Assisted Living in Texas

Being the second largest state in America, Texas encompasses a diverse range of climates and landscapes. From the semi-arid marshes of the coast to the spring-fed hills farther north, this expansive state is likely to appeal to retirees from many different regions. For senior citizens, most of whom live on fixed incomes, finding such atmospheric variety in a state that does not have a state income tax is exceptional.

Directory of Assisted Living Facilities in Texas

Making senior care decisions can mean reviewing pages of jargon and useless information to find relevant facts. To streamline the research process, we have conducted a review of Texas assisted living facilities. In the table below, we have compiled a comprehensive list of facilities including key data points such as info on amenities, costs, and Medicaid acceptance status.

Paying for Assisted Living in Texas

The Cost of Assisted Living

When compared to the national average of $4,000, the cost of assisted living in Texas is relatively affordable at $3,795 per month according to the 2018 Genworth Cost of Care survey. Many of Texas’ neighboring states are less expensive, though these states are generally lower-income areas and, unlike Texas, collect an income tax.

Costs associated with Assisted Living Facilities (ALFs) in Texas can vary significantly from city to city. This state is home to some of the most populous urban centers in the country, such as the Dallas-Fort Worth area, where prices can be expected to climb above the national average.

The level of care that an individual needs has a huge impact on what he or she can expect to pay. Monthly prices in Texas are highest for people seeking nursing home residence or memory care. The opposite is true for people seeking Adult Day Healthcare, where median costs are likely to represent less than 21% of the average expense for assisted living.

Financial Assistance for Assisted Living in Texas

STAR+PLUS

STAR+PLUS is a multifaceted program which provides reimbursement for people seeking assisted living. The STAR+PLUS Home- and Community-Based Waiver is a part of the program that helps seniors who are assessed as nursing home-eligible continue receiving their Medicaid benefits without being institutionalized. Eligible applicants are reimbursed for services that promote independence, such as assistance with personal grooming tasks, basic mobility, and caregiver respite. Services may be provided by direct care aides at an assisted living facility or by home health contractors.

Who is Eligible?

The STAR+PLUS program has absorbed many Texas Medicaid plans and services, so understanding whether you qualify can be difficult. This is due to the many caveats that may apply if you are eligible for multiple state programs under the STAR+PLUS umbrella, or for other programs like Supplemental Security Income. Eligibility requirements are listed on the Texas Health and Human Services website, though understanding what you may qualify for is likely to require the assistance of a dedicated case worker.

Eligible applicants are people who need an institutional level of care and qualify for Medicaid. Medicaid applicants over 65 should have a maximum income of $2,250 and countable assets of no more than $2,000, though eligibility criteria varies with marital status, level of assistance needed, and other factors.

How to Apply

This waiver is a non-entitlement program, which means that it can only support a limited number of active participants. Applying for the waiver is likely to result in one’s name being added to a waiting list for enrollment, so it is advised that interested parties sign up as far in advance as possible.

Applicants are encouraged to seek qualified counseling to help them navigate the enrollment process and eligibility requirements of STAR+PLUS. To begin the application process, contact The Office of the Ombudsman at (866) 566-8989, or consult the Texas Area Agencies on Aging by calling (800) 252-9240. Find your local Area Agency on Aging by consulting the directory in this guide.

The Community First Choice (CFC) Program

The Community First Choice program is a lot like the STAR+PLUS HCBS waiver in what it offers, except that CFC is a Medicaid entitlement program, meaning there are no maximum recipient caps and no waiting lists for enrollment. Community First Choice offers Medicaid reimbursement to low-income assisted living residents for the provision of assistance with activities of daily living, such as personal grooming tasks, mobility, and basic house chores. People already enrolled to receive other Medicaid waiver services may elect to switch to the Community First Choice Program.

Services provided under the CFC Program may include:

• Personal assistance with activities of daily living
• Skills education for self-care and independent living
• Emergency response services
• Training for support staff management
• Consumer-directed service options

Who is Eligible?

Applicants for the Community First Choice program must qualify for Medicaid and must be assessed by a physician as nursing home-eligible. Coverage of personal care services through this program is provided based on an assessment of which services an individual requires.

How to Apply

Interested parties can apply online at YourTexasBenefits.com, or call 2-1-1 for guidance and consultation. Your local Area Agency on Aging can also help with Medicaid and non-Medicaid applications. To initiate an assessment and determine your eligibility, consult the directory in this guide to find a nearby Area Agency on Aging.

PACE

Serving the cities of El Paso, Amarillo, and Lubbock, PACE is the Texas branch of the national Program for All-Inclusive Care for the Elderly. It is a Medicaid-administered program intended to provide total coverage of all medical and personal care needs for especially frail seniors, helping them to avoid institutionalization. This program reimburses for a broad array of services that may be provided by assisted living facility staff or home health contractors.

PACE provides these services:

• Personal care services and home healthcare
• Adult day healthcare
• Medical care
• Coverage for all necessary prescription drugs
• Hospital and nursing home care when necessary
• Social services
• Caregiver respite

Who is Eligible?

• Individuals aged 55 and older who are nursing home-eligible
• People who live in an area covered by PACE services
• Those who can live safely at home or in an assisted living community

Private payment is accepted for individuals not receiving Medicare or Medicaid and fees for these participants will not exceed average costs for nursing home care in Texas. However, space in the program is limited, and preference is given to applicants who have greater medical and financial needs. Most recipients of PACE are dually eligible for both Medicaid and Medicare. All applicants must have family or caregivers who can provide limited support during short intervals of respite.

How to Apply

To find out if you’re eligible and to learn about what PACE offers, contact your local HHS office by dialing 2-1-1, or 7-1-1 for the hearing impaired. You can also consult your local Area Agency on Aging for more details and application assistance. Find your local Area Agency on Aging by searching the directory included in this guide.

More Ways to Finance Assisted Living

Some additional ways to finance assisted living costs include:

• Veterans Benefits: Veterans can take advantage of several different pension programs to help cover the cost of assisted living. For more information, see the article on benefits.va.gov.

• Life Insurance Policies: Even if a spouse or loved one hasn’t died, certain types of life insurance policies can be used to pay for assisted living. More information is available at longtermcare.acl.gov

• Long-Term Care Insurance: Long-term care insurance is a type of insurance policy that pays for long-term care when it becomes necessary, including the cost of assisted living. For more information on the benefits and drawbacks of this financing method, visit longtermcare.acl.gov.

• Reverse Mortgages: Reverse mortgages allow seniors to access the equity from a home that they own, and these funds can be used to pay for assisted living. The U.S. Department of Housing and Urban Development offers a federally insured reverse mortgage program.

Free Assisted Living Resources in Texas

Texas is home to hundreds of nonprofits and government resource providers that assisted living residents can look to for added support. Some of these organizations, like the Area Agencies on Aging, operate in every state across the country, while others are dedicated only to specific regions in the state of Texas. All of these services are free to use. However, some organizations listed here may have income and health-related requirements intended to preserve resources for those who are most in need.

The Aging & Disability Resource Center

This center was opened by the HHS as part of the national No Wrong Door initiative, and it is intended to streamline public access to resources and information concerning long-term services and supports. The Aging & Disability Resource Center helps to reduce confusion and facilitate access to care for long-term care recipients in all 254 counties of Texas.

Contact them by calling (855) YES-ADRC, or (855) 937-2372. Find out more online by visiting hhs.texas.gov.

The Long-Term Care Ombudsman Program

Most states have a Long-Term Care Ombudsman program which organizes volunteers to act as advocates for recipients of LTC benefits. Ombudsmen periodically visit residents of ALFs and nursing homes to verify the quality of their care and environment, field complaints and concerns, help them protect their rights, and keep them in touch with the service providers and authorities they may rely on. The services of ombudsmen are always free and confidential, and their organizations avoid conflicts of interest by remaining unaffiliated with service providers and government agencies.

The Texas LTC Ombudsman program can be reached via e-mail at [email protected] and toll-free at (800) 252-2412.

211 Texas

The Texas Health and Human Services Commission provides 211 Texas as an anonymous social service hotline with 25 information centers across the state. They are available to take calls 24/7, and can help citizens understand and gain information on any programs administered by Health and Human Services, which includes long-term care facilities like assisted living and other supports for seniors.

Reach 211 Texas by simply dialing 2-1-1, or visit them online at 211Texas.org.

Area Agencies on Aging

The AAA is a national, federally funded organization. It acts as a central agency, unifying hundreds of community outreach programs and supports for citizens over 60 years of age. Texas hosts 27 Area Agencies on Aging, making this a convenient resource for people in all regions of the state.

Call to find your local office at (800) 252-9240, or consult the table below.

Veterans Affairs

Veterans Affairs has many locations throughout Texas, including outpatient clinics, medical centers, healthcare offices, and vet centers in every region of the state. The Texas VA website lists contact numbers for various types of inquiries, so a visit to the website is advisable to reach the correct department. There are two Regional Benefit Offices and one Regional Loan Center which provide assistance to veterans and their families.

Social Security Offices

The federal government maintains a central website for the Social Security Administration at SSA.gov. Many Social Security-related tasks can be completed online, including:

• Applying for Social Security Benefits
• Requesting replacement Social Security cards
• Making sure you qualify for benefits
• Estimating your benefits
• Receiving Social Security statements electronically or by mail

For further assistance, contact or visit the SSA office in your local area. Refer to the alphabetically sorted table below to find your nearest location.

The Senior Source

The Senior Source in Dallas is one of the more comprehensive elder resource centers in the state. They provide support for most aspects of senior life, like foster grandparent and volunteer programs, classes, and social gatherings.

Find them online at www.TheSeniorSource.org. Visit The Senior Source at 3910 Harry Hines Boulevard, Dallas, Texas 75219, or call (214) 823-5700.

Nutrition & Services for Seniors

Meals on Wheels operates through Nutrition & Services for Seniors in Jefferson and Hardin counties, bringing home-delivered meals to individuals and pets. This organization also provides valuable services, such as congregate dining, free transportation, and emergency communication systems.

Find them online at www.SeniorMeals.org. Visit Nutrition & Services for Seniors at 4590 Concord, Beaumont, TX 77703, or call (409) 892-4455.

Project Amistad

Providing services for El Paso, Midland-Odessa, and the Big Bend areas of far west Texas, this organization is designated by the Department of Health and Human Services as the Managed Transportation Organization for Texas’ Region 2. Project Amistad provides free transport to Medicaid beneficiaries, as well as many other vital services, such as money management and family counseling, and guardianship advisement.

Find them online at www.ProjectAmistad.org. Visit the Project Amistad offices at 3210 Dyer Street, El Paso, TX 79930. Call their main office at (915) 532-3790, or reach their call center at (877) 633-8747.

Assisted Living Laws and Regulations in Texas

Long-term care in the state of Texas is directed by the Health and Human Services Commission (HHSC), and all assisted living facilities in the state must be licensed with the HHSC. Below is an overview of the standards and requirements for Assisted Living Facilities (ALFs) in the state of Texas.

Assisted Living Service Plans

Within 14 days of admission to a Texas ALF, service providers must meet with new residents to fill out a service plan, sometimes called a needs assessment. ALF administrators will interview potential residents to determine their needs and desires in order to make sure their experience at the facility will be sufficient to their needs.

Administrators must also use this meeting to disclose regulations and practices concerning things like activities of daily living (ADL) patterns, psychosocial issues, and behavioral symptoms, as well as residents’ rights and community rules.

Any residents who receive behavioral care must have goals and strategies included in their service plan, and the plan must be confirmed by a physician or behavioral healthcare provider. If the plan involves recurrent medication administration or other skilled nursing services, a nurse or medical practitioner must review and confirm the provisions.

Assisted Living Admission Requirements

An assisted living facility cannot accommodate residents whose medical needs exceed the capabilities of staff unless a resident is covered by a licensed home health agency. Home health agencies can be hired by residents with greater care needs, although there are limitations on residency in an ALF for more fully disabled individuals. The state of Texas determines the extent of care available at ALFs by designating two levels of assistance, Type A and Type B, with Type A residents not requiring the added assistance of a home health agency.

Residents cannot be admitted to an ALF if they are permanently bedridden, or if their medical needs cannot be met by the facility or by a contracting home health agency.

Assisted Living Scope of Care

Texas ALFs can provide personal care services (assistance with activities of daily living) and/or medication assistance to residents. They can also provide skilled nursing care, but only for limited purposes, such as:

• To coordinate resident care
• To delegate or offer medication administration or personal care services
• To perform level of care assessments for residents
• To care for residents in case of illness, injury, or other emergency for up to 30 days

Type A facilities are designed for more able and active seniors, while Type B facilities are able to accommodate seniors who need more specialized care.

Type A facilities can admit residents who:

• Can demonstrate the ability to evacuate the facility unassisted in the event of an emergency
• Do not require routine attendance during sleeping hours
• Are mentally capable of following directions

Type B facilities can admit residents who:

• Suffer from dementia or Alzheimer’s disease
• Are not permanently bedridden, but may require assistance getting in and out of bed
• May require staff assistance to evacuate in emergency situations
• May be incapable of following directions in emergency situations
• May require assistance during sleeping hours

Assisted Living Medicaid Policy

Unlike some other states, Texas does not provide Medicaid reimbursement to ALF residents unless they have a very low income or are Home- and Community-Based Services waiver recipients. Only nursing-home eligible residents can receive waiver services, and these individuals must reside in Type B assisted living communities. Waiver services are provided by managed care organizations, and all services they provide, such as personal care and medication assistance, can be reimbursed through Medicaid.

Assisted Living Facility Requirements

In a single assisted living unit, no more than four residents may live in the space, and in any ALF community, no more than 50% of all units can be inhabited by more than two residents.

Space requirements:

• Usable floor space in Type A units must be at least 80 square feet for a single room, and no less than 60 feet per bed for multi-residential units.
• Usable floor space in Type B units must be at least 100 square feet for a single room, and no less than 80 feet per bed for multi-residential units.

Bathroom requirements:

• All bedrooms must be accompanied by gender-specific restrooms.
• Restrooms may be communal, private, or connecting between bedrooms.
• Each sleeping floor of an assisted living unit must have at least one water closet, lavatory, and bathing area.
• One water closet and one lavatory must be provided per every six residents, and at least one bathing area must be provided per every ten residents.

Fire safety and emergency evacuation standards are determined by the National Fire Protection Association’s Life Safety Code. Among the Code’s specifications are rules for the provision of automatic sprinkler systems and smoke alarms, along with spatial navigability and maximum occupancy regulations.

Medication Management Regulations

The staff at Texas ALFs are permitted to assist residents with their self-administration of medicines. They typically do this by helping to open medication packaging, or by providing cues to remind residents to take their medicines. If an ALF resident either chooses not to self-administer or cannot do so due to physical or mental limitations, staff may administer their medicines for them under voluntary and regulated conditions.

To administer medicines to residents, staff must adhere to the following:

• Hold a current license to administer medications
• Hold a current aide permit, acting under direct supervision by a licensed nurse
• Be an employee to whom the task has been delegated by a registered nurse

Staffing Requirements

Facilities must keep at least one manager on staff to direct operations, and each month managers will audit and then disclose staffing patterns. There is no legal ratio of staff to residents in Texas, but all facilities must retain sufficient staff to cover the following processes:

• Maintain order, safety, and cleanliness
• Assist residents with their medication regimens
• Prepare and serve meals
• Provide laundry assistance
• Provide care and supervision to meet basic needs
• Ensure evacuation in emergency situations

Staff Training Requirements

Administrators and staff of Texas assisted living facilities must undergo many hours of rigorous training, and in some cases they must earn further licensure. The state requirements for administrators and other staff include different training modules and differing levels of depth in educational material.

Within an administrator’s first year of employment, they must complete at least 24 hours of assisted living management training. At least 12 additional hours must be spent every year in training and education on at least two of the following subjects:

• Resident/provider rights and responsibilities concerning abuse, neglect, and confidentiality
• Basic management principles
• Professional skills for interacting with residents, families, and other service providers
• Likely needs and characteristics of residents
• Community resources
• Accounting and budgeting
• Basic emergency first aid
• Federal laws, such as the Americans with Disabilities Act and the Fair Housing Act

All on-staff attendants at Texas ALFs must complete four hours of orientation before beginning employment at a facility, and continuous on-the-job supervision is required during their first 16 hours of work. Full-time attendants must be at least 18 years of age or hold a high school diploma. The state mandates more extensive and specific training/licensure requirements for nurses, nurses’ aides, medication aides, and direct care staff.

Background Checks for Assisted Living

Before someone can be hired for work in any position at a Texas ALF, they must undergo a multi-faceted background check. Facilities must check prospective employees’ criminal history, Employee Misconduct Registry status, and Nurse Aide Registry status.

• The Texas Department of Public Safety Crime Record Service is used to look for any criminal acts in an applicants past, especially any involving assault, abuse, or neglect.
• The Employee Misconduct Registry ensures that personnel who have committed abusive, exploitive, or neglectful acts against consumers cannot find employment at a long-term care facility.
• The Nurse Aide Registry is a credential management system, and checking it ensures that all personnel have the proper licensure.

Though all Texas ALF employees are required to be subject to an extensive background check, independent contractors who may be working on facility grounds are not subject to the same requirement.

Reporting Abuse

Texas supplies resources for reporting facility malpractice and for reporting elder abuse. The HHS website also provides means of finding out if any complaints have been lodged against an assisted living facility in the past.

To file a complaint of an assisted living facility, the Texas Health and Human Services Commission suggests first approaching facility administrators about the problem. If that fails, the Office of the Ombudsman should be contacted. This central office can be reached by calling their toll free number at (877) 787-8999, or for the hearing impaired, call the Texas Relay service by dialing 7-1-1, or (800) 735-2989. Complaints can also be filed online here.

To find out about past complaints, investigations, and inspections of Texas assisted living facilities, use the Texas LTC Provider Search tool by visiting hhs.texas.gov

To make a report of elder abuse, the HHS provides a hotline that anyone can call to confidentially report neglect, exploitation, or abuse. Anyone who knows about an instance of elder abuse or neglect is legally required to report it. To make a report, call the Department of Disability and Aging Services at (800) 458-9858.

Texas COVID-19 Rules for Assisted Living Facilities

Note: The following information was compiled and most recently updated on 2/15/22. Since COVID-19 is a rapidly evolving crisis, be sure to contact your assisted living facility or local Area Agency on Aging for the most up-to-date information.

Sources: www.hhs.texas.gov www.cms.gov