OHCQ Maryland: Memory Care Licensing and Assisted Living Levels

Maryland Does Not Issue a Memory Care License

This is the single most important regulatory fact families miss: Maryland does not have a standalone "memory care license." There is no separate licensing category for a standalone memory care facility; a facility instead uses its Assisted Living Program license plus written OHCQ approval for an Alzheimer's Special Care Unit.

Instead, memory care in Maryland operates as an approved Alzheimer's Special Care Unit (ASCU) inside a standard licensed Assisted Living Program. The licensing and oversight authority for all assisted living — including any unit marketing itself as memory care — is the Office of Health Care Quality (OHCQ), a division of the Maryland Department of Health.

What this means practically: when a facility advertises "licensed memory care," what they hold is a regular assisted living license with written OHCQ approval to operate a dementia-specific unit under COMAR 10.07.14.32. The regulation, not a separate license, is what distinguishes a memory care unit from a general assisted living residence.

The COMAR 10.07.14.32 Disclosure Requirement

Before an assisted living program can market itself as offering dementia care, Alzheimer's care, or operate an Alzheimer's Special Care Unit, it must obtain written approval from OHCQ. The facility is then legally required to complete and make available the Alzheimer's Special Care Unit Disclosure Form.

This disclosure must be provided to prospective residents or their families before admission and posted alongside the facility's official license. It is a binding document, and it covers:

• Philosophy and mission — the unit's clinical approach to dementia care
• Admission and discharge criteria — who the unit serves, what behaviors it can manage, and what cognitive decline milestones trigger an involuntary discharge
• Assessment process — how care needs are evaluated and how the care plan is updated as the disease progresses
• Staff training and staffing patterns — the number of hours of dementia-specific training provided annually across all job classifications (state rules require a minimum of six hours of advanced cognitive impairment training)
• Activities — the presence and frequency of dementia-specific therapeutic programming
• Fee structure — base rate, what dementia-specific services add to the monthly cost, and how care level reassessments trigger fee increases

If a facility cannot or will not show you this form, that is a disqualifying red flag. Either they have not obtained OHCQ approval to operate a memory care unit, or they are not following the regulatory requirements that govern one.

Maryland's Three Assisted Living Levels

OHCQ categorizes assisted living services into three regulated levels, and understanding where your parent falls determines which facilities can legally serve them.

Level 1 (Low) — The resident needs occasional help with personal care or health-related tasks. This might mean medication reminders, help scheduling medical appointments, or light assistance with dressing. Most residents at this level are cognitively intact or in very early cognitive decline.

Level 2 (Moderate) — The resident requires substantial assistance with personal care, activities of daily living, medication administration, and behavioral management. This is where many mid-stage dementia residents fall — they need consistent daily support but do not require round-the-clock skilled nursing.

Level 3 (High) — The resident requires extensive, frequent, and comprehensive assistance with multiple ADLs, active health monitoring, and management of frequent behavioral changes associated with advanced cognitive decline. This is the level most memory care units operate at.

The level matters for two reasons. First, a facility licensed only for Level 1 or Level 2 cannot legally keep a resident whose needs escalate to Level 3 — they must discharge that resident, often abruptly and in the middle of a health crisis. Second, the level assignment helps determine whether the facility can continue to meet the resident's needs and how its fees change.

When evaluating a facility, ask specifically which levels they are licensed for. A memory care unit that cannot serve Level 3 residents is a facility your parent may be forced to leave as their dementia progresses.

The Delegating Nurse Requirement

Every licensed assisted living facility in Maryland must contract with or employ a Registered Nurse known as the delegating nurse, governed by COMAR 10.07.14. This nurse is legally responsible for:

• Conducting a formal clinical assessment of each resident upon admission
• Reassessing at least once every 45 days
• Immediately reassessing after any significant change in physical or cognitive condition
• Determining whether the resident's needs align with the facility's licensed level of care
• Supervising personal care aides and medication technicians

For dementia families, the delegating nurse is a key figure. They are the person who determines whether your parent's care plan is adequate and whether the facility can continue to meet their needs. If you have concerns about your parent's care in a Maryland assisted living facility, the delegating nurse is the first person to contact — and if that conversation does not resolve the issue, the next step is filing a complaint with OHCQ directly.

How to Verify a Facility's Status

OHCQ maintains a public database of all licensed assisted living programs in Maryland. Before touring any facility that markets memory care services, verify:

1. Active license status — confirm the facility's license is current and not under suspension or provisional review
2. Approved care levels — confirm the facility is approved for the level of care your parent needs
3. ASCU approval — confirm the facility has specific OHCQ approval to operate an Alzheimer's Special Care Unit
4. Inspection history — review recent survey results and any citations for deficiencies

You can check licensing status through the OHCQ website or by calling OHCQ directly. Complaint and inspection records are public.

For families working through the full facility evaluation process — from licensing verification to the Special Care Unit Disclosure Form audit to understanding how HCBOW Medicaid pays for assisted living memory care — the Maryland Dementia & Memory Care Guide provides a structured vetting checklist alongside the Medicaid application roadmap.

See more Maryland guides →