Assisted living facilities across the country are facing a wave of regulatory changes. States are updating their rules at a pace not seen in years, and property managers and operators who oversee these communities need to understand what is changing and why it matters.
Maryland is one of the most notable examples right now, with a set of significant new regulations taking effect on July 1, 2026. But Maryland is not alone. A new national report confirms that state legislatures everywhere are tightening standards, with a clear focus on resident safety, staff training, and accountability.
Why Assisted Living Facilities Are Regulated at the State Level
One important thing to understand about assisted living facilities is that they are not governed by federal regulations the way nursing homes are. According to the Congressional Research Service, assisted living facilities are licensed and regulated entirely by individual states. Because they do not receive dedicated federal financing for services in the same way nursing homes do through Medicare and Medicaid, the federal government has not set minimum quality or staffing standards for these settings.
That means every state sets its own rules for licensing, inspections, staffing levels, training requirements, and enforcement. It also means that when a state updates its regulations, every assisted living operator in that state needs to respond.
Maryland to Implement New Regulations in July 2026
Maryland’s new rules represent one of the most comprehensive overhauls to assisted living program regulations the state has seen in over a decade. The Maryland Department of Health’s Office of Health Care Quality updated its regulations with the goal of maximizing independence and promoting individuality, personal dignity, and freedom of choice for residents while setting reasonable health and safety standards.
As of May 1, 2025, there were 1,625 licensed assisted living programs in Maryland, with 82 percent classified as small businesses licensed for 15 or fewer beds.
The key changes targeting a July 1, 2026 implementation date include the following.
Manager Licensing Requirements
Assisted Living Managers will now be required to complete an 80-hour training course covering a range of topics and obtain a license through the Maryland State Board of Long-Term Care Administrators. Their expanded duties will include resident assessments, staffing oversight, quality assurance, and reporting to the Department of Health.
Stronger Criminal Penalties
The updated regulations strengthen criminal penalties for operating a facility without a license. They also provide for immediate prosecution and injunctive relief when allegations of resident neglect, abuse, or financial exploitation are substantiated.
Resident Rights and Protections
Facilities must now provide residents with a Resident Bill of Rights prior to or upon admission. The Bill of Rights must be posted in a visible location and must specifically highlight residents’ right to be free from financial exploitation and involuntary seclusion.
The regulations also prohibit any staff member from serving as both a resident representative and the representative payee, a rule designed to prevent financial conflicts of interest.
Staffing and Dietary Standards
Facilities operating an approved Alzheimer’s Special Care Unit must now maintain awake overnight staff at all times. Staffing schedules, including dates, shifts, and staff names, must be kept on file for 18 months.
Nutritionally adequate menus must be reviewed by a dietician or nutritionist prior to licensure and at least every three years. Menus must be posted weekly and kept on file for six months.
Other States are Making Changes
Maryland’s overhaul reflects a national trend. The National Center for Assisted Living’s 2025 Assisted Living State Regulatory Review found that 18 states, including the District of Columbia, updated their assisted living regulations between January 1, 2025, and December 31, 2025. The top areas for regulatory changes in 2025 included the following.
- Direct care staff education and training requirements, updated in 10 states (20 percent)
- Administrator and director education and training requirements, updated in 9 states (18 percent)
- Staff scheduling requirements, updated in 7 states (14 percent)
The report’s author, NCAL Director of Policy and Regulatory Affairs Jill Schewe, noted that states are showing a reinforced commitment to updating training and staffing requirements and that regulations are expected to continue changing to better meet the needs of current and future residents.
What This Means for US Operators and Property Managers
For anyone managing or overseeing an assisted living facility, the message is clear. Compliance is no longer a background concern. It is an active operational requirement that is changing year over year.
Each state sets its own rules for licensing, inspections, and enforcement. There is no single federal resource for tracking violations at the facility level, which makes it the responsibility of operators to stay current with their state’s requirements and inspection outcomes.
Common areas where facilities face citations include food handling and storage, medication management, failure to conduct background checks, and emergency preparedness. With states now adding criminal penalties and stronger enforcement mechanisms, the consequences of non-compliance are more serious than they have been in the past.
For Maryland facilities in particular, operators should be taking steps now to ensure their current policies and procedures align with the new requirements before the July 1, 2026 deadline. That includes reviewing whether managers are on track to meet the new licensure requirements, updating staffing documentation practices, and confirming that resident rights materials are properly distributed and posted.
The Bigger Picture
The increase in state-level regulatory activity reflects a broader shift in how lawmakers and regulators are approaching senior care. Residents in assisted living facilities are often among the most vulnerable members of a community, and the lack of a federal oversight framework means that state rules are the primary line of protection.
With 18 states updating regulations in a single year and more changes expected, property managers who oversee assisted living facilities need to treat regulatory compliance as an ongoing priority rather than a one-time checklist. Staying current with your state’s requirements, conducting regular internal reviews, and keeping documentation practices tight are the most effective ways to stay ahead of inspections and avoid enforcement action. If these new regulations mean that you need some work done on your facility, fill out the form below or use our Bidsource tool to get a bid fast.
Frequently Asked Questions
Are assisted living facilities regulated by the federal government?
No. Unlike nursing homes, assisted living facilities are not regulated at the federal level. They are licensed and regulated on a state-by-state basis. Each state sets its own standards for licensing, staffing, inspections, and enforcement, which means requirements can vary significantly depending on where a facility is located.
What new regulations are going into effect for Maryland assisted living facilities?
Maryland’s updated regulations, targeting a July 1, 2026 implementation date, include a requirement that Assisted Living Managers complete an 80-hour training course and obtain a license through the Maryland State Board of Long-Term Care Administrators. The updates also strengthen criminal penalties for operating without a license and for substantiated cases of resident neglect, abuse, or financial exploitation. Additional changes address resident rights, staffing documentation, overnight staffing on Alzheimer’s units, and dietary standards.
How many states updated their assisted living regulations in 2025?
According to the National Center for Assisted Living’s 2025 Assisted Living State Regulatory Review, 18 states and the District of Columbia updated their assisted living regulations between January 1, 2025, and December 31, 2025. The most common areas of change included direct care staff training requirements, administrator education requirements, and staff scheduling.
