In Texas regulations, an assisted living facility (ALF) is a residence that provides room and board, meals, assistance with activities of daily living (ADLs) like eating and bathing, and assistance with medications. Recreational activities to encourage exercise and socialization are also provided, and some ALFs 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 (HHSC) cannot use the term “assisted living”.
Texas has two types of assisted living facilities (ALFs): 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. That said, a resident must not be confined to his/her bed.
All ALFs that accommodate persons with Alzheimer’s disease and related dementias are Type B assisted living residences and are formally referred to as “Alzheimer’s certified facilities” or “Alzheimer’s certified units.” That said, these names are considered to be mostly legal terminology. In more common language, these residences are called “memory care homes.” People with dementia related to Alzheimer’s disease may also live there, meaning those with vascular, Lewy body, frontotemporal and other dementias.
Memory care homes in Texas differ from traditional assisted living in several ways:
– increased security and supervision
– additional staff training
– a greater number of employees
– recreational activities specific for persons with dementia
– higher cost
A point of distinction should be made that 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 communities 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 house-like residence. For free help finding memory care of any size to meet your family’s needs and budget, click here.
How Much Does Memory Care Cost in Texas? While the average monthly cost of memory care in Texas is $4,699, the state has some of the highest cost variation of any state in the nation. Memory care in the most expensive areas can be almost 100% higher than the least expensive areas. In Texas, of all states, it is worthwhile to shop around if cost is a concern.
It should be mentioned that memory care provides more security and care than traditional assisted living, therefore memory care costs approximately $1,100 per month more.
The most expensive city for memory care in Texas is Victoria (in the coastal plain) for about $6,529 per month and $78,348 annually. The most affordable memory care is in Texarkana (on the border with Arkansas) for about $3,049 per month and $36,588 annually. In the more populated urban centers of Texas, costs can also vary widely.
These are some of Texas’s biggest cities, with costs. The Dallas figures are for the Dallas area, including Fort Worth and Arlington.
|Texas Memory Care / Assisted Living Costs (updated Mar. 2021)|
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The states that border Texas have prices that are comparable, but if you live near the border with New Mexico (about $4,771 per month for memory care), Oklahoma ($4,412), or Louisiana ($4,305), it is worth investigating communities in those states. Again, costs can vary widely so be sure to spend enough time to investigate all your memory care options before signing a move-in contract.
To be admitted to an assisted living residence in Texas, including Alzheimer’s certified facilities, one must be at least 18 years of age and have a functional need based on a functional assessment score. Residents must have a physical exam within a defined period of time, to be completed by a medical professional who works for the residence. This timeframe is between 30 days prior to admission to 14 days after admittance. An exception is made for residents transferring from another ALF or a hospital where a physical exam has already been done and is in one’s medical file.
The cost of assessing is often included in the base rate, though some memory care communities charge a one-time “community fee” that covers move-in costs including the first assessment. 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. In other words, 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 then updated regularly. The assessment is also useful to know if someone should not be admitted, because Individuals cannot be admitted to a residence if they have needs that are greater than can be met at the residence (or have needs that are unable to be met through third party services).
This should go without saying, but 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. An important note: 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 the person with dementia can provide for making a final decision.
In Texas, Alzheimer’s certified facilities and units are physically constructed for the safety and wellbeing of those with such neurological disorders. Examples of what this might entail 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 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 ALF must be a minimum of 18 years old or a graduate of high school. Training of staff varies depending on position and responsibilities, but all employees must go through a 4-hour orientation. After the orientation and prior to working independently, 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 persons with Alzheimer’s disease and related dementias in Alzheimer’s certified facilities and units, the training is more 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. That said, all ALFs, 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 right away. 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 and available.
State regulations in Texas do not have much guidance for the process of evicting a resident from assisted living, including memory care. Very 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, meaning it gets worse, 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 quite expensive, financial assistance is available for low-income persons who need it.
STAR+PLUS (Medicaid) is a jointly funded federal and state health care program, and in Texas (like all states), it pays for nursing home care for those who qualify based on income and assets limits. However, unlike in all states, STAR+PLUS will also pay for a portion of the cost of memory care / assisted living. To be clear, this program will not cover the cost of room and board. It only covers care assistance.
One of the ways this program saves money in Texas is by offering home and community based services (HCBS) via a HCBS Medicaid waiver. Services available under this waiver include personal care assistance for persons residing at home or in assisted living facilities (and Alzheimer’s certified facilities). Please note: 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, abbreviated as CCAD, provides adult day care, meal delivery, emergency response services, and assistance with daily living activities for persons 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.
Due to increased rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), veterans are more likely to develop dementia than those who have not served. While not limited to Texas, the VA offers an Aid & Attendance (A&A) pension (monthly cash assistance) for veterans and surviving spouses who are eligible for one of two pensions: Basic VA pension or the basic survivor’s VA pension. The cash assistance received from VA pensions can be used as the recipient sees fit, which means it can go towards the cost of memory care. Applicants must be a minimum of 65 years of age (or disabled) and require assistance with completing activities of daily living. Examples include assistance with mobility, transferring, toileting, eating, and bathing. In addition, the cost of residential care can be deducted from one’s income, effectively reducing countable income when determining one’s pension benefit amount. As of 2021, veterans can receive as much as $27,540 per year, and surviving spouses can receive as much as $14,928 per year. For additional information, click here.
Another option is state Veterans homes, which are residential care facilities that provide long-term care for veterans. In addition to nursing home care and assisted living, memory care is provided. Payment is made directly from the VA to the facility. There are eight memory care homes in Texas that offer help for veterans with Alzheimer’s disease and related dementias:
– Watkins-Logan-Garrison Texas State Veterans Home in Tyler (northern coastal plain)
– Clyde W. Cosper TSVH in Bonham (north of Dallas)
– Lamun-Lusk-Sanchez TSVH in Big Spring (high plains)
– Alfredo Gonzalez TSVH in McAllen (southernmost coastal plain)
– Ussery-Roan TSVH in Amarillo (northern great plains)
– Ambrosio Guillen TSVH in El Paso
– Frank M. Tejeda TSVH in Floresville (30 minutes outside San Antonio)
– William R. Courtney TSVH in Temple (eastern great plains)
Because there are a limited number of beds, there may be a waiting list. For contacts and more information including an admissions application, click here.
There are other ways to help pay for memory care, including 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, including some assisted living costs.
For a married person moving into memory care whose spouse continues to live in the home, a reverse mortgage might be a good option. The reverse mortgage would become due should the spouse move out.
Elder care loans are for families to cover initial costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. Examples of this would be if one is waiting for a VA pension to be approved or waiting on the sale of a home.