What's Included in $5,000 a Month at Bright Hands

By Nimmi Perera — MD-ALM, CMT, CNA · Owner, Bright Hands Assisted Living

Last updated: 2026-07-15

Room & Board

The $5,000 monthly rate at Bright Hands starts with the room. We offer both private and shared rooms, and the monthly rate is the same for either — we do not up-charge for a private room or discount for a shared room. Families choose based on the resident's temperament: some people sleep and settle better with a roommate nearby, some need the quiet of a private room, and a few start in shared and move to private (or vice versa) once we see what they actually prefer after the first month.

Rooms come unfurnished by default, and families are welcome — encouraged, actually — to bring a familiar bed, dresser, recliner or armchair, bedside table, lamps, a television, family photographs, and anything else that makes the room feel like a continuation of home rather than a hotel. Familiar furniture matters clinically, not just emotionally. For residents with early dementia or recent relocation stress, the visual anchors of home reduce confusion and agitation in the first two to three weeks. We walk the room with the family before move-in and plan the layout together so there is clearance around the bed for transfers, room for a walker to turn, and a safe path to the bathroom at night.

Utilities are bundled: heat, air conditioning, electric, water, trash, and Wi-Fi. Residents do not see a utility bill. If a resident wants a personal cable TV subscription or a private phone line, that is billed directly to the family by the provider — we do not add a telecom fee. The room also includes routine maintenance: burned-out bulbs, sticking doors, a loose grab bar. We do not wait for a work-order queue.

Three Meals Daily + Snacks

Three meals a day plus snacks are included, and every meal is cooked in our own kitchen rather than reheated from a centralized commissary. That distinction matters more than families expect. When the kitchen is on-site and the cook is in the building, dietary accommodations are handled by adjusting the recipe — a lower-sodium version of the same Wednesday chicken — rather than by opening a different sealed tray from a different supplier. Dietary restrictions are the rule, not the exception, in a house of older adults, so we plan for them as the baseline.

We accommodate diabetic-friendly meals, low-sodium meals for residents with heart failure or hypertension, soft or pureed textures for residents with swallowing difficulty, vegetarian meals, and cultural or religious food preferences within reason. Allergens are documented on each resident's care plan at admission and cross-checked against every grocery order. If a resident wants scrambled eggs instead of oatmeal on a morning they do not feel like oatmeal, they get scrambled eggs — we are a five-resident house, not a banquet hall on a fixed serving schedule.

Dining is family-style at a shared table, which is both a social anchor and a practical way to keep eyes on who is eating well and who is not. Meal times are roughly 8 a.m., noon, and 5:30 p.m., with mid-morning and mid-afternoon snacks plus evening snacks for residents who wake up hungry at ten. Families are welcome to join for a meal during visits; we just ask for a day's notice so we can plan portions. Birthday cakes, holiday meals, and a resident's favorite recipe handed down from a daughter are all part of the normal rhythm of the house.

24/7 Care & Supervision

The single largest piece of what $5,000 buys is staffing. Bright Hands is licensed by Maryland OHCQ under license #AL-00806 as a Level 3 home, which means we are authorized to accept residents at Levels 1, 2, or 3 under the state's care-level framework. Our staff is on-site twenty-four hours a day, seven days a week, including an awake overnight caregiver — not an on-call caregiver, not a sleeping staffer who responds to a call bell, but a caregiver who is awake and moving through the house through every hour of the night.

Staff credentials: our caregivers are CMT-certified (Certified Medication Technician under Maryland's training and testing requirements) so the same person who helps a resident with breakfast is also authorized to administer the morning medication — no coverage gap between caregiver shifts and a separate medication nurse. Nimmi Perera RN, the owner, lives five minutes from the house and is on call as the delegating nurse, with a physical presence at the house multiple days a week for care planning, family meetings, and staff oversight.

Included in daily care are all Activities of Daily Living: bathing (shower or bed bath, resident's choice and the care plan's schedule), dressing, toileting, continence care, transfers (one-person or two-person, with proper equipment for safe lifts), mobility assistance, skin checks, and the hundred small things that families only notice when they stop happening — reminders to drink water, a second pass on medication at 8 p.m., a repositioning every two hours for a resident who cannot shift themselves, a quiet conversation at 3 a.m. when someone wakes up confused. None of those are add-on services. They are the baseline of the $5,000.

Because Bright Hands is a Level 3 home, we do not discharge residents when their acuity rises from Level 1 to Level 2 or from Level 2 to Level 3. A resident who moves in walking with a cane and over three years becomes a two-person transfer stays in the same room with the same caregivers. That continuity is part of what families are paying for — not just the hours of care today, but the assurance that today's home is still the home two years from now.

Medication Management

Medication administration is fully included — there is no separate medication-management fee, no per-dose charge, and no surcharge for residents on a long list of medications. A Certified Medication Technician administers every scheduled dose under COMAR 10.07.14.27, which sets Maryland's training, competency, and documentation standards for medication administration in assisted living. Every pass is documented in a state-compliant medication log: the medication, the dose, the time, the route, the staff initials, and any refusal or hold. PRN (as-needed) medications follow the same documentation, with the reason for administration and the outcome recorded.

We communicate directly with the resident's pharmacy for refills, synchronize fill dates so the family is not juggling multiple pickup trips, and flag prescription changes with the primary care physician during the first med pass of every new order. Narcotics and other controlled medications are stored in double-locked cabinets with count-to-count logs at every shift change. If a medication is discontinued, the remaining supply is documented and either returned to the family or destroyed per policy — never simply left in a bin.

The only medication cost the resident still pays is the pharmacy bill for the prescriptions themselves, which is charged directly to the resident's insurance or paid by the family. That bill never passes through us and we never mark it up. For a deeper walkthrough of our medication process — how the med sheet is built, what a med pass looks like, and how errors are prevented and documented — see our medication management in assisted living guide.

Activities & Social

Honest framing first: we are a five-resident home, not a sixty-resident community with a full-time life-enrichment director and a van parked out front. Our activity program is proportional to that scale. What we offer is a daily rhythm — a morning coffee and news conversation, mid-morning exercises appropriate to each resident's mobility, after-lunch quiet time or music, afternoon cards or puzzles or a craft, and evening wind-down — rather than a printed monthly calendar of themed events.

Specific things that happen in the house, not as marketing claims but as the normal week: a weekly sing-along (often hymns or standards chosen by whichever resident has the strongest preferences that week), puzzles and card games at the dining table, chair yoga led by a visiting instructor, a weekly group walk in the backyard when weather permits, a bird feeder visible from the main living room that generates more conversation than most scheduled activities, and periodic small outings — a short drive to see holiday lights, a trip to a family's home for a celebration, a visit to a nearby park.

Spiritual and religious accommodations are part of daily care, not an add-on. Residents who want to watch a televised church service on Sunday morning do so. Residents whose pastor or chaplain visits are welcomed into the living room. Residents who observe dietary rules at religious holidays have meals planned around those observances. We do not run denominational programming, but we make space for every resident's practice.

What we will not do is pad this section. If a family is looking for a salon, a woodshop, a chapel, and a theater, a large chain facility is a better fit. If the priority is tight staffing, predictable faces, and a calm daily rhythm, Bright Hands is closer to what a home feels like. Both are legitimate. For a closer look at how an actual day unfolds here, see our day in the life at Bright Hands walkthrough.

Laundry & Housekeeping

Personal laundry is done weekly in-house. Clothing is washed, dried, folded, and returned to each resident's room — we keep a simple label system so items do not cross between residents. Families provide the resident's clothing at move-in and replace worn items over time; we do not run a clothing program. If a resident has incontinence, we handle soiled laundry daily as part of routine care rather than waiting for the weekly cycle.

Linens are changed weekly at minimum and more often as needed. Bedding is provided by Bright Hands; families who prefer a specific quilt or blanket from home are welcome to bring it, and we launder it on the same schedule. Towels and washcloths are provided and rotated regularly.

Room tidying happens daily — beds made, surfaces wiped, trash emptied, floor swept or vacuumed — as a normal part of morning and evening care. Deeper cleaning (baseboards, windows, under furniture, bathroom deep-clean) is on a weekly or biweekly schedule handled by the caregiving team. Common areas — living room, dining room, kitchen, hallways — are cleaned multiple times a day because that is where we all spend time. We do not use a separate housekeeping contractor; our caregivers handle cleaning as part of the daily flow, which means the same people who know a resident's routines are the ones keeping their space comfortable.

What's NOT Included

Honest exclusions matter. If we pretend $5,000 covers literally everything a resident needs, families feel misled the first time an unexpected invoice shows up. The following are real exclusions from the Bright Hands monthly rate — things the family pays separately or arranges independently:

• Private-duty one-on-one caregivers. Our normal staffing provides 24/7 coverage across the house. If a family wants a dedicated one-on-one companion for a specific shift — say, a sitter during a hospital discharge recovery, or a private-duty aide for a spouse visiting for an hour at a time — the family hires that separately through an agency or privately.
• Outside medical transportation. We do not own a shuttle or van. Our default model is to bring the doctor to the resident through house-call primary care. For appointments that cannot come to us — specialists, imaging, labs — the family provides transportation, or the family hires a medical transport service, or we help the family arrange one. We do not charge a transportation fee because we do not provide transportation.
• Specialty therapies (PT, OT, speech). Physical therapy, occupational therapy, and speech therapy are medically ordered and billed to Medicare Part B, not to us. Therapists visit the house to see residents in their own room, which is usually gentler than a clinic visit. We coordinate scheduling and follow through on the home exercise program — the therapy itself is a separate bill the resident never sees because it goes through Medicare.
• Incontinence supplies beyond a baseline. We keep a baseline stock of adult briefs, pads, and wipes and draw from it for daily care. Residents who need premium brands, specialty sizes, or high-absorbency overnight products at volumes above the baseline — which is common at higher acuity — have those supplies ordered by the family, often through a Medicare-covered supplier or a standing Amazon order.
• Phone plans and personal telecom. Wi-Fi in the house is included. A personal cell phone plan, a landline, or a premium cable TV package is billed directly to the family by the provider. We do not mark up telecom and we do not bundle it.
• Hair salon services. Haircuts, color, and salon services are not included. Several Silver Spring mobile salon providers visit the house on request and bill the family directly, usually $35 to $60 per visit depending on service.
• Prescriptions themselves. Medication administration is included — the medications are not. The pharmacy bills the resident's insurance or the family directly.
• Dentistry, podiatry, optometry, audiology. Visiting dental hygienists, podiatrists, optometrists, and audiologists come to the house on request; their visit fees are billed directly to the resident or to the resident's insurance and never pass through us.
• Personal items and incidentals. Clothing, books, stationery, a birthday gift for a grandchild — these are family responsibilities and normal ones. We are the care provider, not the personal shopper.

Two things worth saying out loud. First, the exclusion list at Bright Hands is shorter than the exclusion list at most chain facilities because we do not itemize care-level add-ons, medication fees, or community fees. Second, we will say "that is not included" to your face on a tour rather than hide it in a page-eleven clause of the admission agreement. Honesty compounds over months of care.

How This Compares to Chain Facilities

The flat-rate model is easier to explain than to price-shop against, because chains quote a base rate and add charges as the resident's needs are assessed. The table below shows the typical Silver Spring chain-facility structure — drawn from our cost of assisted living in Silver Spring guide — alongside the Bright Hands line. Numbers for chains are 2026 market ranges, not a specific named competitor.

Two caveats on the comparison. First, the chain model comes with amenities the Bright Hands model does not — a salon, a therapy gym, a chapel, a bistro, a theater. If those matter to a family, that is a legitimate reason to pay more. Second, the chain model also comes with larger staffing ratios (typically 1:8 to 1:12 during the day), more caregiver turnover, and a care-level assessment that can raise the bill mid-stay without a move. The real question is not "which is cheaper" but "which model matches what this parent actually needs." For many families, the answer is the small home; for some, it is the chain. The price difference exists for reasons, and we try to be honest about them on every tour.

Frequently Asked Questions

Helpful guides

• Bright Hands Pricing — $5,000/mo All-Inclusive
• Cost of Assisted Living in Silver Spring, MD (2026 Update)
• Medication Management in Assisted Living
• A Day in the Life at Bright Hands
• About Bright Hands & Nimmi Perera RN