services
George Taylor DC/MSC
7500 Ritchie Highway
Glen Burnie, MD 21061
(410) 421-8500
(410) 508-2079 (fax)
Legal Aid Bureau, Inc.
229 Hanover Street
P.O. Box 943
Annapolis, MD 214040
(410) 263-8330 (Anne Arundel)
(410) 269-0846 (Balto.)
(301) 261-1956 (DC)
(800) 666-8330
(410) 269-8916 (fax)
Area Agency on Aging
Anne Arundel County Department of
Aging
2666 Riva Road, Suite 400
Annapolis, MD 21401
(410) 222-4346
(410) 222-4346 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 222-4464
Senior Health Insurance Assistance
Program (SHIP)
(410) 222-4464
Senior Information and Assistance
Central Offices
(800) 492-2499
Ombudsman Program
(410) 222-4464
Baltimore City
Adult Evaluation and Review Services
Baltimore City Health Department
5610 Harford Road
Baltimore, MD 21214
(410) 396-6006
Department of Social Services
300 Metro Plaza
Baltimore, MD 21215
(410) 361-4600
(410) 889-6805 (fax)
58 - Assisted Living in Maryland: What You Need to Know
Legal Aid Bureau, Inc. Medicaid Waiver Provider Information
500 E. Lexington Street
Baltimore, MD 21202
(410) 539-5340
(800) 999-8904
TTY (800) 458-5340
Legal Aid Bureau, Inc.
Cherry Hill Neighborhood Center
606 Cherry Hill Road
Baltimore, MD 21225
(410) 355-4223
(410) 354-0579 (fax)
Legal Services Programs
Sixty Plus Program
Lawyer Referral and Information
Service
111 North Calvert Street, Suite 627
Baltimore, MD 21202
(410) 539-3112
Assistance to seniors in writing wills,
powers of attorney and advance direc-
tives.
Legal Services to the Elderly
Baltimore City Bar Association
111 North Calvert Street, Suite 631
Baltimore, MD 21201
(410) 396-1322
Area Agency on Aging
Baltimore City Commission on Aging
& Retirement Education
10 North Calvert Street, Suite 3000
Baltimore, MD 21201
(410) 396-3144
(410) 385-0381 (fax)
and Assistance
(410) 396-4932
Senior Health Insurance Assistance
Program (SHIP)
(410) 396-4932
Senior Information and Assistance
Central Offices
(410) 396-1341
Ombudsman Program
(410) 396-3144
Baltimore County
Adult Evaluation and Review Services
Baltimore Co. Health Dept.
1 Investment Place
Towson, MD 21204
(410) 887-2754
Department of Social Services
6401 York Road
Baltimore, MD 21212
(410) 853-3000
Legal Services for the Elderly
Legal Aid Bureau
29 West Susquehanna Avenue,
Suite 305
Towson, MD 21204
(410) 296-6705
(410) 296-4837 (fax)
(800) 367-7563
Assisted Living in Maryland: What You Need to Know - 59
Sixty Plus Lawyer Referral Service
410 Bosley Avenue
Towson, MD 21204
(410) 337-9100
(410) 823-3418 (fax)
Assistance to seniors in writing wills,
powers of attorney and advance direc-
tives.
Area Agency on Aging
Baltimore County Department of Aging
611 Central Avenue
Towson, MD 21204
(410) 887-4200
(410) 887-5789 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 887-4634
Senior Health Insurance Assistance
Program (SHIP)
(410) 887-2594
Senior Information and Assistance
Central Offices
(410) 887-2594
Ombudsman Program
Ateaze Senior Center
7401 Holabird Avenue
Baltimore, MD 21222
(410) 887-7327
Ombudsman Program
Catonsville Senior Center
510 North Rolling Road
Catonsville, MD 21228
(410) 887-0918
Ombudsman Program
Parkville Senior Center
8601 Harford Road
Baltimore, MD 21234
(410) 887-5225
Calvert County
Adult Evaluation and Review Services
Calvert County Health Dept.
P.O. Box 980
Prince Frederick, MD 20678
(410) 535-5400
Department of Social Services
Louis Goldstein Building
200 Duke Street
Prince Frederick, MD 20687
(410) 286-2100
(410) 286-7429 (fax)
Legal Aid Bureau, Inc.
Southern Maryland Office
15364 Prince Frederick Road
P.O. Box 249
Hughesville, Md 20637
(410) 535-3278 (Calvert Co.)
(301) 884-5935 (St. Mary’s Co.)
(301) 843-5850 (DC)
(301) 932-6661 (Charles Co.)
Area Agency on Aging
Calvert County Department of Aging
450 West Dares Beach Road
Prince Frederick, MD 20678
(410) 535-4606
(410) 535-1903 (fax)
60 - Assisted Living in Maryland: What You Need to Know
Medicaid Waiver Provider Information
and Assistance
(410) 535-4606 or
(301) 855-1170
Senior Health Insurance Assistance
Program (SHIP)
(301) 855-1170
Senior Information and Assistance
Central Offices
(410) 535-4606
Ombudsman Program
(410) 535-4606
Caroline County
Adult Evaluation and Review Services
Caroline Co. Health Dept.
403 South 7
th
Street, Room 262
P.O. Box 10
Denton, MD 21629
(410) 479-8055
Department of Social Services
Denton Multiservice Center
207 South Third Street
P.O. Box 100
Denton, MD 21629
(410) 479-5900
(410) 479-5910 (fax)
Legal Aid Bureau, Inc.
Tred Avon Square, Suite 3
210 Marlboro Road
Easton, MD 21601
(410) 763-9676
(800) 477-2543
TTY (410) 763-8751
Area Agency on Aging
Upper Shore Aging, Inc.
P.O. Box 89
Chestertown, MD 21620
(410) 778-6000
(410) 778-3562 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 758-6500
Senior Health Insurance Assistance
Program (SHIP)
(410) 822-2869
Senior Information and Assistance
Central Offices
(410) 479-2093
Ombudsman Program
(410) 778-6000
Carroll County
Adult Evaluation and Review Services
Carroll County Health Department
P.O. Box 845
Westminster, MD 21158
(410) 876-4949
Department of Social Services
10 Distillery Drive
Westminster, MD 21157
(410) 386-3300
(410) 876-2190 (Baltimore City and
County)
(410) 386-3429 (fax)
Assisted Living in Maryland: What You Need to Know - 61
Legal Aid Bureau, Inc.
203A Broadway
Frederick, MD 21701
(301) 694-7414 (Frederick Co.)
(800) 679-8813
(800) 763-4152
Area Agency on Aging
Carroll County Bureau of Aging
125 Stoner Avenue
Westminster, MD 21157
(410) 876-3363
(410) 840-0436 (fax)
Senior Health Insurance Assistance
Program (SHIP)
(410) 876-3363
Medicaid Waiver Provider Information
and Assistance
(410) 848-4049
Senior Information and Assistance
Central Offices
(410) 876-3363
Ombudsman Program
(410) 876-3363
Cecil County
Adult Evaluation and Review Services
410 Bow Street
Elkton MD 21921
(410) 996-5170
Department of Social Services
Elkton District Court, Multipurpose
Center
170 East Main Street
Elkton, MD 21921
(410) 996-0100
(410) 996-0464 (fax)
Legal Aid Bureau, Inc.
5 North Main Street, Suite 200
Bel Air, MD 21014
(410) 836-8202 (Harford Co.)
(410) 879-3755 (Balto. Co.)
(800) 444-9529
Area Agency on Aging
Cecil County Department of Aging
214 North Street
Elkton, MD 21921
(410) 996-5295
(410) 620-9483 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 996-5295
Senior Health Insurance Assistance
Program (SHIP)
(410) 996-5295
Senior Information and Assistance
Central Offices
(410) 996-5295
Ombudsman Program
(410) 996-5295
62 - Assisted Living in Maryland: What You Need to Know
Charles County
Adult Evaluation and Review Services
P. O. Box 1050
White Plains, MD 20695
(301) 609-6900
Department of Social Services
200 Kent Avenue
P.O. Box 1010
La Plata, MD 20646
(301) 392-6400
(301) 870-3958 (fax)
Legal Aid Bureau, Inc.
Southern Maryland Office
15364 Prince Frederick Road
P.O. Box 249
Hughesville, MD 20637
(301) 932-6661 (Charles Co.)
(301) 843-5850 (DC area)
(301) 884-5935 (St. Mary’s Co.)
(301) 535-3278 (Calvert Co.)
Area Agency on Aging
Charles County Department of Com-
munity Services
8190 Port Tobacco Road
Port Tobacco, MD 20677
(301) 934-0133
(301) 934-5624 (fax)
Medicaid Waiver Provider Information
and Assistance
(301) 934-9305 X5145
Senior Health Insurance Assistance
Program (SHIP)
(301) 934-9305 X 5118
Senior Information and Assistance Central
Offices
(301) 934-5423
Ombudsman Program
(301) 934-0133
Dorcester County
Adult Evaluation and Review Services
3 Cedar Street
Cambridge, MD 21613
(410) 228-3223
Department of Social Services
627 Race Street
P.O. Box 217
Cambridge, MD 21613
(410) 901-4100
(410) 901-1047 (fax)
Legal Aid Bureau, Inc.
111 High Street
P.O. Box 4116
Salisbury, MD 21801
(410) 546-5511
(800) 444-4099
(410) 860-2148 (fax)
Area Agency on Aging
MAC, Inc.
1504 Riverside Drive
Salisbury, MD 21801
(410) 742-0505
(410) 742-0525 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 376-3662
Assisted Living in Maryland: What You Need to Know - 63
Senior Health Insurance Assistance Medicaid Waiver Provider Information
Program (SHIP)
(410) 742-0505
Senior Information and Assistance
Central Offices
(410) 221-1930
Ombudsman Program
(410) 376-3662
Frederick County
Adult Evaluation and Review Services
350 Montevue Lane
Frederick, MD 21702
(301) 694-9577
Department of Social Services
100 East All Saints Street
P.O. Box 237 (Frederick, MD 21705)
Frederick, MD 21701
(301) 694-4555
(301) 694-4550 (fax)
Legal Aid Bureau, Inc.
203A Broadway
Frederick, MD 21701
(301) 694-7414 (Frederick Co.)
(800) 679-8813
(800) 763-4152
Area Agency on Aging
Frederick County Department of Aging
520 Market Street
Frederick, MD 21701
(301) 694-1605
(301) 631-3520
(301) 631-3554 (fax)
and Assistance
(301) 694-1604
Senior Health Insurance Assistance
Program (SHIP)
(301) 694-1604
Senior Information and Assistance
Central Offices
(301) 694-1604
Ombudsman Program
(301) 694-1605
Garrett County
Adult Evaluation and Review Services
1025 Memorial Drive
Oakland, MD 21550
(301) 934-9577
Department of Social Services
12578 Garrett Highway
Oakland, MD 21550-0556
(301) 533-3000
(301) 334-5449 (fax)
TTY (301) 334-5449
Legal Aid Bureau, Inc.
110 Greene Street
Cumberland, MD 21502
(301)777-7474 (Allegany Co.)
(301) 334-8832 (Garrett Co.)
(301) 777-1563 (fax)
64 - Assisted Living in Maryland: What You Need to Know
Area Agency on Aging
Garrett County Area Agency on Aging
104 East Centre Street
Oakland, MD 21550-1328
(301) 334-9431 ext. 138
(301) 334-8555 (fax)
Medicaid Waiver Provider Information
and Assistance
(301) 334-9431 or
(888) 877-8403 ext. 139
Senior Health Insurance Assistance
Program (SHIP)
(301) 334-9431
Senior Information and Assistance
Central Offices
(301) 334-9431
Ombudsman Program
(301) 334-9431 ext. 138
Harford County
Adult Evaluation and Review Services
Harford County Health Dept.
Edgewater Village Shopping Center
1837 Pulaski highway
Edgewood, MD 21040
(410) 612-1683
Department of Social Services
Mary E. W. Risteau DC/MSC
2 South Bond Street
Bel Air, MD 21014
(410) 836-4954
(410) 836-5413 (fax)
Legal Aid Bureau, Inc.
5 North Main Street, Suite 200
Bel Air, MD 21014
(410) 836-8202 (Harford Co.)
(410) 879-3755 (Balto. Co.)
(800) 444-9529
Area Agency on Aging
Harford County Department on Aging
145 N. Hickory Avenue
Bel Air, MD 21014
(410) 638-3025
(410) 638-3069 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 638-3025
Senior Health Insurance Assistance
Program (SHIP)
(410) 638-3025
Senior Information and Assistance
Central Offices
(410) 638-3025
Ombudsman Program
(410) 638-3025
Howard County
Adult Evaluation and Review Services
Howard County Health Dept.
6751 Columbia Gateway Drive
c/o ACES–2nd Floor
Columbia, MD 21046
(410) 313-6450
Assisted Living in Maryland: What You Need to Know - 65
Department of Social Services
7121 Columbia Gateway Drive
Columbia, MD 21046
(410) 872-4200
(410) 872-4231 (fax)
Legal Aid Bureau, Inc.
District Court, 2
nd
floor
3451 Court House Drive
Ellicott City, MD 21043
(410) 480-1057
(888) 215-5316
Area Agency on Aging
Howard County Department on Aging
6751 Columbia Gateway Drive, 2
nd
floor
Columbia, MD 21046
(410) 313-6423
(410) 313-6593 (fax)
(410) 313-6540 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 313-6052
Senior Health Insurance Assistance
Program (SHIP)
(410) 313-7212
Senior Information and Assistance
Central Offices
(410) 313-7212
Ombudsman Program
(410) 313-6423
Kent County
Adult Evaluation and Review Services
Kent County Health Dept.
125 S. Lynchburg St.
P.O. Box 359
Chestertown, MD 21620
Department of Social Services
350 High Street
P.O. Box 670
Chestertown, MD 21620
(410) 810-7600
(410) 778-1497 (fax)
Legal Aid Bureau, Inc.
Tred Avon Square, Suite 3
210 Marlboro Road
Easton, MD 21601
(410) 763-9676
(800) 477-2543
TTY (410) 763-8751
Area Agency on Aging
Upper Shore Aging, Inc.
P.O. Box 89
Chestertown, MD 21620
(410) 778-6000
(410) 778-3562 (fax)
Senior Health Insurance Assistance
Program (SHIP)
(410) 778-2564
Medicaid Waiver Provider Information
and Assistance
(410) 758-6500
66 - Assisted Living in Maryland: What You Need to Know
Senior Information and Assistance Central Senior Health Insurance Assistance
Offices
(410) 778-2564
Montgomery County
Adult Evaluation and Review Services
Montgomery County Dept. of Health
and Human Services
Aging & Disability Services
410 Hungerford Dr. 3
rd
Floor
Rockville, MD 20850
(240) 777-3000
Department of Social Services
410 Hungerford Drive, 5
th
floor
Rockville, MD 20850
(240) 777-3000
(240) 777-1495 (fax)
TTY (240) 777-4575
Legal Aid Bureau, Inc.
14015 New Hampshire Avenue
Silver Spring, MD 20904
(301) 879-8752
(888) 215-5316
Area Agency on Aging
Montgomery County Dept. of Health
and Human Services
Long Term Care Ombudsman Program
410 Hungerford Drive, 3
rd
floor
Rockville, MD 20850
(240) 777-3369
(240) 777-1436 (fax)
Medicaid Waiver Provider Information
and Assistance
(240) 777-3043
Program (SHIP)
(301) 590-2819
Senior Information and Assistance
Central Offices
(240) 777-3000
Ombudsman Program
(240) 777-3910
Montgomery County PASRR
16220 Frederick Road
Suite 510
Gaithersburg, MD 20877
(301) 208-0775
Prince George’s County
Adult Evaluation and Review Services
Prince George’s Co. Health Dept.
D. Leonard Dyer Regional Health Ctr.
9314 Piscataway Road
Clinton, MD 20735
(301) 856-9460
Department of Social Services
805 Brightseat Road
Landover, MD 20785
(301) 909-7000
(301) 909-7001 (fax)
Department of Social Services
Out-of-Home Services
925 Brightseat Road
Landover, MD 20785
(301) 909-2000
(301) 909-2003 (fax)
Assisted Living in Maryland: What You Need to Know - 67
Legal Aid Bureau, Inc. Department of Social Services
6811 Kenilworth Avenue
Calvert Building, Suite 500
Riverdale, MD 20737
(301) 927-2101 (business)
(301) 927-6800 (intake)
(888) 215-5316
TTY (301) 864-3093
Area Agency on Aging
Long Term Care Unit
Aging Services Division
5012 Rhode Island Avenue
Hyattsville, MD 20781
(301) 699-2684
(301) 699-2845 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 767-1272 or
(800) 243-3425 X 1272
Senior Health Insurance Assistance
Program (SHIP)
(301) 699-2893
Senior Information and Assistance
Central Offices
(301) 699-2696
Ombudsman Program
(301) 699-2684
Queen Anne’s County
Adult Evaluation and Review Services
206 North Commerce Street
Centreville, MD 21617
(410) 758-3711
120 Broadway
Centreville, MD 21617
(410) 758-8000
Legal Aid Bureau, Inc.
Tred Avon Square, Suite 3
210 Marlboro Road
Easton, MD 21601
(410) 763-9676
(800) 477-2543
TTY (410) 763-8751
Area Agency on Aging
Queen Anne’s County Department on
Aging
104 Powell Street
Centreville, MD 21617
(410) 758-0848
(410) 758-4489 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 758–0848
Senior Health Insurance Assistance
Program (SHIP)
(410) 758-0848
Senior Information and Assistance
Central Offices
(410) 758-0848
Ombudsman Program
(410) 758-0848
68 - Assisted Living in Maryland: What You Need to Know
Somerset County
Adult Evaluation and Review Services
Somerset County Health Dept.
11678 Somerset Avenue
Princess Anne, MD 21853
(410) 651-5640
Department of Social Services
30397 Mt. Vernon Road
Princess Anne, MD 21853
(410) 677-4200
(410) 677-4300 (fax)
Legal Aid Bureau, Inc.
111 High Street
Salisbury, MD 21801
(410) 546-5511
(800) 444-4099
(410) 860-2148
Area Agency on Aging
MAC, Inc.
1504 Riverside Drive
Salisbury, MD 21801
(410) 742-0505
(410) 742-0525 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 742-0505
Senior Health Insurance Assistance
Program (SHIP)
(410) 742-0505
Senior Information and Assistance
Central Offices
(410) 651-0020
Ombudsman Program
(410) 742-0505
St. Mary’s County
Adult Evaluation and Review Services
St. Mary’s County Health Dept.
P.O. Box 316
21580 Peabody Street
Leonardtown, MD 20650
Department of Social Services
Joseph D. Carter Building
23110 Leonard Hall Drive
Leonardtown, MD 20650
(240) 895-7000
(240) 895-7099 (fax)
Legal Aid Bureau, Inc.
Southern Maryland Office
15364 Prince Frederick Road
P.O. Box 249
Hughesville, Md 20637
(410) 535-3278 (Calvert Co.)
(301) 884-5935 (St. Mary’s Co.)
(301) 843-5850 (DC)
(301) 932-6661 (Charles Co.)
Area Agency on Aging
Long Term Care Program Manager
St. Mary’s County Office on Aging
Garvey Senior Center
P.O. Box 653
Leonardtown, MD 20656
(301) 475-4509
(301) 475-4503 (fax)
Medicaid Waiver Provider Information
and Assistance
(301) 475-7119
Assisted Living in Maryland: What You Need to Know - 69
Senior Health Insurance Assistance
Program (SHIP)
(301) 475-4444
Senior Information and Assistance
Central Offices
(301) 475-5100
Ombudsman Program
(301) 475-4509
Talbot County
Adult Evaluation and Review Services
Talbot County Health Dept.
100 South Hanson Street
Easton, MD 21601
(410) 819-5640
Department of Social Services
10 South Hanson Street
Easton, MD 21601
(410) 822-1617
(410) 820-7067 (fax)
Legal Aid Bureau, Inc.
Tred Avon Square, Suite 3
210 Marlboro Road
Easton, MD 21601
(410) 763-9676
(800) 477-2543
TTY (410) 763-8751
Area Agency on Aging
Upper Shore Aging, Inc.
P.O. Box 89
Chestertown, MD 21620
(410) 778-6000
(410) 778-3562 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 758-6500
Senior Health Insurance Assistance
Program (SHIP)
(410) 822-2869
Senior Information and Assistance
Central Offices
(410) 822-2869
Ombudsman Program
(410) 778-6000
Washington County
Adult Evaluation and Review Services
Washington Co. Health Dept.
1302 Pennsylvania Avenue
Hagerstown, MD 21742
(301) 791-3293
Department of Social Services
122 North Potomac Street
P. O. Box 1419
Hagerstown, MD 21741-1419
(240) 420-2100
(240) 420-2111 (fax)
Legal Aid Bureau, Inc.
203A Broadway
Frederick, MD 21701
(301) 694-7414 (Frederick Co.)
(800) 679-8813
(800) 763-4152
70 - Assisted Living in Maryland: What You Need to Know
Area Agency on Aging
Washington County Commission on
Aging
9 Public Square
Hagerstown, MD 21740
(301) 790-0275
(301) 739-4957 (fax)
Medicaid Waiver Provider Information
and Assistance
(301) 790-0275
Senior Health Insurance Assistance
Program (SHIP)
(301) 790-0275
Senior Information and Assistance
Central Offices
(301) 790-0275
Ombudsman Program
(301) 790-0275
Wicomico County
Adult Evaluation and Review Services
108 East Main Street
Salisbury, MD 21801
(410) 543-6938
Department of Social Services
Salisbury DC/ MSC
201 Baptist Street
Salisbury, MD 21802-2298
(410) 543-6900
(410) 543-6682 (fax)
Legal Aid Bureau, Inc.
111 High Street
Salisbury, MD 21801
(410) 546-5511
(800) 444-4099
(410) 860-2148
Area Agency on Aging
MAC, Inc.
1504 Riverside Drive
Salisbury, MD 21801
(410) 742-0505
(410) 742-0525 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 742-0505
Senior Health Insurance Assistance
Program (SHIP)
(410) 742-0505
Senior Information and Assistance
Central Offices
(410) 543-0388
Ombudsman Program
(410) 742-0505
Worcester County
Adult Evaluation and Review Services
Worcester Co. Health Dept.
P.O. Box 249
Snow Hill, MD 21863
(410) 632-1100
Department of Social Services
299 Commerce Street
P.O. Box 39
Snow Hill, MD 21863
(410) 677-6800
Legal Aid Bureau, Inc.
111 High Street
Salisbury, MD 21801
(410) 546-5511
(800) 444-4099
(410) 860-2148
Assisted Living in Maryland: What You Need to Know - 71
Area Agency on Aging
MAC, Inc.
1504 Riverside Drive
Salisbury, MD 21801
(410) 742-0505
(410) 742-0525 (fax)
Medicaid Waiver Provider Information
and Assistance
(410) 742-0505
Senior Health Insurance Assistance
Program (SHIP)
(410) 742-0505
Senior Information and Assistance
Central Offices
(410) 632-1289
Ombudsman Program
(410) 742-0505
72 - Assisted Living in Maryland: What You Need to Know
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Assisted Living in Maryland: What You Need to Know - 73
NOTES -
74 - Assisted Living in Maryland: What You Need to Know
