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Commentary Health Care

Opinion: Time to End Neglect in Md. Assisted Living and Dementia Care Homes

Photo by Matthias Zomer from Pexels.

Editor’s Note: The headline was changed to specify the type of care homes.

A few days ago, our new President and Vice President held a ceremony honoring the 500,000 Americans who have lost their lives to COVID-19. It was fitting and proper that they do so.

Governor Hogan in his many news conferences portrays that he is empathetic to the vulnerable population in nursing homes and assisted living facilities. Yet, in Maryland 45 percent of the folks who have died from this pandemic were seniors living in nursing homes, assisted living and memory care facilities. Maryland has not updated assisted living regulations since 2008, despite the law requiring them to be updated every eight years.

The current regulations (COMAR 10.07.14) are 92 pages long and are best described as the fox guarding the hen house. There is no requirement for direct care aides in these facilities to be licensed Geriatric Nursing Assistants or Certified Nursing Assistants. And a registered nurse at these facilities can be responsible for an unlimited number of residents.

Qualified medical technicians are not required to be on duty 24 hours a day, so if someone needs to be medicated in the wee hours of the morning, usually no qualified staff is available. No minimum direct care staffing levels are required and smaller facilities are not required to have an awake overnight staff. There have been numerous incidences of demented residents wandering out of these facilities endangering themselves. Lack of training results in improper infection control, as we sadly have seen in this pandemic.

The Maryland Department of Health reviewed the COMAR regulations and received public comment from all stakeholders from 2008 through 2016. And the department proposed regulations but never adopted them.

In 2018, an industry-backed bill — which established the Oversight Committee on Quality of Care in Nursing Homes and Assisted Living Facilities to study regulations and make changes as necessary — became law. This large, unwieldy committee has been an abject failure. It only meets every three months, and, before the pandemic, had trouble drawing a quorum.  And the committee has neither proposed nor made changes to the regulations.

During the current legislative session, Sen. Pamela G. Beidle (D-Anne Arundel) has proposed Senate Bill 204, crossfiled in the House of Delegates as HB 416. These bills instruct the Department of Health to review and adopt regulations of Assisted Living and Memory Care facilities. A hearing on the House bill is expected soon.

However, this is something that should have been done by now. Why hasn’t Gov. Hogan’s Department of Health adopted the regulations proposed in 2016? Not doing so violates state law that requires review and updates every eight years.

Even if regulations proposed in 2016 had been adopted, they would be woefully inadequate.

Regulations for childcare providers require minimum ratios of caregivers to children. There are no such regulations for the elderly in assisted living facilities. Childcare providers are required to be licensed and trained, but there are no such requirements for direct care staff in assisted living facilities. Neither are there limits on the number of residents the delegating nurse is responsible for.

In short, the State of Maryland is complicit in fleecing of our elderly residents of their life savings, for the benefit of out of state corporations, while those residents are provided care that is inferior to what we would give a 3-year-old child.

If Gov. Hogan is truly interested in keeping elderly Maryland residents safe, he will direct his Department of Health to adopt the regulations that were proposed in 2016 immediately, and to review further the injustice being forced on vulnerable elderly residents of these facilities.


The writer, a Maryland resident for most of his 68 years, is a retired carpenter and a member of Eldercare Advocates of Central Maryland.


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Opinion: Time to End Neglect in Md. Assisted Living and Dementia Care Homes