Questions to Ask a Memory Care Facility in Maryland

Start with the Disclosure Form

Before asking any other question, request the facility's Alzheimer's Special Care Unit Disclosure Form. Under COMAR 10.07.14.32, any Maryland assisted living facility operating a memory care unit must complete and provide this document before admission. It is a regulatory requirement, not a courtesy.

If the admissions coordinator hesitates, deflects, or says they will "get it to you later," treat that as a disqualifying signal. Either the facility does not have OHCQ approval to operate a memory care unit, or they are not following the regulatory requirements that govern one.

The disclosure form contains specific, binding information about the unit's care philosophy, staffing patterns, admission and discharge criteria, training hours, therapeutic activities, and fee structure. It is the single most useful document you will receive during the evaluation process — more useful than the marketing brochure, the tour, or the admissions presentation.

Licensing and Regulatory Status

"What assisted living level is this facility licensed for?"

Maryland categorizes assisted living into three levels — Level 1 (Low), Level 2 (Moderate), and Level 3 (High). A memory care unit serving residents with mid-to-late-stage dementia should hold at least Level 2, and ideally Level 3 licensing. If the facility holds only a Level 1 license, your parent will be discharged when their care needs escalate — and with dementia, escalation is a certainty.

"When was your last OHCQ inspection, and were there any citations?"

OHCQ inspection records are public. Ask the facility for their most recent survey results and check independently through the OHCQ database. Repeated citations for staffing deficiencies, medication errors, or inadequate supervision in the memory care unit are significant risk indicators.

"Is this unit approved by OHCQ as an Alzheimer's Special Care Unit?"

Not every facility with a "memory care wing" has formal ASCU approval. Some facilities market dementia services without the regulatory designation, which means they are not subject to the specific staffing, training, and disclosure requirements that govern approved units.

Staffing and Training

"What is the staff-to-resident ratio in the memory care unit during day, evening, and overnight shifts?"

This is the single most important operational question. A facility that provides one aide for every six residents during the day may cut that to one for every twelve at night. Dementia residents are often most active and agitated during evening and nighttime hours (sundowning), so overnight staffing directly affects safety.

"How many hours of dementia-specific training do your staff receive annually?"

Maryland requires a minimum of six hours of advanced cognitive impairment training for staff working in approved memory care units. Ask whether staff receive training beyond the minimum, and what topics are covered — de-escalation techniques for aggressive behavior, fall prevention protocols, and communication strategies for residents with limited verbal ability are all indicators of a serious program.

"What is your staff turnover rate?"

High turnover disrupts the consistency that dementia residents depend on. A parent with mid-stage Alzheimer's who sees different faces every week cannot build the familiarity that reduces agitation. Facilities with high turnover often struggle with care quality regardless of their licensing level.

Admission and Discharge Criteria

"Under what circumstances would you discharge my parent?"

This is the question families most often forget to ask — and the one that matters most 18 months after admission. Common discharge triggers include:

• Physical aggression toward staff or other residents that the facility cannot manage
• Elopement attempts (repeated escape from the secured unit)
• Medical needs that exceed the facility's licensed level of care (needing IV medications, wound care, or tube feeding)
• Inability to pay the monthly rate

Ask for the specific criteria in writing. The Alzheimer's Special Care Unit Disclosure Form should address this, but get the facility to confirm the practical thresholds.

"What is your policy when a resident's care needs increase? How does that affect the monthly rate?"

Most memory care facilities conduct periodic care level reassessments. When a resident's needs increase — from moderate assistance to extensive assistance — the facility may reclassify them to a higher care level with a corresponding fee increase. Ask how often reassessments occur, who conducts them, and whether the family receives advance notice of fee changes.

Programming and Daily Life

"What dementia-specific activities does the unit offer, and how many hours per day?"

A well-run memory care program provides structured, cognitively appropriate activities throughout the day — music therapy, sensory stimulation, art programs, guided movement, and reminiscence activities. Ask to see a weekly activity calendar. If the calendar shows television or "free time" for large blocks of the day, the programming is inadequate.

"How do you manage sundowning behavior?"

Sundowning — increased confusion, agitation, and restlessness in late afternoon and evening — is nearly universal in mid-to-late-stage dementia. A facility with genuine dementia expertise has specific protocols: adjusted lighting, calming activities in the late afternoon, staffing adjustments for the evening transition, and individualized approaches for residents with severe sundowning. A generic answer ("we monitor them") indicates the facility does not have a meaningful strategy.

Financial Structure

"What exactly does the monthly rate include, and what costs extra?"

Get a line-item breakdown. Common items that facilities charge separately:

• Incontinence supplies
• Specialized medication administration (beyond standard oral medications)
• Laundry services
• One-on-one companion care for high-acuity residents
• Transportation to medical appointments

The base rate that a facility quotes during a tour is rarely the full cost. Understanding the add-ons prevents surprises.

"Do you accept Maryland Medicaid through the Community Options Waiver?"

Not every licensed memory care facility participates in the HCBOW program. If your parent may need Medicaid to fund their care — either now or after private-pay resources are exhausted — confirming HCBOW participation before admission avoids a forced transfer later.

Evaluating What You See

Numbers and documents tell part of the story. During the tour, observe:

• Do current residents look engaged or parked in front of a television?
• Does the unit smell clean, or are odors being masked with air freshener?
• Do staff address residents by name and engage with them, or do they move through tasks mechanically?
• Is the secured perimeter genuinely secure, or could a determined exit-seeker reach an unsecured area?
• Are hallways well-lit and free of obstacles?

Visit at least twice — once during the tour and once unannounced at a different time of day. The facility you see at 10 AM on a Tuesday may look very different at 7 PM on a Saturday.

For a structured facility evaluation process — from licensing verification through financial planning to Medicaid application — the Maryland Dementia & Memory Care Guide includes a step-by-step vetting checklist alongside the program eligibility roadmap.

See more Maryland guides →