In Texas, an assisted living facility is a residence that provides room, board, meals and assistance with activities of daily living. Activities of daily living can include help with eating, bathing, and medications. Recreational activities to encourage exercise and socialization are also provided, and some facilities offer limited skilled nursing services. These residences must accommodate a minimum of 4 residents, none of whom may be a relative of the owner of the facility. Any residence that is not licensed by the Texas Health and Human Services Commission cannot use the term “assisted living”.
Texas has two types of assisted living facilities: Type A and Type B. The main difference is the residents’ ability to safely exit the facility in an emergency. In Type A facilities, residents must be able to evacuate the facility without assistance. In addition, residents must be able to understand and act when given directions, must show that they can comply with evacuation practices, and must not require regular assistance during the night.
None of the above rules apply in Type B facilities. Residents can require assistance with exiting the residence if there is an emergency, and they can require regular assistance overnight. A resident must not be confined to his/her bed.
All assisted living facilities that accommodate people with Alzheimer’s disease and related dementias are Type B residences and are referred to as “Alzheimer’s certified facilities”, or “Alzheimer’s certified units”, or “memory care homes.” People with other dementias may also live there, meaning those with vascular, Lewy body, frontotemporal and other dementias can be residents.
Memory care homes in Texas differ from traditional assisted living in several ways by:
– increased security and supervision
– additional staff training
– a greater number of employees
– recreational activities specific for persons with dementia
– higher cost
Memory care homes are not nursing homes. In most cases, memory care is less expensive and offers a better quality of life to residents. People who need round-the-clock, nursing-home-level care often have extremely serious health problems and usually cannot move into assisted living.
There are more than 670 memory care homes in Texas. There are also more than 800 board-and-care homes, which offer the same services as assisted living (sometimes including memory care) for fewer than 16 people in a home-like residence. For free help finding memory care of any size to meet your family’s needs and budget, click here.
The statewide cost of memory care in 2022 in Texas is $4,822 monthly. Texas has some of the highest cost variation of any state in the nation ranging from $3,350 to $6,778 monthly. Memory care in the most expensive areas of the state can be almost 100% higher than in less expensive areas. In Texas it is worthwhile to shop around if cost is a concern.
The most expensive city for memory care in Texas is Austin where it will cost $6,778 monthly. The most affordable memory care is in Texarkana on the border with Arkansas for $3,350 per month.
The states that border Texas have prices that are comparable. In New Mexico, memory care runs about $5,448 per month, Oklahoma costs $4,675 monthly, and Louisiana is $4,527 per month. Because of these differences, it can be worth investigating communities in neighboring states.
|Texas Memory Care / Assisted Living Costs (updated June 2022)|
|Region / City||Daily Cost||Monthly Cost|
To be admitted to an assisted living residence in Texas you must be at least 18 years old and have a medical need based on a functional assessment score. Residents must have a physical exam when they move in, done by a medical professional who works for the residence. Normally, this is done between 30 days prior to admission to 14 days after admittance. An exception is made for residents transferring from another assisted living facility or a hospital where an exam was already done.
The cost of the assessment is often included in the base rate, though some memory care facilities charge a one-time community fee that covers all move-in costs. Community fees are usually between $1,500 and $2,500.
The purpose of the assessment is to get to know your loved one’s behavioral issues, psychosocial issues, and activities of daily living patterns. Staff needs to know as specifically as possible what a new resident can and can’t do, and how to communicate and engage with that person. A personalized care plan with this information is created and updated regularly. The assessment is also useful to know if someone should not be admitted, because persons cannot be admitted to a residence if they have needs that are greater than can be met at the residence.
Residents of Alzheimer’s certified facilities and units must have Alzheimer’s disease or some form of dementia. This does not mean they need an official diagnosis, however. Alzheimer’s and related diseases including frontotemporal, Lewy body, and vascular dementias are difficult to diagnose as the process requires expensive tests including PET brain scans. Someone with all the symptoms of dementia, who clearly needs the services of memory care, will be able to move into assisted living if the residence is a good fit.
It is possible to find assisted living in Texas on short notice, but it’s not a good idea. In most cases, it will take several weeks, or even months, for a family to research and choose an assisted living residence that will best suit the needs of their loved one. Then, a few more weeks are usually spent relocating their loved one and getting him/her settled in. Many assisted living residences have waiting lists, which means admission is not always immediate. Also remember that the sooner you begin looking for the right residence, the more input your loved one can provide while making a decision.
In Texas, Alzheimer’s certified facilities must be constructed based on patients safety and wellbeing. Examples of what this might be are special locks to prevent wandering, a secure outdoor area so residents can spend time in the open air, bright lighting and paint colors, and an easy-to-navigate facility layout.
Bedrooms (or living units) must be at least 100 square feet. There cannot be more than four residents per room, though residents in dementia care typically have single units or just one roommate. Living units usually have private bathrooms, but regulations require one toilet for every six residents, and a tub or shower for every 10.
Employees at a Texas assisted living facility must be at least 18 years old and a high school graduate. Staff training varies depending on position and responsibilities, but all employees must complete a 4-hour orientation. After the orientation and prior to working, those who provide direct care to the residents must complete 16 hours of on-the-job training. In addition, direct care employees require an additional 6 hours of training each year. For employees working with patients with Alzheimer’s disease and related dementias in Alzheimer’s certified facilities and units, the training is dementia-specific.
Memory care residences that house 17 or more residents are classified as large by the state. Large residences require an activity director who works at least 20 hours per week. Residences that have less than 17 residents do not have to hire an activity director, but must appoint a staff member to organize and carry out cognitive and recreational activities.
There isn’t a specified staff-to-resident ratio in Texas. Assisted living facilities, including memory care homes, must have enough employees to meet the residents’ needs. In addition, it is required that residences report and post the number of staff (and their positions) each month. For night shift staffing, small and large traditional assisted living facilities must have employees to meet the needs of the residents. With memory care, the overnight staff must be awake at all times, regardless of the size of the residence. For large Alzheimer’s certified facilities or units, there must be two night shift employees on duty.
There are no state regulations in Texas that guide the process of evicting a resident from assisted living. Generally, a person cannot remain in a residence where their personal and medical needs cannot be met. This means staff must be trained to handle their specific health needs. If a residence is not able to care for people who are non-ambulatory, for instance, then a resident who loses the ability to walk would need to be evicted (or transferred).
Because dementia is progressive, you need to know that staff can continue caring for your loved one as memory and physical abilities deteriorate. During the assessment (see above) staff should get a good idea of the stage of dementia and how the disease will progress. You want to be sure a residence can handle your loved one’s needs before agreeing to a move-in contract.
It’s important to know the policy on evicting, discharging, or transferring residents before moving in. Get it in writing, because unfair evictions are a big problem in assisted living nationwide. Can a person be evicted for non-payment or late payment of bills? Is aggressive behavior enough to get someone evicted? Is there a way to appeal? Does the residence help with transfers to a more appropriate home? Residences in Texas will have their own procedures for handling evictions, discharges, and transfers, so get the answers to every possible question in writing. If you receive an eviction notice and need to know next steps, click here.
While the cost of memory care can be expensive, financial assistance is available for people who need it.
STAR+PLUS (Medicaid) is a jointly funded federal and state health care program, and in Texas , it pays for nursing home care for those who qualify based on income and assets limits. However, STAR+PLUS will also pay for a portion of the cost of memory care or assisted living. This program will not cover the cost of room and board, only care assistance.
There are both financial and medical criteria. An individual with dementia will, very likely, meet the medical requirement. Financially, in 2023, a single person needs to make less than $2,742 per month and have limited assets. More details on TX Medicaid eligibility. Alternatively, take a quick TX Medicaid eligibility test.
One of the ways this program saves money is by offering home and community based services (HCBS) via a HCBS Medicaid waiver. Services available under this waiver include personal care assistance for people residing at home or in assisted living facilities including Alzheimer’s certified facilities. Unlike with the state Medicaid plan, the Medicaid waiver has participant enrollment limits, which means a waiting list may exist.
The Texas Community Care for the Aged / Disabled Program provides adult day care, meal delivery, emergency response services, and assistance with daily living activities for people over the age of 18 who have a functional need. This is a federally funded, non-Medicaid program that covers many of the same benefits as STAR+PLUS (described above). Available services may include help with bathing, grooming, dressing/undressing, eating, mobility, transitioning, cooking, and shopping for essentials. Personal care assistance is available in one’s home, an adult foster care home, or in an assisted living facility. Like Medicaid, this program covers costs of care but not room and board. To apply, contact your local Aging and Disability Resource Center.
Veterans are statistically more likely to develop dementia. Among the reasons for this is that traumatic brain injuries and posttraumatic stress disorder lead to a higher probability of developing the condition. The VA offers many benefits for Alzheimer’s and dementia as well as different pension types.
There are three types of VA Pensions available. The benefits change annually and are valid from December 2022 to December 2023. The benefits (and their maximum allowance) are as follows:
1) Basic Pension – This benefit is also known as a death pension. It is for veterans and surviving spouses who are aged or disabled. The qualifying disability does not need to be related to their military service. On an annual basis, the Basic Pension pays:
– Veterans without spouses or children up to $16,073
– Veterans with dependent spouses or children up to $21,001
– Surviving spouses without dependent children up to $10,756
2) Aid & Attendance – Abbreviated as A&A, this is an important program for veterans and their surviving spouses who require assistance with activities of daily living. This means they need assistance with activities like bathing, dressing, and eating. A&A is particularly helpful for people with dementia, especially in the middle and later stages of the disease, when the need for more assistance becomes necessary. A&A is intended to help with the long-term care costs of adult day care, in-home care, assisted living, memory care, and skilled nursing. Based on an individual’s need and the progression of the disease, most of these additional services that support your loved one will become necessary. Annually, the A&A pays:
– Veterans without spouses or children a maximum of $26,751
– Veterans with dependent spouses or children a maximum of $31,713
– Surviving spouses without dependent children a maximum of $17,191
3) Housebound – For veterans and surviving spouses who are permanently disabled and unable to leave their homes, making them require additional assistance. The definition of “home” can include assisted living, memory care, and nursing home. The Housebound pension, like the A&A pension, is meant to help cover long-term care costs. Annually, the Housebound pays:
– Veterans without spouses or children a maximum of $19,598
– Veterans with dependent spouses or children a maximum of $24,562
– Surviving spouses without dependent children a maximum of $13,145
There are eight veterans’ homes in Texas, which are residential care facilities that provide long-term care for veterans. They are in Tyler, Bonham, Big Spring, McAllen, Amarillo, El Paso, Floresville and Temple. Neighboring states have more veterans’ homes, so a loved one might consider looking there for more options as there are no requirements that one must live in the state. For example, to the north in Oklahoma there are 7 VA homes statewide. Additionally, to the east in Louisiana there are 5 homes and New Mexico has 2 VA homes to the west. More info.
1) Elder care loans exist for families to cover the costs of moving into memory care while waiting for other financial resources to become available. For example, if one is waiting for a VA pension to be approved or waiting to sell a home. More on bridge loans for memory care.
2) Tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you can claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that can include assisted living costs.
3) A reverse mortgage can be an option for a married person moving into memory care, if their spouse continues to live in the home. However, if the spouse moves from their home, the reverse mortgage becomes due.