The resident agreement

It is always an exciting time when a new resident chooses to move into your community! Many hours of work from your team have paid off and now you welcome a new member to the “family”- but it’s not done yet! The state of Maryland requires a written admission agreement for every new person moving into an Assisted Living Facility. Agreements should always be signed prior to the resident moving in or taking possession of the apartment. Check out the regulations below as to what needs to be included in the written admission agreement:

.24 Resident Agreement — General Requirements and Nonfinancial Content.

A. Except as otherwise provided under §E of this regulation, for a person admitted for other than short-term
residential care, the resident or the resident’s agent and the assisted living manager shall sign, before or at the time of
admission, a resident agreement that:
(1) Is a clear and complete reflection of commitments agreed to by the parties and the actual practices that will
occur in the assisted living program;
(2) Is accurate, precise, easily understood, legible, readable, and written in plain English;
(3) Conforms to all relevant State and local laws and requirements; and
(4) Recommends review of the agreement by an attorney or other representative chosen by the resident.

B. For a person admitted for short-term residential care, the assisted living program shall sign a resident
agreement with the resident or resident’s agent as set forth in this regulation excluding the provisions of §D(7)(c)
and (8)(c) and (d) of this regulation.

C. The assisted living program shall:
(1) Give a copy of the signed resident agreement to the resident and the resident’s agent;
(2) Maintain a copy of the resident agreement on-site; and
(3) Make the resident agreement available for review by the Department or its designee.

D. The resident agreement shall include provisions, which include at a minimum:
(1) A statement of the level of care for which the assisted living program is licensed;
(2) The level of care needed by the resident, as determined by the initial assessment required by Regulation .21
of this chapter;
(3) Unless the assisted living program is part of a continuing care retirement community and the agreement is
signed by a continuing care subscriber as defined in COMAR 32.02.01.01B(35), a statement indicating that if a
resident’s level of care, after admission, exceeds the level of care for which the licensee is permitted to provide and a
waiver for the continued stay of the resident has not been granted, the assisted living program shall discharge the
a resident from the program;
(4) If the assisted living program is part of a continuing care retirement community and a separate, concurrent
the resident agreement is signed by a continuing care subscriber as defined at COMAR 32.02.01.01B(35), a statement
indicating that if the resident’s level of care, after admission to assisted living, exceeds the level of care for which the
licensee is permitted to provide and a waiver for the continued stay of the resident has not been granted:
(a) The licensee may not provide any services to the resident beyond that which it is licensed to provide;
(b) If the licensee offers either comprehensive care services or priority access to comprehensive care
services and a comprehensive care bed is available for occupancy, the resident shall be given the option to transfer
to comprehensive care; and
(c) The resident may be discharged from the continuing care retirement community only for just cause asset
forth in COMAR 32.02.02.31;
(5) A listing of services provided by the assisted living program and a listing of those services the assisted
the living program does not provide;
(6) An explanation of the assisted living program’s complaint or grievance procedure;
(7) Occupancy provisions including:
(a) Policies regarding bed and room assignment, including the specific room and bed assigned to the resident
at the time of admission;
(b) Procedures to be followed when the assisted living program temporarily or permanently changes the
resident’s accommodation by:
(i) Relocating the resident within the facility;
(ii) Making a change in roommate assignment; or
(iii) Increasing or decreasing the number of individuals occupying a room;
(c) Procedures to be followed in transferring the resident to another facility;
(d) The availability of locks for storage;
(e) The availability of locks, if any, for the resident’s room;
(f) Security procedures which the licensee shall implement to protect the resident and the resident’s property;
(g) The staff’s right, if any, to enter a resident’s room;
(h) The resident’s rights and obligations concerning use of the facility, including common areas;
(i) The assisted living program’s bed hold policy in case of unavoidable or optional absences such as
hospitalizations, recuperative stays in other settings, or vacation, including the conditions under which the program
will hold a bed, relevant time frames, and payment terms, and the circumstances under which the program will no
longer hold the bed;(j) Provisions for continuous service in the event of an emergency; and
(k) An acknowledgment that the resident or the resident’s representative has reviewed all assisted living
program rules, requirements, restrictions, or special conditions that the program will impose on the resident;
(8) Admission and discharge policies and procedures including:
(a) Any additional admission requirement imposed by the assisted living program;
(b) Those actions, circumstances, or conditions which may result in the resident’s discharge from the assisted
living program;
(c) The procedures which the assisted living program shall follow if it intends to discharge a resident without
the resident’s agreement, and thereby terminate the resident agreement, including a provision under which the
the assisted living program shall give not less than 30 days notice to the resident or resident’s representative before the
the effective date of the discharge and termination of the resident agreement, except in the case of a health emergency or
substantial risk to the health and safety of the other residents or staff in the program;
(d) The procedures which the resident shall follow if the resident wishes to terminate the resident agreement,
including a provision that the resident, or appropriate representative, shall give not less than 30 days notice to the
assisted living program before the effective date of the termination, except in the case of a health emergency; and
(e) In a unit in which more than one resident is the contracting party, the terms under which the agreement
maybe modified in the event of one of the resident’s discharge or death, including provisions for termination of the
agreement and appropriate refunds;
(9) Obligations of the licensee, the resident, or the resident’s representative as to:
(a) Arranging for or overseeing medical care; and
(b) The monitoring of the health status of the resident; and
(10) A policy on the administration of medications by a spouse or domestic partner to their spouse or domestic
partner, when both parties reside in the same assisted living program.

E. If the services provided in an assisted living program that is part of a continuing care retirement community are
covered under a continuing care agreement that complies with Article 70B, §13(d), and Health-General Article, §19-
1806, Annotated Code of Maryland:
(1) The Department may not require a separate resident agreement for the assisted living program; and
(2) The requirements set forth in this regulation and Regulation .25 of this chapter do not apply.

F. The licensee may not include a provision in the agreement which is inconsistent with any of the requirements
of this chapter.

Pro Tip:
• Often times a facility will be cited during an unexpected visit for not keeping a proper record of the written admission agreement. Ensure that your community has a policy in place for 1. Identifying
WHEN the contract will be signed and WHO will be present for the signing. 2. Tracking system for resident written admission agreement after completion. (It is recommended to keep a binder or
folder for each resident with any documents pertinent to their residency just as you would with a
clinical chart)

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