How to open an assisted living home or group home in Maryland
The license is issued by the state, but the house has to pass zoning, fire code and an inspection first. Pick the property with that in mind and you save months.
By Stephen Wilson, REALTOR and owner of a licensed Maryland general contractor. Updated October 25, 2026.
Who licenses what
| Type of home | Who licenses or approves it |
|---|---|
| Assisted living program | Maryland Department of Health, Office of Health Care Quality (OHCQ) |
| Group home for people with developmental disabilities | Developmental Disabilities Administration (DDA) provider approval, licensed through OHCQ |
| Behavioral health residential program | Maryland Department of Health, behavioral health licensing |
| In-home care (home care agency) | OHCQ, as a residential service agency |
Requirements and forms change. Get the current application packet straight from the agency before you spend money on a property.
The usual order of steps
- Pick the population and level of care. It sets the staffing, training and fire rules, and which agency you deal with.
- Plan the business. Staffing for 24-hour care is the largest cost. Assisted living also needs a trained assisted living manager and a delegating nurse.
- Check zoning for the property. Ask the county how many residents are allowed in that zoning district and whether a special exception or use permit is needed.
- Check the fire code. The fire marshal's rules depend on the number of residents and whether they can leave the building on their own in an emergency. Sprinklers, smoke alarms, exits and door hardware are the common upgrades.
- Prepare the house, then apply. The licensing survey looks at the actual home: bedrooms, bathrooms, accessibility, safety and records.
What to look for in the house
This is where a contractor's eye saves the most money. Before you buy, look for:
- Bedrooms and a full bathroom on the main level, so residents with limited mobility avoid stairs.
- A step-free entrance, or room to add a ramp that meets the slope rules.
- Wide enough halls and doors for walkers and wheelchairs, or walls that can move without major structural work.
- An electrical panel and water service that can carry sprinklers, more laundry and a bigger kitchen load.
- Parking for staff and visitors, which some counties require.
Ask for a written estimate of every change before the inspection contingency runs out. A house that needs a sprinkler system, a new bathroom and a ramp can cost far more to convert than its price suggests.
Quick answers
- Who licenses assisted living homes in Maryland?
- The Maryland Department of Health, through its Office of Health Care Quality (OHCQ). Assisted living programs are licensed by level of care, and the license is tied to a specific address, so the house is inspected as part of the process.
- How do I get a group home license in Maryland?
- It depends on who the home serves. Homes for people with developmental disabilities are run by providers approved through the Developmental Disabilities Administration (DDA) and licensed through OHCQ. Behavioral health residential programs are licensed by the Maryland Department of Health under the behavioral health rules. Start by deciding which population you will serve, then follow that agency's provider application.
- Can I open an assisted living home in a regular house?
- Often, yes. Many small assisted living homes in Maryland operate in single-family houses. The house still has to meet zoning, the fire code for its size and level of care, and accessibility needs of the residents, so not every house works.
- How do I start a home care agency in Maryland?
- In-home care is licensed separately from assisted living. Agencies that send staff into clients' homes are generally licensed by OHCQ as residential service agencies. No property is involved, so the license process is about staffing, policies and supervision.
This guide is general information, not legal, tax or financial advice. Rules change and vary by county; confirm the details for your situation with the agency named above, a tax professional or an attorney.