State health officials reported tremendous progress Thursday on a backlog of nursing home inspections, going from 130 cases last year to just 10 today, about half the time they thought it would take to clear the backlog.
But in the same House Health Committee briefing on oversight of senior living facilities, officials said they face a rising challenge keeping track of assisted living facilities, many of which are unlicensed and undetected until a complaint is filed.
“We’re in a much stronger place than we were a couple years ago, even last session, but still have a lot to do,” said Dr. Meg Sullivan, Maryland’s deputy director of public health services, in testimony to the committee.
But Sullivan said she knew she was inheriting “a very wide portfolio of issues” when she took the job last year. She succeeded Dr. Nilesh Kalyanaraman, who told lawmakers last year that there were 130 nursing homes that had not received their federally mandated annual inspection.
Kalyanaraman said the department was making progress, but predicted that it would take two years to fully catch up.
Sullivan said Thursday that the department brought in more staff to complete surveys, trained other staff to perform the inspections and streamlined the process overall.
Tia Witherspoon, executive director of the Office of Health Care Quality (OHCQ), said an “overarching theme” inspectors have found as they cleared the backlog has been “buildings that need a lot of work.”
“Unfortunately, it takes quite a bit of capital to renovate these buildings, so they do repairs where they can, but this is the majority of what we see,” Witherspoon said.
Meanwhile, monitoring assisted living programs is a growing concern for the state.
Assisted living facilities are senior living options for residents who need additional supports for daily tasks but do not need the same level of intensive medical care provided in nursing homes.
Besides the fact the federal government does not require inspections of assisted living facilities, as it does nursing home, state officials face the additional challenge of finding them all — an undetermined number operate without a license and are not on the state’s radar.
There are 1,617 licensed assisted living facilities across the state, that are inspected on a schedule. Officials have the authority to investigate unlicensed facilities as well, but only when complaints are brought to the OHCQ.
“By nature, unlicensed facilities are not registered with the state, so we can only investigate based on information that is shared,” Sullivan said.
She said the situation is “complicated” by the fact that unlicensed facilities may not be malicious actors, just small operators who may not know they need to register with the state. Sullivan said officials typically receive 8-10 complaints per month related to unlicensed facilities, what she called a “small subset” of the more than 1,000 complaints the agency sees monthly.
From July through December, the state issued violations to 10 unlicensed assisted living facilities, finding evidence of abuse or neglect in two facilities, which were referred to the attorney general. For all of fiscal 2025, the state issued violation notices to 13 unlicensed facilities. None of those had signs of abuse or neglect.
“We’re really focused on, first and foremost, increasing the number of licensed assisted living programs to safely serve Maryland residents,” Sullivan told lawmakers. “We are improving interagency coordination to streamline processes, respond to needs of residents … and working holistically across the government to address the broader issue of ensuring adequate numbers of safe, affordable facilities and services for Maryland’s aging populations.”
Advocates for the state’s seniors worried that some of Maryland’s most vulnerable population may not be receiving adequate care, especially in unlicensed facilities.
But Danna Kauffman, speaking for Lifespan Network, a senior care provider association, told lawmakers that there is a “senior housing crisis” in Maryland. Affordable care needs to be part of any discussions on unlicensed assisted living facilities, she said.
“We are very concerned about … making sure that the state has enough providers to provide the care that is needed in the community,” she said. “We do not have enough senior housing options, especially for low-income.
“It’s hard to say this, but it’s true – just because you are unlicensed doesn’t mean you are providing bad care,” Kauffman said.
“Some people just don’t know that they need to be licensed because they are caring for two or three people, that they had referrals from their church, or their community or friends,” she said. “We need to work with those folks.”
After the briefing, Nancy Carr, a communications director with the AARP Maryland, said she understands that some people may be “well-intentioned” and “didn’t know better,” but she wants to ensure that seniors are receiving the appropriate care.
Sara Westrick, AARP Maryland’s advocacy director, agrees.
“This is an important matter,” said Westrick said. “This is not a business one should enter lightly.”