Review of Assisted Living Facility and Contract

Assisted living facilities offer an attractive option for older individuals who require care and services in a home-like environment while maintaining their independence. These facilities have become the fastest-growing form of residential housing for older Americans, bridging the gap between nursing homes and traditional homes. Many residents view these facilities as their long-term homes and develop meaningful relationships with fellow residents, creating a sense of community within the facility.

It’s important to note that most assisted living facilities are licensed to provide care up to a certain level of need. These levels may be categorized as low, moderate, and high care needs, excluding skilled nursing care typically found in nursing homes. Residents with low care needs can reside in any type of assisted living facility, while those with moderate care needs are limited to facilities licensed for moderate or high care. Similarly, residents with high care needs can only reside in facilities licensed for high care. Quality care standards are established for each level to ensure residents receive adequate care based on their needs.

However, it’s crucial to strike a balance between allowing residents to “age in place” and ensuring they receive appropriate care. Some assisted living facilities have been known to accept and retain residents with significant healthcare needs that the facility may not be equipped to handle. Therefore, it’s essential to consider both goals—providing a home-like environment and delivering quality care—when evaluating an assisted living facility.

The term “assisted living” lacks a meaningful federal definition. Currently, the federal government doesn’t play a significant role in setting standards, guidelines, or rules for assisted living facilities. However, the State of Maryland defines assisted living as a program that provides housing, supportive services, supervision, personalized assistance, health-related services, or a combination thereof to individuals unable to perform activities of daily living independently. While this definition sounds comprehensive, it lacks specific details regarding the level of service required. It fails to clarify the extent of health-related services, staff availability, or what “optimum dignity” entails. As a result, it’s up to individual assisted living providers to determine and offer services, which can lead to variations in the level of care provided.

The vague and unenforceable nature of the definition also poses challenges. Rather than directly establishing standards, the state anticipates that standards will be negotiated between the facility and the incoming resident. However, admission agreements are often presented to residents on a take-it-or-leave-it basis, leaving little room for negotiation or protection for residents. A report from the General Accounting Office (GAO) highlighted that assisted living contracts varied in format, were often unclear or potentially misleading, and lacked standardization.

Discharge from an assisted living facility in Maryland is authorized for violations of the admission agreement, which grants the facility significant discretion. The admission agreement may set discharge justifications, ranging from legitimate reasons like endangering other residents or nonpayment to potentially unfair justifications such as using a wheelchair in dining rooms. This discretion can lead to two discharge-related issues: premature discharge when a resident’s needs become expensive or inconvenient for the facility, and delayed discharge when a facility retains a resident for whom they are unable to provide adequate care.

Assisted living facilities can differ from one another, even within the same state. Therefore, it’s essential to thoroughly evaluate the facility and review the contract to ensure your rights are protected. Contracts may contain language that is unenforceable or disadvantageous to the resident, taking advantage of the contract’s vagueness to provide minimal services. Proper evaluation of the facility and contract is necessary to safeguard your health, satisfaction, and rights as a resident.

To learn more about estate planning and elder law, visit Estate and Elder Planning by David Wingate at For an Initial Consultation, call (301) 663-9230. We can assist you with powers of attorneys, living wills, wills, trusts, Medicaid planning, and asset protection. With office locations in Frederick, Washington, and Montgomery Counties, Maryland, we are here to provide you with peace of mind.


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