.05 Levels of Care.

A. A licensee may provide:

(1) The level of care for which the assisted living program has been approved; and

(2) Any lower level of care.

B. At the time of initial licensure and each subsequent renewal, an applicant shall request approval to provide services at one of the three levels of care set forth in §G of this regulation. An applicant or licensee shall demonstrate that it has the capacity to provide the level of care requested either directly or through the coordination of community services.

C. If, at any time, a licensee wants to provide a higher level of care than that for which it is licensed, the licensee shall request authority from the Department to change its licensed level of care.

D. The Department shall determine if an applicant or licensee has the capacity to provide and ensure the requested level of care.

E. The Department may approve or deny the request. If an applicant or licensee is aggrieved by the Department's decision, the applicant or licensee may appeal by filing a request for a hearing consistent with Regulation .64 of this chapter.

F. As provided in Regulation .14C of this chapter, the resident's care needs shall determine the need, amount, frequency of nursing overview by the registered nurse, and the need for on-site nursing services as well as when awake overnight staff is not required. The Department may approve a waiver of the requirement for awake overnight staff when the facility has demonstrated to the Department its use of an effective electronic monitoring system. The licensee shall comply with applicable requirements of COMAR 10.27.09.

G. Levels of Care.

(1) The applicant or licensee shall request one of the levels of care listed in §G(2)—(4) of this regulation. Program staff shall have the abilities necessary to provide the level of care and the abilities to provide the services listed for the level of care selected by the applicant or licensee.

(2) Level 1: Low Level of Care.

(a) An assisted living program that accepts a resident who requires a low level of care shall have staff with the abilities to provide the services listed in §G(2)(b)—(g) of this regulation, and the program shall provide those services.

(b) Health and Wellness. Staff shall have the ability to:

(i) Recognize the causes and risks associated with a resident's current health condition once these factors are identified by a health care practitioner; and

(ii) Provide occasional assistance in accessing and coordinating health services and interventions.

(c) Functional Condition. Staff shall have the ability to provide occasional supervision, assistance, support, setup, or reminders with two or more activities of daily living.

(d) Medication and Treatment. Staff shall have the ability to assist a resident with taking medication or to coordinate access to necessary medication and treatment.

(e) Behavioral Condition. Staff shall have the ability to monitor and provide uncomplicated intervention to manage occasional behaviors that are likely to disrupt or harm the resident or others.

(f) Psychological or Psychiatric Condition. Staff shall have the ability to monitor and manage occasional psychological or psychiatric episodes or fluctuations that require uncomplicated intervention or support.

(g) Social and Recreational Interests. Staff shall have the ability to provide occasional assistance in accessing social and recreational services.

(3) Level 2: Moderate Level of Care.

(a) An assisted living program that accepts a resident who requires a moderate level of care shall have staff with the abilities to provide the services listed in §G(3)(b)—(g) of this regulation, and the program shall provide those services.

(b) Health and Wellness. Staff shall have the ability to:

(i) Recognize and accurately describe and define a resident's health condition and identify likely causes and risks associated with the resident's condition; and

(ii) Provide or ensure access to necessary health services and interventions.

(c) Functional Condition. Staff shall have the ability to provide or ensure:

(i) Substantial support with two or more activities of daily living; or

(ii) Minimal support with any number of activities of daily living.

(d) Medication and Treatment. Staff shall have the ability to:

(i) Provide or ensure assistance with taking medication; or

(ii) Administer necessary medication and treatment, including monitoring the effects of the medication and treatment.

(e) Behavioral Condition. Staff shall have the ability to monitor and provide or ensure intervention to manage frequent behaviors which are likely to disrupt or harm the resident or others.

(f) Psychological or Psychiatric Condition. Staff shall have the ability to monitor and manage frequent psychological or psychiatric episodes that may require limited skilled interpretation, or prompt intervention or support.

(g) Social and Recreational Interests. Staff shall have the ability to provide or ensure ongoing assistance in accessing social and recreational services.

(4) Level 3: High Level of Care.

(a) An assisted living program that accepts a resident who requires a high level of care shall have staff with the abilities to provide the services listed in §G(4)(b)—(g) of this regulation, and the program shall provide those services.

(b) Health and Wellness. Staff shall have the ability to:

(i) Recognize and accurately describe and define a resident's health condition and identify likely causes and risks associated with the residents' condition; and

(ii) Provide or ensure ongoing access to and coordination of comprehensive health services and interventions including nursing overview.

(c) Functional Condition. Staff shall have the ability to provide or ensure comprehensive support as frequently as needed to compensate for any number of activities of daily living deficits.

(d) Medication and Treatment. Staff shall have the ability to:

(i) Provide or ensure assistance with taking medication; and

(ii) Administer necessary medication and treatment, including monitoring or arranging for monitoring of the effects of complex medication and treatment regimens.

(e) Behavioral Condition. Staff shall have the ability to monitor and provide or ensure ongoing therapeutic intervention or intensive supervision to manage chronic behaviors which are likely to disrupt or harm the resident or others.

(f) Psychological or Psychiatric Condition. Staff shall have the ability to monitor and manage a variety of psychological or psychiatric episodes involving active symptoms, condition changes, or significant risks that may require skilled interpretation or immediate interventions.

(g) Social and Recreational Interests. Staff shall have the ability to provide or ensure ongoing access to comprehensive social and recreational services.