In Maryland regulations, the types of communities that can offer a place to live with full-time care and services for people with Alzheimer’s disease, or a related dementia, are called “assisted living facilities” with an “Alzheimer’s special care unit.” Another common term for these is “memory care.” Broadly, residents in assisted living are given housing, supervision, support, and health-related services including help with activities of daily living (ADLs) like eating and dressing.
Assisted living facilities in Maryland offer three designations of care: low, moderate, or high. Someone in the late stages of Alzheimer’s will obviously need to live in a high-level residence, while a person in the early or middle stages will live in low or moderate. An important note, however, is that assisted living may not legally house someone whose health needs cannot be met there. Because Alzheimer’s is progressive, meaning it gets worse over time, your loved one in low or moderate memory care will eventually need to move somewhere offering more care, like a high-level residence or a nursing home.
There are 240 memory care communities in Maryland. There are also 150 board and care homes, which offer the same services as assisted living (often including memory care) in a smaller house-like setting, typically with fewer than 12 residents. For free help finding the perfect memory care home to meet your family’s needs and budget, click here.
Any assisted living residence housing people with dementia must submit the following to the Office of Health Care Quality, which regulates assisted living under the banner of the Maryland Department of Health:
– Description of the unit (memory care facilities are typically built with special considerations, including secure outdoor areas and special locks on bedroom units)
– Statement of philosophy or mission
– Staff training and titles (see below)
– All procedures that go beyond the treatment provided in normal assisted living
The average cost of memory care per month in Maryland in 2020 is $5,120, which breaks down to about $61,440 annually. The state’s most expensive place for memory care is California (in St. Mary’s County), where memory care costs about $7,480 per month and $89,760 annually. The least expensive city for memory care is Cumberland, for about $4,470 per month and $53,640 per year. In the Baltimore area, including the state’s second-largest city Columbia, memory care costs about $5,050 per month and $60,600 annually.
Maryland’s eastern shore is generally much more expensive than memory care in the Appalachian and Grand Valley sections of the state (like Cumberland and Hagerstown, where average monthly costs are less than $5,000).
If you live in northern Maryland, it’s possible to find more affordable memory care out-of-state in Pennsylvania, where average costs are $4,690 per month and $56,280 annually. Delaware, Virginia, and West Virginia all average higher memory care costs than Maryland. Washington D.C. is much more expensive than its neighbors, at an average monthly cost of $13,470 and $161,640 annually.
Within 30 days before admission, a resident must be assessed using the Residential Assessment Tool to gauge health, function, and psychosocial status (which is like emotional and social well-being). This assessment is provided by the residence into which they hope to move, and performed by a medical professional who works there. Based on the results, the memory care home will create a resident’s service plan that outlines what your loved one needs and how those needs will be met.
The cost of the assessment is typically included in what’s called a “community fee” charged when your loved one moves in. The community fee is usually between $1,500 and $2,500, and covers other move-in expenses as well, like deep cleaning and painting a new resident’s room.
Assisted living homes in Maryland may not admit someone with any of these issues:
– Requires full-time nursing care
– Stage III or IV skin ulcers
– Requires a ventilator
– An acute and fluctuating medical condition that requires monitoring and frequent medication and treatment changes
– Illness that requires isolation from other residents
– Presents a danger to self or others
Please note, however, that this is not a hard rule because a home may request a waiver specific to a resident who has one of the above conditions or issues. They may therefore be allowed to move in, or stay at the residence if their condition has gotten worse.
A diagnosis of Alzheimer’s disease, or related illness like vascular, frontotemporal, or Lewy body dementia, is not required to move into memory care in Maryland. Diagnosing dementia is difficult as symptoms change, different diseases often share those symptoms, and it’s important to match a person with the home that makes them most comfortable and can handle unique needs.
You can move into a memory care community on short notice, but this is not a good idea. Finding the right home takes months of inspecting residences and asking the right questions. You do not want to hurry this process. Also, your loved one will have more say about where they end up if you begin searching for a home before the move is actually necessary.
Bedroom units must have at least 80 square feet of space for a single-person room, and 120 square feet per person if there are multiple occupants. The most people allowed in one bedroom is two. That space does not include the closet or bathroom. There also must be one toilet for every four residents and one shower or bathtub for every eight. Smoke detectors are required in every bedroom and outside the rooms within their vicinity. A plan for fire evacuation must be posted on every floor, and fire drills are required four times per year.
Unlike other states, Maryland memory care communities are not specifically required by regulations to have physical designs that are dementia-friendly. People with Alzheimer’s disease and related dementias are more comfortable in homes with easily navigated spaces, circular hallways that don’t run to dead ends, and outdoor spaces that allow for time in the open air. Be sure to thoroughly inspect any home you are considering for your loved one, with an eye on whether they can be comfortable in the spaces.
There are no staff-to-resident ratio requirements in Maryland, though regulations say staffing must at all times be adequate to serve the needs of every resident. Assisted living communities in Maryland must have a contract with a registered nurse who may or may not be directly employed there. Managers must be at least 21 years old, with a high school diploma (or equivalent) and sufficient training to fulfill the role of running an assisted living community. For a community offering high-level care, the manager must have a four-year college degree, two years’ experience in health care, and at least one year of experience in assisted living. An 80-hour assisted living training program must also be completed.
Staff who aren’t managers must be at least 18 years old, and must complete five hours of training on cognitive impairment and mental illness within 90 days of starting work. An orientation and ongoing training are also required.
Unfair evictions are a major problem for families with a loved one in assisted living. Unlike many other states, Maryland does not have rules outlining specific reasons a person might be evicted from memory care. Whether or not a resident can be discharged for nonpayment, aggressive behavior, or some other reason is up to the specific residence. When considering a memory care community, ask before moving in for the specific reasons someone can be evicted or discharged, and get the answer in writing. What to do if you receive an eviction notice.
Services for someone in memory care in Maryland may be covered with funds from the Community Options Waiver. This waiver is for people who fulfill Medicaid requirements, including monthly income below $2,382 in 2021, and stay in a moderate- or high-level assisted living facility (see above). The idea behind it is that someone who needs expensive nursing-home level care can actually stay in their house or memory care community, and use Medicaid funds to cover intermittent nursing care and things like nutritional services, case management, and behavioral counseling. The program is popular in Maryland, so there may be a waiting list; depending which part of Maryland you live in, enrollment could take years. To apply, contact your local Area Agency on Aging.
ICS is for people in nursing homes who want to transition back to their own houses or into assisted living. Services covered for Medicaid-eligible Marylanders include help with ADLs, which is part of living in memory care. The benefits are similar, in fact, to the Community Options Waiver (above) but the income requirements are different. ICS is available for people who have a higher level of income, so long as their monthly income does not exceed the cost of care. To apply, contact the Maryland Department of Health at 410-767-1739.
This is another Medicaid program designed to keep people who need nursing-home-level care out of a nursing home and in their own houses or assisted living. Community First Choice also has the added bonus of applicants never going on a waiting list, so meeting eligibility requirements (including requiring assistance with two ADLs and monthly income under $2,382 in 2021) should get someone quickly enrolled. Services covered include help with ADLs. Apply through the state’s Medicaid program. A slightly outdated fact sheet is available here.
This program provides money to recipients expressly for the purpose of covering the costs of assisted living. The income requirements are different from Medicaid’s (a person’s monthly income cannot exceed 60 percent of the state’s median). This program is not available in some Maryland counties, and there may be a waiting list. For more information, visit the Department of Aging website. To apply, contact your local Area Agency on Aging.
Veterans are statistically more likely to develop dementia. Relevant in all states including Maryland is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is an amount of money added to veterans’ and survivors’ basic pensions. Applicants must be at least 65 years old (or disabled) and require assistance with activities of daily living (ADLs) like eating, bathing, and mobility. The cash assistance from these pensions can be used as the recipient wishes, meaning it can go toward the cost of memory care. In addition, the cost of residential care can be deducted from one’s income, effectively reducing the amount of calculable income used to determine the benefit amount. The latest (2020) maximum amount a veteran can receive through A&A is $27,194 per year, and surviving spouses can receive as much as $14,761. Learn more here.
There is also one veterans’ home in Maryland, a residential care facility that provides long-term care for veterans. The Charlotte Hall Veterans Home in Charlotte Hall (in the southern region) offers assisted living, skilled nursing, and memory care for more than 300 veterans at a time. Payment is made directly from the VA to the facility. State veterans’ homes are typically reserved for veterans whose need for care stems at least 70 percent from their military service. Because there is often a waiting list, contact the home before visiting to see if your loved one is eligible to live there. Contacts, admission requirements and more are available here.
Other ways to help pay for memory care include tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you can claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that may include some assisted living costs.
A reverse mortgage may be a good option for a married person moving into memory care, if their spouse continues to live in the home. Should their spouse move from their home, the reverse mortgage would become due.
Elder care loans are for families to cover initial costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. For example, if one is waiting for a VA pension to be approved or waiting to sell a home.