Texas Memory Care (Residential Alzheimer’s Care): Laws, Costs & Financial Help

Legal Definition of Memory Care in Texas

In Texas, an assisted living facility 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 house at least 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 exit the facility in an emergency. Additionally:

– 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 their bed. All assisted living facilities that accommodate people with Alzheimer’s disease are Type B residences and are referred to as Alzheimer’s certified facilities, Alzheimer’s certified units, or memory care homes.

Memory care homes in Texas are not nursing homes and differ from traditional assisted living in several ways by:

– Increased security and supervision
– Additional staff training
– A greater number of employees
– Recreational activities specifically for people with dementia
– Higher cost

Texas Memory Care / Residential Alzheimer’s Care Costs

Texas has one of the largest differences statewide in the cost of residential Alzheimer’s care due to its large geographical size. In 2023, it is estimated that it will range from $3,685 to $7,455 monthly with an average cost of $5,304 per month. Memory care in the most expensive areas of the state can be almost 100% higher than in less expensive areas. In Texas, it can be worthwhile to shop around for memory care.

Austin, the capital of Texas, has the priciest memory care in the state. The most affordable city for similar care is in Texarkana, on the border with Arkansas.

Bordering states can have more affordable memory care options, but Texas’s neighbors have comparable prices. In New Mexico, memory is $5,992 per month, in Oklahoma $5,142 monthly, and in Louisiana $4,979 per month. Other major cities and average costs are:

Assisted Living Laws & Regulations

Admissions Requirements & Process

To be admitted to an assisted living residence in Texas you must:

– Be at least 18 years old
– 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. 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. The assessment provides insight into your loved one’s behavioral issues, psychosocial issues, and activities of daily living patterns. The assessment is also useful to know if someone should not be admitted because someone cannot be admitted to a residence if they have needs that can not 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. 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.

Upon move-in, Texas residences must provide a “disclosure statement”. This documents explains in written form what services and care supports are offered, the facilities policies including eviction, and all potential fees and patient rights. It is unlikely a residence will provide their disclosure statement on their website. However, by law, the residence must provide this documentation to residents upon admission. They should also keep a record of it, should a family have misplaced their copy.

Additionally, when looking for more information about residences and their disclosure statements, one can check with the Texas Department of Aging and Disability Services (DADS). This governing body licenses and regulates Texas’s healthcare residences such as assisted living and memory care communities. They can be reached at (800) 458-9858 or via e-mail at [email protected].

Facility / Residence Requirements

In Texas, Alzheimer-certified facilities must be designed for patients’ safety and well-being. This can include 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. Additionally, the resident bedrooms must be at least 100 square feet. There cannot be more than four residents per room, though residents in dementia care normally have single units or just one roommate. These units usually have private bathrooms, but regulations require one toilet for every six residents and a tub or shower for every 10.

Staff & Training Requirements

Employees in assisted living facilities in Texas must:

– Be at least 18 years old
– A high school graduate
– All employees must complete a 4-hour orientation.
– Staff who provide direct care to the residents must complete 16 hours of training and an additional 6 hours of continuing education every year.
– Employees working with patients with Alzheimer’s disease and related dementias in Alzheimer’s certified facilities and units, the training is dementia-specific.

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. With memory care, the overnight staff must be awake at all times, regardless of the size of the residence. For large Alzheimer-certified facilities or units, there must be two night-shift employees on duty.

Regarding medication management in memory care, staff with a Medication Aide License and working under the guidance of a registered nurse can help administer medications to your loved one. Licensed staff can remind a patient to take their medication, bring medication to them, help them read the label, open the bottle, put the medication in a patient’s mouth, or apply it topically.

Evictions

There are no state regulations in Texas that guide the process of evicting a resident from assisted living. Residences will have their own procedures for handling evictions, discharges, and transfers. Generally, a person cannot remain in a residence where their personal and medical needs cannot be met. If a resident 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.

It’s important to know the policy on evicting, discharging, or transferring residents before moving in. Get it in writing, to have clarity and avoid an unfair eviction. 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? These are important questions that should be answered before signing a contract to move in. For tips on evictions, including what to do if you receive an eviction notice, click here.

Reporting Complaints and Concerns

If you have concerns or complaints about a memory care community or a resident’s treatment, you can contact Texas’s long term care ombudsman office. This is a governmental entity that protects the elderly living in long-term care communities and that the communities are complying with their move-in contract. They also help to resolve problems, investigate injustices, and act as oversight to different state and federal programs that have to do with the health and welfare of elderly residents in long-term care facilities.

Financial Assistance for Memory Care in Texas

Memory care can be expensive and there is financial assistance is available for people who need it.

STAR+PLUS (Medicaid)

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.

One of the ways this program saves money is by offering home and community-based services via an 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.

Community Care for the Aged / Disabled Program

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.

Veteran’s Affairs (VA)

Veterans are statistically more likely to develop dementia. Among the reasons for this are 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.

VA Pensions

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

Veterans’ Homes

In Texas, there are eight state-run Veterans Homes. These are long-term care facilities managed on a state level for qualified veterans, their spouses, or children. They offer a range of services that support  veterans who can no longer reside in their homes. The services can range from nursing home care to assisted living, memory care, and adult daycare. These homes are designed to give veterans the quality of care they need while costing less than a privately owned long-term care facility.

Since the Veterans Homes are managed by the state, there is no uniform nationwide cost. Many factors affect the price one has to pay after qualifying to be admitted. There is the cost of the VA home, a person’s service-connected disability rating, their assets, and monthly income. There are limits set as to how much a VA facility can charge (again these vary state by state) and they cost approximately 50 to 70% of a typical privately owned assisted living facility or nursing home. Additionally, there are two different costs to patients in Veterans Homes. Either one has to pay an out-of-pocket deductible or the cost is entirely covered by the VA because of their disability rating. If the patient has to pay a portion of the bill, the state additionally pays a subsidy that is either a percentage of an individual’s income or a set daily rate. Normally, Veterans will need to combine this financial help with other VA and state benefits so they are left with a minimal out-of-pocket expense.

The Veterans’ Homes are located 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.

Other Options

1) Eldercare 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.