.26 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 agent and the assisted living manager or their designee 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 in effect when the agreement is executed; 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 resident or the resident agent and the assisted living manager or their designee shall sign, before or at the time of admission, a resident agreement as set forth in this regulation excluding the provisions of §D(9)(c) and 8(d) and (e) of this regulation.

C. The assisted living program shall:

(1) Give a copy of the signed resident agreement to the resident and the resident 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, at a minimum, the following provisions:

(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 .05 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, a statement indicating that if a resident’s level of care, after admission, exceeds the level of care for which the assisted living program 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 resident from the program;

(4) If the assisted living program is part of a continuing care retirement community and a separate, concurrent resident agreement is signed by a continuing care subscriber as defined in COMAR 32.02.01.01B, a statement indicating that if the resident’s level of care, after admission to assisted living, exceeds the level of care for which the assisted living program is permitted to provide and a waiver for the continued stay of the resident has not been granted:

(a) The assisted living program may not provide any services to the resident beyond that which it is licensed to provide;

(b) If the assisted living program 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 as set forth in COMAR 32.02.01.31B;

(5) A listing of services provided by the assisted living program and a listing of personal care and health care services the assisted living program does not provide;

(6) An explanation of the assisted living program’s complaint or grievance procedure;

(7) A policy on resident self-administration of medications;

(8) A policy on the administration of medications to a resident by a spouse or domestic partner who is also a resident of the assisted living program;

(9) 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) Policies for temporary or permanent changes to the resident’s accommodations, including:

(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 for 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 assisted living program 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) If non-residents live on the premises, the assisted living program shall disclose what parts of the licensed space they are permitted in and during what hours;

(j) Provisions for continuous service in the event of an emergency;

(k) An acknowledgment that the resident or the resident representative has reviewed all assisted living program rules, requirements, restrictions, or special conditions that the assisted living program will impose on the resident; and

(l) 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:

(i) The conditions under which the assisted living program will hold a bed;

(ii) Relevant time frames;

(iii) Payment terms;

(iv) The circumstances under which the program will no longer hold the bed; and

(v) The period of time during which the resident is permitted to return and resume residence in the facility;

(10) 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 to verify that the receiving program or facility has the required license to operate that type of program or facility;

(d) The procedures which the assisted living program shall follow when discharging a resident without the resident’s consent, except in the case of a health emergency or substantial risk to other residents, including:

(i) The termination of the resident agreement on discharge; and

(ii) At least 30 calendar days written notice to the resident or resident representative before the effective date of the discharge;

(e) Procedures that the assisted living program shall follow when discharging, without 30 calendar days notice, a hospitalized resident whose medical needs have advanced beyond the level of care for which the assisted living program is licensed to provide. The procedures shall include at a minimum:

(i) A statement that a transfer to the hospital is not grounds for discharge; and

(ii) A requirement that the delegating nurse shall perform and document a nursing assessment of the resident’s condition at the hospital to determine if the resident can safely return to the facility;

(f) Procedures that the resident shall follow when terminating the resident agreement;

(g) A statement that the resident or resident representative shall give at least 30 calendar days notice to the assisted living program before the effective date of termination except in the case of a health emergency;

(h) Procedures the assisted living program shall follow when a multiple person unit is vacated by one resident due to discharge or death, including provisions:

(i) For termination of the agreement; and

(ii) Appropriate refunds;

(11) Obligations of the licensee, the resident, or the resident representative as to:

(a) Arranging for or overseeing medical care; and

(b) The monitoring of the health status of the resident;

(12) Adult medical day care policies and availability; and

(13) Any arrangements the resident has made, or wishes to make, with regard to burial, including, but not limited to:

(a) Financial;

(b) Religion preferred funeral director, if any; and

(c) The name, address, and relationship of any person who has agreed to claim the body of the resident or who has agreed to assume funeral or burial responsibility.

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 Human Services Article, Title 10, Subtitle 4, 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 .27 of this chapter do not apply.

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