This information has been prepared by the Elder Law Section and the Public Awareness Committee of the Maryland State Bar Association. It is intended to inform the public and not serve as legal advice.

Introduction

While nursing homes may be necessary for certain individuals because of their medical needs, Maryland seniors can choose from a variety of supported living arrangements. This information has been prepared in an effort to discuss the options and agencies that can help make the choice easier.

Remaining at Home

Most seniors prefer to remain in their own home for as long as possible. A person who is ill or disabled and needs assistance may consider bringing help to his or her own home. These services can range from housekeeping, to meals delivered to the house or advanced medical care.

• The Department of Health and Mental Hygiene maintains a director of licensed entities, e.g., home health, residential service agencies and hospice programs that are available for certain health-related services. Contact (410) 764-4980.
• Medicaid – (Maryland Medical Assistance) covers some home health care and personal care for qualified people with low incomes.
• Medicare – (administered by Social Security) and some private insurance plans cover skilled nursing care in the home, if ordered by a doctor and the recipient meets certain requirements. Personal care such as assistance with bathing, feeding or dressing is only covered if skilled nursing care is necessary.

Assisted Living

An Assisted Living Program can be an alternative to nursing home placement for many individuals. These programs are licensed by the Maryland Department of Health and Mental Hygiene and monitored in conjunction with the Office of Aging and the Department of Human Resources. These programs provide housing and a combination of supportive services. Programs vary in size from small residential to larger facilities.

Depending on the level of care provided by a program, the degree of service may vary. Services may include: 1) monitoring residents’ general health; 2) providing supervision and assistance with daily living activities; 3) coordinating access to medication and/or treatment; 4) monitoring and managing residents’ behavioral needs, including psychological needs; 5) offering residents social and recreational activities.

Although there is currently very little public funding for assisted living, individuals who receive Supplemental Security Income (SSI) or Medical Assistance and meet certain eligibility guidelines may be eligible to receive additional funds to hope pay or defray the costs of the program. In addition, private insurance, e.g., long-term care insurance may cover some costs.

For more information, contact the Department of Health and Mental Hygiene at (410) 764-2770 or your local agency on Aging or Department of Human Resources.

Continuing Care Communities

These communities typically promise a lifetime residence plus a range of services. Some provide facilities, while others are affiliated with nearby nursing homes. Seniors live in garden apartments, high-rises or private cottages, but move into other units, as health care needs change.

Many continuing care communities began as church affiliated “life care” homes, where residents turned over all their assets in return for a promise of a home and medical care for the rest of their lives. Today, seniors have more options. For-profit companies run some communities and there are many different payment options. Some communities require a large down payment with monthly charges from that day forward; others may be more like rentals, even cooperative or condominiums, with additional services paid by the resident as services are needed.

Continuing care communities must meet certain requirements of the State of Maryland, but not all programs are the same. It is important to read the contract carefully, understand the costs involved, whether the entry fee is refundable, what health care is provided, whether a community has an extensive care or fee for service contract, what role the residents have in the management of the community and how residency and health care decisions are made.

The continuing care community should encourage talking with the residents about their opinion of the facility as well as providing a guided tour.

For information, contact the Maryland State Office on Aging at (410) 767-1100 or (800) 338-0153.

Government Subsidized Housing

There are many federally funded assisted rental housing programs around Maryland for seniors with low or moderate incomes. Non-profit groups or the local housing authority may run them. Some facilities offer services for those who cannot manage all daily living activities. In congregate housing, meals may be served in a main dining room. Some of the programs employ a coordinator who assists in obtaining community services.

For more information contact your local Housing Authority or local agency on aging.

Adult Evaluation and Review Services – Geriatric Evaluation Service

A local health department can send a team to your home at no cost to help you decide which type of services would meet your needs. The teams have input from doctors, nurses and social workers. For more information, contact your local health department.

Making a Choice

Remember you have a right to choose. When trying to find the right alternative, consider your present and future needs, along with personal preference and budget. Visit the places under consideration, ask questions and carefully read all contacts. You have the right to obtain legal advice about the rights and responsibilities in the contract before it is signed. Keep in mind that the Department of Health and Mental Hygiene, the Department of Human Resources, the Maryland Office on Aging and your local office on aging are available for information and referrals.

Alternatives to Nursing Home Placement © 1993, MSBA, Inc. Revised 1998 All rights reserved. No part of this work may be reproduced in any form without written permission from the Maryland State Bar Association.