1. A. Initial Approval of an Alzheimer’s Special Care Unit. An assisted living program requesting the initial approval to operate an Alzheimer’s Special Care Unit shall submit to the Department a written description of the Alzheimer’s Special Care Unit using a disclosure form developed by the Department. The description shall explain how:

   1. (1) The form of care and treatment provided by the Alzheimer’s Special Care Unit is specifically designed for the specialized care of individuals diagnosed with Alzheimer’s disease or a related dementias; and
   2. (2) The care in the Alzheimer’s Special Care Unit differs from the care and treatment provided in the nonspecial care unit.

2. B. Approval of an Alzheimer’s Special Care Unit.

   1. (1) An assisted living program shall have written approval from the Department prior to operating an Alzheimer’s Special Care Unit.
   2. (2) An assisted living program shall have written approval from the Department of an Alzheimer's Special Care Unit prior to advertising or marketing the unit.
   3. (3) The Department will either approve or not approve the operation of the Alzheimer’s Special Care Unit.

3. C. Substantive Changes to the Alzheimer’s Special Care Unit.

   1. (1) The written description of the Alzheimer’s Special Care Unit shall accurately reflect the current operation of the unit.
   2. (2) If any substantive changes are made to the Alzheimer’s Special Care Unit, the revised written description shall be submitted to the Department for review and approval.
   3. (3) The Department shall inform the provider of the decision of the review within 30 calendar days from the Department’s receipt of the revised written description.

4. D. An assisted living program with an Alzheimer’s Special Care Unit shall disclose the written description of the unit to:

   1. (1) Any person on request;
   2. (2) The resident, as appropriate; and
   3. (3) The family or resident representative before admission of the resident to the Alzheimer’s Special Care Unit.

5. E. The description of the Alzheimer’s Special Care Unit shall include:

   1. (1) A statement of philosophy or mission;
   2. (2) How the services of the unit are different from services provided in the rest of the assisted living program;

   3. (3) Staff training and staff job titles, including:

      1. (a) A description of a minimum of 6 hours of advanced cognitive impairment training for any staff who is licensed, certified, or registered under Health Occupations Article, Annotated Code of Maryland, or any staff whose job duties include providing personal care on the Alzheimer’s Special Care Unit, including:

         1. (i) 2 hours related to effective communication;
         2. (ii) 2 hours related to behavioral interventions; and
         3. (iii) 2 hours related to making activities meaningful; and
      2. (b) The number of hours of dementia-specific training provided annually for all staff by job classification and a summary of training content;
   4. (4) Admission procedures, including screening criteria;
   5. (5) Assessment and service planning protocol, including criteria to be used that would trigger a reassessment of the resident’s status before the customary 6-month review;

   6. (6) Staffing patterns, including:

      1. (a) The ratio of direct care staff to resident for a 24-hour cycle;
      2. (b) A description of how the staffing pattern differs from that of the rest of the assisted living program; and
      3. (c) Use of awake overnight staff on the unit;
   7. (7) A description of the physical environment and any unique design features appropriate to support the functioning of cognitively impaired individuals;
   8. (8) A description of activities, including frequency and type, how the activities meet the needs of residents with dementia, and how the activities differ from activities for residents in other parts of the assisted living program;
   9. (9) The assisted living program’s fee or fee structure for services provided by the Alzheimer’s Special Care Unit;
   10. (10) Discharge criteria and procedures;
   11. (11) Any services, training, or other procedures that are over and above those that are provided in the existing assisted living program; and
   12. (12) Any other information that the Department may require.
6. F. The Department shall restrict admission or close the operation of an Alzheimer’s Special Care Unit if the Department determines that the assisted living program has not demonstrated compliance with this regulation or the health or safety of residents is at risk.

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)