1. A. The 80-hour assisted living manager basic training course shall include the following content:

   1. (1) Philosophy of assisted living, 2 hours, including:

      1. (a) Philosophy and background of assisted living and aging in place;
      2. (b) Objectives and principles of assisted living resident programs;
      3. (c) Comparison of assisted living to other residential programs;
      4. (d) Basic concepts of choice, independence, privacy, individuality, and dignity; and
      5. (e) Normalization of the environment;

   2. (2) Aging process and its impact, 4 hours, including:

      1. (a) Physical characteristics of the assisted living residents;
      2. (b) Psychosocial characteristics of the assisted living residents;
      3. (c) Basic needs of the elderly and disabled; and
      4. (d) Activities of daily living;

   3. (3) Assessment and level of care waiver, 6 hours, including:

      1. (a) Purpose and process;
      2. (b) Guidelines for conducting assessments;
      3. (c) Level of care assessments; and
      4. (d) Collaboration with the delegating nurse;

   4. (4) Service planning, 6 hours, including:

      1. (a) Required services;
      2. (b) Enhanced scope of services;
      3. (c) Development of individualized service plans;
      4. (d) Scheduling of appropriate activities;
      5. (e) Structure of activities;
      6. (f) Care notes; and
      7. (g) Collaboration with the delegating nurse;

   5. (5) Clinical management, 20 hours, including:

      1. (a) Role of the delegating nurse;
      2. (b) Appropriate nurse delegation;
      3. (c) Concept of self-administration of medications;
      4. (d) Concept of medication management;
      5. (e) Assistance with self-administration of medications;
      6. (f) Administration of medications;
      7. (g) Coordination of services and care providers;
      8. (h) Collaboration with the delegating nurse;
      9. (i) Preventing medication errors;
      10. (j) Patient safety;
      11. (k) Medication monitoring;
      12. (l) Pharmacy consultation;
      13. (m) Medication storage;

      14. (n) Infection prevention and control to include:

          1. (i) Standard and contact precautions;
          2. (ii) Bloodborne pathogens;
          3. (iii) Standard hand hygiene practices;
          4. (iv) Safe injection practices;
          5. (v) Use of personal protective equipment; and
          6. (vi) Cleaning and disinfection of equipment and the environment;
      15. (o) Appropriate staffing patterns;
      16. (p) Pressure sores;
      17. (q) Effective pain management;
      18. (r) Basic first aid taught by a first aid instructor certified by a national organization;
      19. (s) Basic cardiopulmonary resuscitation (CPR), including a hands-on component, taught by a CPR instructor certified by a nationally recognized organization;
      20. (t) Substance abuse;
      21. (u) Trauma-informed care; and
      22. (v) A trauma-informed approach to care delivery;

   6. (6) Admission and discharge criteria, 4 hours, including:

      1. (a) Overview of criteria for admission and discharge;
      2. (b) Resident contracts;
      3. (c) Resident rights;
      4. (d) Financial management of resident’s funds; and
      5. (e) Working with families of residents;

   7. (7) Nutrition and food safety, 8 hours, including:

      1. (a) Menu and meal planning;
      2. (b) Basic nutritional needs;
      3. (c) Safe food handling;
      4. (d) Preventing food-borne illnesses;
      5. (e) Therapeutic diets; and
      6. (f) Dehydration;

   8. (8) Dementia, mental health, and behavior management, 12 hours, including:

      1. (a) An overview consisting of:

         1. (i) Description of normal aging and conditions causing cognitive impairment;
         2. (ii) Description of normal aging and conditions causing mental illness;
         3. (iii) Risk factors for cognitive impairment;
         4. (iv) Risk factors for mental illness;
         5. (v) Health conditions that affect cognitive impairment;
         6. (vi) Health conditions that affect mental illness;
         7. (vii) Early identification and intervention for cognitive impairment;
         8. (viii) Early identification and intervention for mental illness; and
         9. (ix) Procedures for reporting cognitive, behavioral, and mood changes;

      2. (b) Effective communication consisting of:

         1. (i) Effect of cognitive impairment on expressive and receptive communication;
         2. (ii) Effect of mental illness on expressive and receptive communication;
         3. (iii) Effective communication techniques, including verbal, nonverbal, tone and volume of voice, and word choice; and
         4. (iv) Environmental stimuli and influences on communication, including setting, noise, and visual cues;

      3. (c) Behavioral intervention consisting of:

         1. (i) Identifying and interpreting behavioral symptoms;
         2. (ii) Problem solving for appropriate intervention;
         3. (iii) Risk factors and safety precautions to protect other residents and the individual;
         4. (iv) De-escalation techniques; and
         5. (v) Collaboration with the delegating nurse;

      4. (d) Making activities meaningful consisting of:

         1. (i) Understanding the therapeutic role of activities;
         2. (ii) Creating opportunities for activities, including productive, leisure, and self-care; and
         3. (iii) Structuring the day;

      5. (e) Staff and family interaction consisting of:

         1. (i) Building a partnership for goal-directed care;
         2. (ii) Understanding family needs; and
         3. (iii) Effective communication between family and staff; and

      6. (f) Managing staff stress consisting of:

         1. (i) Understanding the impact of stress on job performance, staff relations, and overall facility environment;
         2. (ii) Identification of stress triggers;
         3. (iii) Self-care skills;
         4. (iv) De-escalating techniques; and
         5. (v) Devising support systems and action plans;

   9. (9) End of life care, 4 hours, including:

      1. (a) Advance directives;
      2. (b) Hospice care;
      3. (c) Maryland Medical Orders for Life-Sustaining Treatment (MOLST) order form;
      4. (d) Power of attorney;
      5. (e) Appointment of a health care agent;
      6. (f) Living will;
      7. (g) Pain management;
      8. (h) Providing comfort and dignity; and
      9. (i) Supporting the family;

   10. (10) Management and operation, 4 hours, including:

       1. (a) Role of the assisted living manager;
       2. (b) Overview of accounting, accounts payable, and accounts receivable;
       3. (c) The revenue cycle and budgeting;
       4. (d) The basics of financial statements;
       5. (e) Hiring and training of staff;
       6. (f) Developing personnel policies and procedures;
       7. (g) Census development; and
       8. (h) Marketing;

   11. (11) Emergency planning, 4 hours, including:

       1. (a) Fire, disaster, and emergency preparedness;
       2. (b) Occupational Safety and Health Administration (OSHA) requirements;
       3. (c) Maintaining the building, grounds, and equipment;
       4. (d) Elopements;
       5. (e) Transfers to the hospital;
       6. (f) Evacuations;
       7. (g) Power outages;
       8. (h) Severe weather;
       9. (i) Fire;
       10. (j) Emergency response systems; and
       11. (k) Security systems;

   12. (12) Quality assurance, 4 hours, including:

       1. (a) Incident report processes; and
       2. (b) Quality improvement processes; and

   13. (13) Survey process, 2 hours, including:

       1. (a) State statutes and regulations;
       2. (b) What to expect during a survey; and
       3. (c) Documentation.

2. B. A person seeking to offer the assisted living manager training course shall request and obtain approval by the Department by:

   1. (1) Submitting the proposed curriculum and training materials to the Department; and
   2. (2) Being available for an in-person or telephone interview by the Department.

Authority: Health-General Article, Title 19, Subtitle 18, Annotated Code of Maryland

Effective date: January 1, 1999 (25:26 Md. R. 1923)

Regulation .02B amended effective November 1, 1999 (26:22 Md. R. 1692); July 22, 2002 (29:14 Md. R. 1074)

Regulation .02B amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .03 amended effective August 21, 2000 (27:16 Md. R. 1523)

Regulation .04 amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .06 amended as an emergency provision effective August 15, 2000 (27:18 Md. R. 1664); amended permanently effective November 27, 2000 (27:23 Md. R. 2147)

Regulation .06E adopted effective March 29, 2004 (31:6 Md. R. 508)

Regulation .09B, C amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .12D, E amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .15-1 adopted effective October 10, 2005 (32:20 Md. R. 1655)

Regulation .15-2 adopted effective October 10, 2005 (32:20 Md. R. 1655)

Regulation .17B amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .17E—G adopted effective October 10, 2005 (32:20 Md. R. 1655)

Regulation .21F, K amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .21P adopted effective March 29, 2004 (31:6 Md. R. 508)

Regulation .26A amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .27C, E amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .28D amended, and E—K adopted, effective November 1, 1999 (26:22 Md. R. 1692)

Regulation .29B amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .36A amended effective March 29, 2004 (31:6 Md. R. 508); December 19, 2005 (32:25 Md. R. 1941)

Regulation .46 amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .49B amended effective July 22, 2002 (29:14 Md. R. 1074)

Regulations .01—.53 repealed and new Regulations .01—.64 adopted effective December 29, 2008 (35:26 Md. R. 2249)

Regulation .07A amended effective August 19, 2013 (40:16 Md. R. 1344); August 29, 2016 (43:17 Md. R. 953); March 13, 2017 (44:5 Md. R. 292)

Regulation .07C amended effective March 13, 2017 (44:5 Md. R. 292)

Regulation .13A amended effective June 25, 2012 (39:12 Md. R. 745)

Regulation .24D amended effective June 25, 2012 (39:12 Md. R. 745)

Regulation .29 amended effective June 25, 2012 (39:12 Md. R. 745)

Chapter revised effective April 28, 2025 (52:8 Md. R. 357)