Alzheimer's Special Care Unit Disclosure Form Maryland: What COMAR 10.07.14.32 Requires

Maryland doesn't issue a standalone "memory care license." When a facility advertises memory care, dementia care, or an Alzheimer's unit, what it actually operates is an approved specialty unit inside a standard licensed assisted living program. The regulation that governs this — COMAR 10.07.14.32 — requires facilities to complete a specific disclosure document before they can market those services, and that document is one of the most useful tools a family can demand during their search.

Most families touring memory care facilities never ask for it. They should.

What the Disclosure Form Must Include

Before an assisted living program can operate an Alzheimer's Special Care Unit (ASCU), it must get written approval from the Office of Health Care Quality (OHCQ) and complete the Alzheimer's Special Care Unit Disclosure Form. Under COMAR 10.07.14.32, this disclosure must be provided to prospective residents and their families before admission and posted alongside the facility's license.

The form covers six specific areas:

Philosophy and mission. The facility's clinical approach to dementia care — whether they use a specific therapeutic model, how they view behavioral interventions, and what outcomes they track. This isn't marketing copy; it's a binding document.

Admission and discharge criteria. This is the section that catches families off-guard. It defines which behaviors the unit can manage and, critically, what cognitive or behavioral milestones trigger an involuntary discharge. A facility that can't handle late-stage aggression or total ADL dependence will discharge your parent mid-crisis if this section permits it.

Assessment process. How the facility determines what care your parent needs when they move in, and how the care plan updates as the disease progresses. Look for how often reassessments happen and who conducts them.

Staff training and staffing patterns. The disclosure must document the number of hours of dementia-specific training provided annually across all job classifications. Maryland regulations require a minimum of six hours of ASCU-specific advanced cognitive impairment training for staff working in these units.

Activities. The frequency and type of dementia-specific therapeutic programming — not generic activities, but structured interventions designed for residents with cognitive impairment.

Fee structure. An explicit breakdown of the base rate, what dementia-specific services add to the monthly cost, and how care-level reassessments trigger fee increases. This is where many facilities bury significant cost escalations.

Maryland's Three Assisted Living Levels of Care

Maryland categorizes assisted living services into three regulated levels, and the level determines what a facility can provide:

Level 1 (Low). The resident needs occasional help with personal care — medication reminders, scheduling appointments, light daily assistance. Most early-stage dementia residents start here.

Level 2 (Moderate). The resident needs substantial assistance with personal care, ADLs, medication administration, and behavioral management. This is where most moderate dementia cases land.

Level 3 (High). The resident needs extensive, frequent assistance with multiple ADLs, active health monitoring, and management of behavioral changes associated with advanced cognitive decline. If your parent has mid-to-late-stage dementia with sundowning, aggression, or wandering, they need a Level 3 facility.

The critical point: a facility licensed at Level 2 cannot retain a resident whose needs escalate to Level 3. If the care plan reassessment shows your parent needs a higher level of care than the facility can provide, the facility can initiate a discharge — sometimes with as little as 30 days' notice.

When touring facilities, ask: "What is your current licensed level of care, and what is the process if my parent's needs exceed that level?" The answer should be in the Uniform Disclosure Statement, which every licensed assisted living program must also complete and provide upon request.

How to Use These Documents During a Facility Search

The Disclosure Form and the Uniform Disclosure Statement are comparison tools. When you're evaluating three or four memory care options, request both documents from each facility and compare them side-by-side on these specifics:

Staffing ratios. How many direct-care staff are on the memory care unit during day, evening, and overnight shifts? Some facilities maintain a 1:6 ratio during the day but drop to 1:12 or worse overnight.

Discharge triggers. Compare the discharge criteria across facilities. A facility that lists "aggressive behavior requiring more than one-on-one intervention" as a discharge criterion will handle a behavioral crisis very differently than one that commits to managing escalating behaviors through care plan adjustments.

Fee escalation. Compare the base rate at each level and what triggers a reassessment. Some facilities reassess quarterly; others only when a family or the delegating nurse requests it. Reassessments almost always result in a fee increase.

Training hours. Six hours annually of advanced cognitive impairment training is the ASCU-specific regulatory minimum. Facilities that invest more — particularly in evidence-based programs like CARES Dementia Care or the Alzheimer's Association REACH training — generally provide better day-to-day care.

The Delegating Nurse Requirement

Every licensed Maryland assisted living facility must contract with or employ a Registered Nurse known as the delegating nurse. This person conducts a formal clinical assessment of each resident at admission, at least every 45 days, and immediately upon any significant change in condition. The delegating nurse determines whether your parent's needs align with the facility's licensed level of care.

When visiting a facility, ask to speak with the delegating nurse directly. They can tell you more about day-to-day clinical operations than any marketing director. Ask them: "How many residents are currently on the memory care unit, and what is the typical acuity level?" Their answer will tell you whether the unit is genuinely equipped for your parent's stage of decline.

Where to Find OHCQ Inspection Data

OHCQ maintains licensing and inspection records for all assisted living programs in Maryland. Before signing any admission agreement, check:

• Whether the facility's license is current and in good standing
• Any deficiencies cited during the most recent inspection
• Whether the ASCU approval is specifically documented

You can also file a complaint with OHCQ if you discover a facility marketing memory care services without the required disclosure form or OHCQ approval.

What This Means for Your Search

The facilities that readily hand over their Disclosure Form and walk you through it are generally the ones with nothing to hide. The facilities that deflect, say they'll mail it later, or claim they don't have one on hand are either operating without proper OHCQ approval or hoping you won't read the discharge criteria until it's too late.

The Maryland Dementia & Memory Care Guide includes a facility audit checklist that maps directly to the Disclosure Form and Uniform Disclosure Statement requirements, so you can evaluate each facility against the same regulatory standard the state uses.

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