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<regulation prefix="Regulation" num=".26" citation="COMAR 10.07.14.26" title_num="10" subtitle_num="07" chapter_num="14" heading="Resident Agreement — General Requirements and Nonfinancial Content.">
  <paragraph num="A.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Is accurate, precise, easily understood, legible, readable, and written in plain English;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Conforms to all relevant State and local laws and requirements in effect when the agreement is executed; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Recommends review of the agreement by an attorney or other representative chosen by the resident.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>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.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The assisted living program shall:</text>
    <paragraph num="(1)">
      <text>Give a copy of the signed resident agreement to the resident and the resident agent;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Maintain a copy of the resident agreement on-site; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Make the resident agreement available for review by the Department or its designee.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The resident agreement shall include, at a minimum, the following provisions:</text>
    <paragraph num="(1)">
      <text>A statement of the level of care for which the assisted living program is licensed;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The level of care needed by the resident, as determined by the initial assessment required by Regulation .05 of this chapter;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>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:</text>
      <paragraph num="(a)">
        <text>The assisted living program may not provide any services to the resident beyond that which it is licensed to provide;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>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</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The resident may be discharged from the continuing care retirement community only for just cause as set forth in COMAR 32.02.01.31B;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>An explanation of the assisted living program’s complaint or grievance procedure;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>A policy on resident self-administration of medications;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Occupancy provisions, including:</text>
      <paragraph num="(a)">
        <text>Policies regarding bed and room assignment, including the specific room and bed assigned to the resident at the time of admission;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Policies for temporary or permanent changes to the resident’s accommodations, including:</text>
        <paragraph num="(i)">
          <text>Relocating the resident within the facility;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Making a change in roommate assignment; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Increasing or decreasing the number of individuals occupying a room;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Procedures for transferring the resident to another facility;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The availability of locks for storage;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The availability of locks, if any, for the resident’s room;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Security procedures which the assisted living program shall implement to protect the resident and the resident’s property;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>The staff’s right, if any, to enter a resident’s room;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>The resident’s rights and obligations concerning use of the facility, including common areas;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Provisions for continuous service in the event of an emergency;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>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</text>
      </paragraph>
      <paragraph num="(l)">
        <text>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:</text>
        <paragraph num="(i)">
          <text>The conditions under which the assisted living program will hold a bed;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Relevant time frames;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Payment terms;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>The circumstances under which the program will no longer hold the bed; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>The period of time during which the resident is permitted to return and resume residence in the facility;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(10)">
      <text>Admission and discharge policies and procedures, including:</text>
      <paragraph num="(a)">
        <text>Any additional admission requirement imposed by the assisted living program;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Those actions, circumstances, or conditions which may result in the resident’s discharge from the assisted living program;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>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:</text>
        <paragraph num="(i)">
          <text>The termination of the resident agreement on discharge; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>At least 30 calendar days written notice to the resident or resident representative before the effective date of the discharge;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>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:</text>
        <paragraph num="(i)">
          <text>A statement that a transfer to the hospital is not grounds for discharge; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>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;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>Procedures that the resident shall follow when terminating the resident agreement;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Procedures the assisted living program shall follow when a multiple person unit is vacated by one resident due to discharge or death, including provisions:</text>
        <paragraph num="(i)">
          <text>For termination of the agreement; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Appropriate refunds;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>Obligations of the licensee, the resident, or the resident representative as to:</text>
      <paragraph num="(a)">
        <text>Arranging for or overseeing medical care; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The monitoring of the health status of the resident;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>Adult medical day care policies and availability; and</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Any arrangements the resident has made, or wishes to make, with regard to burial, including, but not limited to:</text>
      <paragraph num="(a)">
        <text>Financial;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Religion preferred funeral director, if any; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>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.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>The Department may not require a separate resident agreement for the assisted living program; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The requirements set forth in this regulation and Regulation .27 of this chapter do not apply.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The assisted living program may not include a provision in the agreement which is inconsistent with any of the requirements of this chapter.</text>
  </paragraph>
</regulation>