Laws, Regs to Boost Oversight of Assisted Living

Two new laws on the books in Maryland will change the way assisted living facilities in the state operate — and should bring a greater measure of protection for more than 25,000 people who call the facilities home.

But to advocates who monitor the industry, more work needs to be done. Among the most important tasks: the first major update of the state regulations that govern the facilities since 2008.

“It is critical that the state regulations provide protection for the rights, well-being, quality of life and quality of care of assisted living residents,” says Stevanne Ellis, Maryland’s long-term care ombudsman.

Assisted living offers care to people who have difficulty living independently but may not require the services of a nursing home; for example, they just need help eating or toileting.

There are 1,726 assisted living facilities in Maryland, the state says. Most have fewer than 10 beds — and those are the ones that raise the most concerns, says Tammy Bresnahan, advocacy director for AARP Maryland. “The smaller facilities tend to be cheaper,” she notes, “but they often don’t provide the higher level of care that is needed.”

Monthly costs at all facilities range from $2,000 to $13,000, depending on services offered, according to the industry’s Health Facilities Association of Maryland. Most residents are private pay, although there is limited funding available for those with low incomes.

Assisted living facilities also fall under different — and generally looser — regulations than nursing homes, something advocates have been trying to change.

Laws target oversight, abuse

AARP Maryland supported the two new laws, which passed in 2022 and 2023 and will be implemented by next year. The first requires more oversight of facility managers, and the second puts more teeth in regulations for unlicensed facilities found to have abused or neglected residents.

What needs to happen next, advocates say, is a revision of regulations that govern the homes. They are supposed to be reviewed at least every eight years. In fact, new rules were proposed in 2016, and then informal draft regulations were circulated in 2021. Since then, however, the draft has been stalled.

The Office of Health Care Quality in the Department of Health oversees the process, but state Sen. Pamela Beidle says, “They can’t seem to come to an agreement.” Beidle (D) is on a committee overseeing assisted living facilities and nursing homes.

Chase Cook, a spokesperson for the state Department of Health, said the office is aiming to formally propose new regulations by the end of the year, and expects to finalize them in 2024.

Ellis and advocates say several changes should be addressed by the regulations, including better training to help staff deal with dementia patients, as well as those with mental health issues; better consumer protections around price increases and evictions; and a minimum staff-to-resident ratio.

The industry says it’s willing to work with the state — but costs are a concern. “Everyone wants and deserves the highest quality of care,” says Danna Kauffman, a lobbyist for LifeSpan Network. “We need to find a way to make that possible without pricing providers out of business.”

For resources on assisted living and other long-term care, see aarp.org/caregiving.

Kathy Jesse is a writer living in Bethesda.

More on Assisted Living

• Assisted Living Facilities: Weighing the Options
• Understanding Long-Term Care