Assisted Living Facilities: Government Agencies Involved in the Oversight of ALF Operators

The Maryland Department of Health and Mental Hygiene (DHMH) is the lead state agency for a multi-agency system that supervises and monitors the assisted living facilities (ALFs) in the state.

• Before 1996, various types of assisted living facilities overseen by to one of three different state agencies, the Department of Aging (senior assisted group homes), DHMH (domiciliary care homes) and the Department of Human Resources (project homes).
  DHMH is currently responsible for the oversight of assisted living facilities.
• It is also the state agency responsible for overseeing and administering medical programs, including the Medicaid program for low-income residents.
• The DHMH web page includes information about long-term care and payment options.
• DHMH is also responsible for the licensing and regulatory oversight of Maryland assisted living facilities through the Office of Health Care Quality.  The DHMH website lists recent regulations. Read more about finding out about the law and regulations on assisted living facilities.

Maryland Department of Aging – The Maryland Department of Aging provides information, education, programs and services for persons aged 60 and over in Maryland.  Before 1999 changes in the law, the Department also directly administered approximately 280 Senior Assisted Group homes. After 1999, the various residential program were consolidated under the Department of Health and Mental Hygiene’s Office of Health Care Quality, which currently licenses all assisted living facilities in the state. However, the Department of Aging (MDoA) and the local area agencies on aging are still involved in certain areas.

• Oversight Committee – A representative from the MDoA serves on this Committee. (See below.)

• Ombudsman program  - This program investigates complaint from assisted living facilities. The State Long-term Ombudsman coordinates a network of local ombudsman staff who work within the local area agencies on aging

• Senior Assisted Group Home Subsidy Program  - Local area agencies on aging monitor “assisted living in small group homes that are licensed by the Department of Health and Mental Hygiene for 4-16 residents. The Group Home subsidies are paid from state funds on behalf of eligible residents who are unable to afford the cost of assisted living and might otherwise be in nursing facilities.”

• The Congregate Housing Program  provides housing services between independent living and assisted living. The Maryland Department of Aging program provides congregate meals, housekeeping and personal services to eligible seniors. The cost of services (except housing) is subsidized by MDOA through this program. Some area agencies on aging also monitor congregate housing program in their area.

• Local agencies on aging (AAAs) are part of local county or city government but also receive funds from MDoA. Some AAAs have responsibility for monitoring local assisted living facilities. For example, in Baltimore County, the local Department of Aging is responsible for monitoring Assisted Living facilities of 4-15 residents and the Congregate Housing Services Program. As of October 2007, the areas agencies on aging in Howard, Anne Arundel and Montgomery counties also monitored local assisted living facilities. As of 2007 all but three of the AAAs also monitor the senior assisted living subsidy programs. (The three exceptions are St. Mary’s, Frederick and the Upper Shore.)

Department of Human Resources - Before 1999 changes in the law, the Department directly administered approximately 400 Project Homes. After 1999, the various residential program were consolidated under the Department of Health and Mental Hygiene’s Office of Health Care Quality, which currently licenses all assisted living facilities in the state. However, the Department of Human Resources (DHR) is still involved in certain areas.

• Oversight Committee – A representative from the MDoA serves on this Committee. (See below.)

• Adult Protective Services  – These programs are part of DHR’s local Departments of Social Services. Staff are responsible for investigating allegations of abuse, neglect, self-neglect or exploitation of vulnerable adults, in a variety of settings, including assisted living facilities.

• Project Home, a related project that provides housing and supportive services to persons with disabilities is operated by DHR,
   

Maryland Department of Public Health - The Maryland Department of the Environment includes information on public health issues such as mold abatement and lead paint poisoning. Local Departments of Public Health may have standards or assistance that apply to assisted living facilities. Some local departments of health monitor assisted living facilities in their counties. For example, in Baltimore County, the local Department of Health plays a significant role in the surveying and monitoring of assisted living facilities where it is responsible for monitoring environmental conditions of Assisted Living facilities with 1-3 residents and 16 or more residents.

Oversight Committee on Quality of Care in Nursing Homes and Assisted Living Facilities  - The Committee evaluates progress in improving the quality of nursing home and assisted-living facility care statewide.

• The Committee membership includes representatives from the DHMH, the Department of Aging, the Department of Human Resources, representatives from the General Assembly and representatives from a variety of industry and consumer interest groups. (Maryland law contains a list of member agencies and organizations.)

• The Committee evaluates the progress in improving assisted living facilities including topics such as quality of care standards, staffing standards, policies and procedures for inspecting assisted living facilities and state funding for assisted living facilities. 

• The Department of Health and Mental Hygiene reports annually to the Committee on the status of the Medicaid Nursing Home Reimbursement System and the implementation of the recommendations of the Task Force on Quality of Care in Nursing Facilities, and the status of quality of care.

Maryland Health Care Commission (MHCC)  - MHCC is an independent state regulatory agency responsible for coordinating the state's policies around health care. It collects data and offers several guides useful to ALF operators.

• The agency manages an on-line Assisted Living Facility Guide  that includes profiles of all Assisted Living Facilities with 10 beds or more.

• ALF operators may also be interested in the county-by-county ALF industry profile. The system gives you an overview of the other facilities (10 beds or more) in your area.

• If you have a choice of hospitals in your area, you may want to develop a relationship with one hospital over another as part of your disaster planning. MHCC offers an on-line comparison tool for Maryland Hospitals.

The Maryland Department of the Environment includes information on public health issues such as mold abatement and lead paint poisoning.  Local Departments of Public Health may have standards or assistance that apply to assisted living facilities. Some local departments of health monitor assisted living facilities in their counties. For example, in Baltimore County, the local Department of Health plays a significant role in the surveying and monitoring of assisted living facilities where it is responsible for monitoring environmental conditions of Assisted Living facilities with 1-3 residents and 16 or more residents.