Maryland doesn't license 'memory care' as its own category — it uses a three-tier Level system instead. Here's what Levels 1, 2, and 3 mean for Bethesda, Silver Spring, Rockville, and Hyattsville families.
By DC Senior Advisor Care Team · February 27, 2026
Maryland licenses assisted living programs through the Maryland Department of Health's Office of Health Care Quality (OHCQ) under COMAR 10.07.14, and instead of a separate memory-care license, it assigns each licensed community — and often each individual resident — to a Level: Level 1 (low intensity), Level 2 (moderate intensity, appropriate for residents who need more help with activities of daily living or have moderate cognitive impairment), or Level 3 (the highest intensity a licensed assisted living program can provide, often used for residents with more advanced dementia or greater nursing-adjacent needs who still don't require a nursing home). A single Montgomery or Prince George's County facility may be licensed to serve multiple Levels within the same building, with residents assessed individually and placed accordingly.
This matters enormously for a Bethesda, Silver Spring, Rockville, Gaithersburg, Wheaton, Hyattsville, or College Park family evaluating a 'memory care' wing: the marketing label tells you the program is designed for residents with dementia, but the OHCQ Level tells you what the facility is actually licensed and staffed to handle. A community advertising memory care that's only licensed for Level 2 may not be authorized to keep a resident whose needs progress to Level 3 territory — which can force an unplanned second move at exactly the wrong moment.
Maryland requires a functional and cognitive assessment, typically at admission and periodically afterward, to determine which Level fits a specific resident, based on how much help they need with activities of daily living (bathing, dressing, mobility, toileting), medication management, and behavioral or cognitive symptoms. As care needs increase, a resident may be reassessed into a higher Level — sometimes within the same building, sometimes requiring a transfer to a different, higher-Level-licensed community if the current facility isn't authorized for that Level.
Before touring, ask any Montgomery or Prince George's County community directly: what Level or Levels are you licensed for, and what happens if my parent's needs exceed the highest Level you're licensed to provide? A facility that's vague about this question is worth a second look — a straightforward answer, including a plan for what happens if a resident's needs outgrow the building, is a good sign of an operator that understands its own licensing scope.
Maryland's OHCQ maintains public licensing and inspection records that families can request to confirm a specific community's licensed Level, capacity, and any past survey findings. This is worth doing before signing a residency agreement, not after — a facility's marketing brochure and its actual OHCQ license don't always describe the same scope of care, especially around Level 3 and dementia-specific programming.
For free local guidance, Montgomery County families can call Montgomery County Aging and Disability Services at (240) 777-3000, Prince George's County families can reach the Prince George's County Aging and Disabilities Services Division, and any Maryland family can start with Maryland Access Point at 1-844-MAP-LINK, the state's front door for aging and disability services. A free senior advisor familiar with Montgomery and Prince George's County communities can also help match a parent's actual assessed needs to a facility genuinely licensed for the right Level, rather than one that simply advertises the right words.
Level 3 is the ceiling of what a Maryland assisted living program can legally provide — it is not the same as a nursing home, and OHCQ draws a firm line between the two. Nursing homes in Maryland are licensed separately by OHCQ as comprehensive care facilities, under different standards entirely, and some residents whose needs exceed what any Level 3 program can safely provide will need that different kind of license, not simply a 'higher' assisted living Level.
This is a common point of family confusion: a facility marketing itself as offering the 'highest level of care available' in assisted living is still capped by Level 3, and if a physician determines your parent genuinely needs nursing-facility-level care, moving to an OHCQ-licensed comprehensive care facility — not a higher-Level assisted living program — is the appropriate next step. A free advisor can help a Montgomery or Prince George's County family understand which side of that line their parent's current and likely future needs fall on.
Maryland requires periodic reassessment of a resident's Level, not just a one-time determination at admission, so a resident's needs — and therefore their Level, and potentially their cost — can shift over the course of a stay. Ask any Montgomery or Prince George's County community how often reassessments happen and how a Level change affects the monthly rate, since this is where a manageable budget can become an unmanageable one without warning.
Building a reassessment date into your own calendar, separate from whatever the facility tracks internally, gives a family a chance to ask informed questions before a Level change shows up as a surprise line item on next month's bill.
Before touring, ask each Montgomery or Prince George's County community for its most recent OHCQ survey date and whether any deficiencies were cited, and in which Level of care those deficiencies occurred. A community with a clean Level 1 survey but a cited deficiency in its Level 3 wing is telling you something specific about where its strengths and weaknesses actually are.
A free advisor who reviews OHCQ records regularly across Montgomery and Prince George's County communities can help translate a survey report into plain language before you commit to a tour, so you walk in already knowing what to ask about.
Free, no pressure, and no one rushing you. We answer to families, not to facilities.