Assisted Living in Texas

Agency: Department of Aging and Disability Services
Phone: (512) 438-3161
Website: www.dads.state.tx.us

ALFs may provide assistance with activities of daily living (ADLs). There are several types of ALFs. In a Type A ALF, a resident must be mentally and physically capable of evacuating the facility unassisted in the event of an emergency; may not require routine attendance during sleeping hours; and must be capable of following directions. In a Type B ALF, a resident may require staff assistance to evacuate; be incapable of following directions under emergency conditions; require attendance during sleeping hours; may not be permanently bedfast, but may require assistance in transferring to and from bed. A Type C ALF is a four-bed, adult foster care, contracted facility that must meet the contracting requirements.

Facility Scope of Care:
Facilities may provide assistance with ADLs and assist with the administration and management of medication.

Move-In/Move-Out Requirements:
Facilities must not admit or retain persons whose needs cannot be met by the facility or by the resident contracting with a home health agency.

Resident Assessment:
A comprehensive resident assessment is required. There is no state-mandated form. Facilities must include specific criteria from the licensing regulations on their assessment form.

Medication Management:
Residents who choose not to or cannot self-administer medication must have medication administered by a person who holds a current license to administer medication; holds a current medication aide permit (this person must function under the direct supervision of a licensed nurse on duty or on call); or is an employee of the facility to whom the administration of medication has been delegated by a registered nurse. Staff who are not licensed or certified may assist with self-administration of medication as allowed under the regulations

Physical Plant Requirements:
Bedroom usable floor space for Type A facilities must be at least 80 square feet for a single-bed room and not less than 60 square feet per bed for a multiple-bed room. Bedroom usable floor space for Type B facilities must be at least 100 square feet per bed for a single-bed room, and not less than 80 square feet per bed for a multiple-bed room. In a Type C facility, bedrooms must have at least 80 square feet of floor space in a single-occupancy room and at least 60 square feet of floor space per client in a doubleoccupancy room. The regulations list extensive fire safety requirements under Chapters 12 or 21 of the National Fire Protection Association (NFPA) Life Safety Code. Type A ALFs are classified as 'slow' evacuation and Type B facilities as 'impractical' evacuation. For Type C facilities, there must be a conspicuously posted emergency/disaster evacuation plan. An evacuation drill must be held every six months with at least one of the required drills occurring during sleeping hours. Each facility must have an operational smoke detection system and a portable ABC-type fire extinguisher charged and ready for use

Residents Allowed Per Room:
A maximum of four residents is allowed per resident unit. No more than 50 percent of residents can be in units with more than two residents.

Life Safety:
ALFs must meet the requirements of the 1988 edition of NFPA 101, the Life Safety Code. Type A large and small facilities, Type E facilities, and Type B small facilities must meet Chapter 21, Residential Board and Care Occupancies based on evacuation capability. Type B large facilities must meet Chapter 12, New Healthcare Occupancies. Sprinkler requirements are established in the Life Safety Code, with Type B facilities requiring sprinkler coverage. Fire alarm and smoke detection systems are established in the Life Safety Code with additional minimum coverage requirements established by state rules.

Alzheimer's Unit Requirements:
Any facility that advertises, markets, or promotes itself as providing specialized care for persons with Alzheimer's disease or related disorders must be certified. Alzheimer's certified facilities are required to have a Type B license. The facility must provide a disclosure statement that describes the nature of its care or treatment of residents with Alzheimer's disease and related disorders.

Staff Training for Alzheimer's Care:
All staff must receive dementia-specific orientation prior to assuming job responsibilities. Direct care staff in an Alzheimer'scertified ALF must annually complete 12 hours of in-service education regarding Alzheimer's disease.

Staffing Requirements:
Each facility must designate a manager to have authority over its operation. A facility must have sufficient staff to maintain order, safety, and cleanliness; assist with medication regimens; prepare and service meals; assist with laundry; provide supervision and care to meet basic needs; and, to ensure evacuation in case of an emergency. There is no specific staffing ratio. Facilities must disclose their staffing patterns and post them monthly.

Staff Education Training:
Full-time facility attendants must be at least 18 years of age or hold a high school diploma. The regulations list specific training requirements for licensed nurses, nurse aides, and medication aides. All staff must receive four hours of orientation on specific topics before assuming any job responsibilities. Attendants must complete 16 hours of on-the-job supervision and training within their first 16 hours of employment following orientation.

Medicaid Policy and Reimbursements:
A Medicaid home and community-based services waiver covers services in assisted living.