Last verified: October 2026
What are Maryland's assisted living levels of care?
Maryland licenses every assisted living program for one of three levels of care -- Level 1 (low), Level 2 (moderate) or Level 3 (high) -- and the program may serve residents at its licensed level or any lower one.
| Level | What OHCQ says it means |
|---|---|
| Level 1 (Low) | Occasional assistance or support in one or more personal care or health-related areas -- for example reminders to take medications, some help with bathing or dressing, help getting to appointments. |
| Level 2 (Moderate) | Substantial assistance or support in one or more personal care or health-related areas, including staff able to administer medications and manage frequent behavioral changes. |
| Level 3 (High) | Extensive and frequent help to keep several personal or health-related areas maintained -- administering medications, performing activities of daily living, managing frequent behavioral changes. |
Source: OHCQ Assisted Living Programs - Consumers
What level are most Baltimore-area programs licensed for?
Almost all of them are Level 3: of the 934 programs on OHCQ's directory in the Baltimore metro, 900 are licensed for Level 3, 32 for Level 2 and 1 for Level 1.
So the level on the license rarely separates Baltimore programs. What separates them is whether staff can really deliver Level 3 care at 3 a.m., which depends on staffing, the delegating nurse and the manager. The license level is a ceiling, not a promise.
What happens when a resident's needs go above the program's level?
COMAR 10.07.14.24: a program may ask OHCQ for a resident-specific level of care waiver to keep a resident whose needs exceed its licensed level; OHCQ answers within 7 calendar days, waivers cannot exceed 50 percent of licensed beds, and no waiver is needed for a temporary increase of 30 days or less.
COMAR 10.07.14.05: a program may provide the level of care it is approved for and any lower level, and must ask the Department before providing a higher level. If OHCQ denies a waiver, the resident must move to a program licensed for the needed level, or to a nursing home. Ask any program how many level-of-care waivers it currently holds and how it has handled residents who outgrew it.
Who can a Maryland assisted living program not admit?
COMAR 10.07.14.23: at initial admission a program may not serve someone who would need more than intermittent nursing care, treatment of stage 3 or 4 skin ulcers, ventilator services, skilled monitoring of a fluctuating acute condition, or monitoring of a chronic condition not controllable with readily available medications -- unless a licensed hospice is involved.
COMAR 10.07.14.21: every program must have a registered nurse serving as delegating nurse, on site to observe each resident at least every 45 calendar days and on call at all times. COMAR 10.07.14.15: the assisted living manager must be licensed under Health Occupations Article 9-3A-01 (OHCQ lists the Board of Long-Term Care Administrators as the licensing board for assisted living managers); Level 3 programs need a manager with a degree or health care experience plus training.
What paperwork should a family ask for?
Each assisted living provider must make available, on request, a completed Maryland Assisted Living Program Uniform Disclosure Statement covering staffing, services and fees (COMAR 10.07.14.10).
Also ask for the resident agreement, the fee schedule tied to assessment results, and -- if dementia is involved -- the Alzheimer's Special Care Unit description. The rules are in COMAR 10.07.14, revised effective April 28, 2025.
Source: COMAR 10.07.14
Is a Level 3 license the same as nursing home care?
No. Level 3 is the top of assisted living, not skilled nursing.
| Level 3 assisted living | Nursing home |
|---|---|
| Extensive help with daily activities and medications | 24-hour licensed nursing |
| Intermittent nursing, delegating RN every 45 days | RN on duty; physician oversight |
| OHCQ license under COMAR 10.07.14 | Licensed and CMS-certified facility |
