Dementia Care Options in Maryland

The Four Care Settings in Maryland

Maryland families navigating a dementia diagnosis face four primary care settings, each with different licensing structures, cost profiles, and Medicaid eligibility pathways. Understanding which setting fits your parent's current stage — and which one they'll likely need next — prevents the costly scramble of an emergency placement.

In-Home Care

Keeping a parent with dementia at home is the default starting point for most families, and Maryland has two types of licensed agencies that provide home-based care.

Residential Service Agencies (RSAs) hold a license under COMAR 10.07.05 and provide non-medical support: bathing, dressing, meal preparation, medication reminders, companionship, and light housekeeping. RSAs do not require a Certificate of Need, which means there are many operating across the state. License renewal is every three years.

Home Health Agencies (HHAs) operate under COMAR 10.07.10 and deliver skilled medical services — nursing, physical therapy, occupational therapy, and speech therapy. HHAs must obtain a Certificate of Need from the Maryland Health Care Commission before applying for licensure, which restricts their numbers.

For early-to-mid-stage dementia, RSA-provided personal care aides are usually sufficient. When the parent develops medical complications alongside their cognitive decline — infections, fall injuries, medication management that requires clinical judgment — an HHA becomes necessary.

Maryland Medicaid covers in-home care through the Community First Choice (CFC) program, which has no waiting list. CFC pays for personal care aides, home modifications, and assistive technology. Eligibility requires Medicaid enrollment and documented need for help with at least one activity of daily living.

Medical Adult Day Care

Adult day care programs provide structured, supervised activities for 6 to 8 hours per day, typically Monday through Friday. Maryland has both social adult day care and licensed Medical Adult Day Care programs; some serve people with cognitive impairments and some can accept Medicaid participants.

For dementia families, adult day care serves two purposes: it provides therapeutic socialization and routine for the parent, and it gives the primary caregiver a full working day of respite without the cost of 24-hour in-home aides.

The right time to consider adult day care is when the parent can no longer be left alone safely but does not yet need the 24-hour supervision of a residential setting. Common indicators include wandering behavior during the day, leaving the stove on, or becoming agitated when the caregiver leaves the room.

Assisted Living Memory Care

Maryland does not issue a separate "memory care" license. Memory care operates as an approved Alzheimer's Special Care Unit (ASCU) inside a standard licensed Assisted Living Program, governed by COMAR 10.07.14.32. The Office of Health Care Quality (OHCQ) must grant written approval before a facility can market itself as offering memory care.

Maryland's three assisted living levels determine what care a facility can legally provide:

• Level 1 (Low): Occasional assistance with personal care or medication reminders
• Level 2 (Moderate): Substantial daily assistance with ADLs, medication administration, and behavioral management
• Level 3 (High): Extensive, frequent support with multiple ADLs, active health monitoring, and management of behavioral changes from advanced dementia

A parent with mid-to-late-stage dementia typically needs Level 2 or Level 3 care. If a facility is only licensed for Level 1, they will eventually have to discharge your parent as the disease progresses — often with little warning.

The Community Options Waiver (HCBOW) is the only Maryland Medicaid program that pays for care services inside licensed assisted living. It has a strict income cap of up to $2,982/month and a statewide Service Registry that had 24,015 people on it in early 2025, with waits lasting several years.

Nursing Home Care

Nursing homes (skilled nursing facilities) provide the highest level of care — 24-hour nursing supervision, wound care, IV medication administration, and management of complex medical conditions alongside dementia. Maryland nursing homes are regulated separately from assisted living and require a higher staffing ratio.

Nursing home care becomes necessary when the parent's medical needs exceed what an assisted living memory care unit can provide — typically when they develop serious co-occurring conditions like advanced diabetes, pressure wounds, or require tube feeding.

Maryland Medicaid covers nursing home care with no income cap (unlike HCBOW). The applicant must contribute all monthly income to care costs except for a $109 personal needs allowance. The financial eligibility threshold for countable assets is $2,500.

A strategic consideration: if a parent resides in a Medicaid-paid nursing facility for at least 30 consecutive days, they can apply for the HCBOW as a nursing facility transition applicant, bypassing the multi-year community waiting list entirely. This "30-day nursing home bypass" is one of the most underused provisions in Maryland's Medicaid system.

Choosing Based on Stage, Not Crisis

The pattern that costs families the most — in money, stress, and care quality — is waiting for a crisis to force the decision. A fall, a wandering episode, a hospitalization, and suddenly the family is choosing a facility from a hospital bed under a 48-hour discharge timeline.

The alternative is mapping the transition points in advance: identifying when in-home care becomes inadequate, which facilities in your area hold Level 3 licenses with ASCU approval, what the Medicaid application timeline looks like, and how to position for the HCBOW waitlist bypass if needed.

The Maryland Dementia & Memory Care Guide walks through each transition point with specific Maryland forms, timelines, and financial thresholds — structured as a planning sequence rather than an emergency response.

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