Once your family has decided that assisted living is the right step, the next question is a practical one: what does it actually take to move in? In Maryland, admission isn’t simply signing a lease; there's a health assessment, a formal level-of-care determination, and specific paperwork, all governed by state regulations. It sounds daunting, but it’s a clear, well-defined process, and a good community will walk you through every step.
This guide explains exactly what to expect when admitting a loved one to an assisted living program in Maryland: the required assessment, the three levels of care, the documents you’ll need, and the conditions that can affect eligibility.
Assisted living programs in Maryland are licensed and overseen by the Office of Health Care Quality (OHCQ), part of the Maryland Department of Health. The rules they must follow are set out in the Code of Maryland Regulations, COMAR 10.07.14. These regulations exist to protect residents they define who can be safely cared for in assisted living, how needs are assessed, and what each community must provide.
Worth knowing: Maryland substantially updated these regulations in 2025, and the legislature passed further changes affecting assisted living in 2026. Specific forms and details can change, so always confirm the current requirements with the community or OHCQ.
The centerpiece of Maryland’s admission process is the Resident Assessment Tool (RAT) , a standardized state form that captures a complete picture of the prospective resident’s health and needs. It must be completed within 30 days before admission, and it does three important things:
Part of the assessment is a health examination that must be based on an exam by a physician, certified nurse practitioner, certified registered nurse midwife, registered nurse, or physician assistant, who certifies that it reflects the person’s current health status. The assessment looks at the whole person, including:
Based on the assessment, a Level of Care Scoring Tool assigns the resident one of three levels. The level reflects how much help and supervision the person needs and it shapes both their care and their cost.
The assessment also flags whether the resident needs awake overnight staff. A community must either provide awake overnight staffing when the assessment triggers it, or document why it isn’t necessary.
Here is the typical sequence families go through when admitting a loved one to a Maryland assisted living program:
Because assisted living is not a skilled medical facility, Maryland regulations bar programs from admitting a new resident who at the time of admission would require care beyond what assisted living can safely provide. Generally, a person may not be admitted if they require:
A person also may not be admitted if they would be dangerous to themselves or others in a way the program cannot safely manage, or are at high risk for complications the program cannot adequately handle.
To make admission smooth, it helps to have these ready:
Admission isn’t the end of the process, it’s the beginning of ongoing, personalized care. Maryland requires the Resident Assessment Tool to be reviewed and updated regularly: at least every six months, and again after any significant change in the resident’s condition or a nonroutine hospitalization. This keeps the service plan matched to your loved one’s current needs, and it means the level of care (and cost) can change over time as needs change.
Since 2000, CR Care Group has welcomed families into small, home-like residential communities in Sandy Spring, Bondmill, Laurel, and Clarksville. We know the Maryland admission process inside and out, and we handle the details with you, coordinating the assessment, explaining the level-of-care determination, helping gather paperwork, and building a service plan around your loved one’s real needs and preferences. Our goal is to make a stressful transition feel calm, clear, and genuinely welcoming.
Admission requires a completed Resident Assessment Tool, including a health examination by a physician, nurse practitioner, registered nurse, or physician assistant within 30 days before admission. The assessment determines the resident’s level of care. The community then creates a service plan, both parties sign a resident agreement, and a medication review is completed within 14 days of admission.
The Resident Assessment Tool (RAT) is a standardized state form used to evaluate a prospective assisted living resident’s health, daily functioning, behaviors, and social needs. It determines the person’s required level of care, forms the basis of their individual service plan, and identifies whether awake overnight staffing is needed. It must be completed within 30 days before admission.
Maryland assigns each resident one of three levels of care using a scoring tool. Level 1 is for largely independent residents needing minimal help, Level 2 is for those needing regular daily assistance, and Level 3 is for residents with significant needs requiring extensive help and closer supervision. The level affects both care and cost.
The health portion of the assessment must be based on an examination by a physician, certified nurse practitioner, certified registered nurse midwife, registered nurse, or physician assistant. Within the community, the delegating nurse and assisted living manager are responsible for the assessment and for reviewing it every six months.
Yes. Maryland regulations prevent programs from admitting someone who needs care beyond what assisted living can safely provide: such as more than intermittent nursing care, ventilator services, or treatment of advanced pressure ulcers. A person may also be turned away if they pose a safety risk the program cannot manage. Residents under licensed hospice care are treated as an exception.
Yes. A health examination is a required part of Maryland’s admission process. It must be conducted by a physician, nurse practitioner, nurse midwife, registered nurse, or physician assistant within 30 days before admission, and the provider certifies that the information reflects the resident’s current health status.
Maryland requires the Resident Assessment Tool to be reviewed at least every six months, and again within a short time after any significant change in the resident’s condition or a nonroutine hospitalization. This keeps the service plan and level of care aligned with the resident’s current needs.
Often, yes. Many Maryland assisted living communities care for residents with dementia, and some offer dedicated memory care. Admission depends on the assessment and whether the community can safely meet the person’s needs. Communities offering memory care follow additional requirements designed to keep residents with cognitive impairment safe.
