Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition

TEXAS

The Texas Department of Aging and Disability Services (DADS) licenses several

types of assisted living facilities (ALFs): assisted living apartments (single-occupancy),

residential care apartments (double-occupancy), and residential care non-apartments. A

person establishing or operating a facility that is not required to be licensed may not use

the term "assisted living" in referring to the facility or the services provided. The ALF

statute requires careful monitoring to detect and report unlicensed facilities.

A facility's licensure type--A or B--is based on residents’ capability to evacuate the

facility. Any facility that advertises, markets, or otherwise promotes itself as providing

specialized care for persons with Alzheimer's disease or other disorders must be

family members, no more than three adults may live in the foster home unless it is

licensed as a Type C ALF, which is a four-bed facility that must have an active contract

with the Department to provide AFC services before it can be licensed. A provider

wishing to serve more than four individuals must obtain a DADS Type A ALF license.

Separate rules apply to adult foster homes and Type C facilities, which are not included

This profile includes summaries of selected regulatory provisions for Type A and

Type B ALFs. The complete regulations are online at the links provided at the end.

medications, and other permitted services.

Facilities must have a written admission agreement with each resident that

includes information about the services to be provided and their cost.

resident, family, or responsible party and must also provide a copy of the Resident Bill

An ALF that provides brain injury rehabilitation services must attach to its

state review, approval, or endorsement of the facility's rehabilitative services. The facility

must document receipt of the disclosure statement.

If the facility provides services and supplies that could be covered Medicare

benefits, the facility must disclose this information to the resident.

required DADS disclosure statement to any individual seeking information about the

facility's care or treatment of residents with Alzheimer's disease or other dementias. The

reflect changes in special services for residents. Prior to admitting a resident to the

facility, staff must discuss and explain the information in the disclosure statement with

the family or responsible party.

during sleeping hours, and may not be permanently bedfast but may require assistance

in transferring to and from bed.

admission, if the resident’s condition changes, the resident may no longer be

appropriate for the facility’s license, and if so, the facility is not required to retain them.

The regulations list some general characteristics of residents in an ALF, including

residents who: (1) exhibit symptoms of mental or emotional disturbance, but are not

considered at risk of imminent harm to self or others; (2) need assistance with mobility,

facility or who cannot secure the necessary services from an outside resource. As part

of the facility's general supervision and oversight of the physical and mental well-being

of its residents, the facility remains responsible for all care provided in the facility. If the

individual is appropriate for placement in a facility, then the decision that additional

services are necessary and can be secured is the responsibility of facility management

with written concurrence of the resident, resident's attending physician, or legal

representative.

If the Department or an ALF determines that a resident is inappropriately placed in

If the DADS surveyor or an ALF determines that a resident is inappropriately

placed because the resident no longer meets the evacuation criteria, a facility may

request that the resident remain at the facility by obtaining an evacuation waiver and

providing a detailed emergency plan that explains how the facility will meet the

evacuation needs of the resident, which includes provisions for a sufficient number of

trained staff on all shifts to move all residents to a place of safety. The facility must meet

the previously listed conditions and submit additional information.

facility or who needs assistance to manage his or her personal life; and supervision or

direct administration of medications. The facility must also provide an activity and/or

social program for residents at least weekly.

An ALF may provide skilled nursing services for limited purposes: (1) coordinating

resident care with an outside home and community support services agency or health

care professional; (2) providing or delegating personal care services and medication

administration; (3) assessing residents to determine required services; and

(4) delivering, for a period not to exceed 30 days, temporary skilled nursing services for

a minor illness, injury or emergency.

Residents who choose not to participate in a large group activity must be offered at

least one small group or one-on-one activity per day. A health care professional may

coordinate the provision of services to a resident within the professional's scope of

practice authorized by the Texas Health and Safety Code, however, a facility must not

provide ongoing services to a resident that are comparable to the services available in a

Within 14 days of admission, the facility must conduct a comprehensive

home visits, to ensure that prospective residents are appropriate and their needs can be

met. Within 14 days of admission, the facility must comprehensively assess the resident

and develop an ISP. The service plan must address the residents’ individual needs,

possible level of physical, cognitive, and social functioning. The service plan must be

updated annually and upon a significant change in condition.

delivered at the facility.

Residents who self-administer their own medications and keep them locked in their

room must be counseled at least once a month by facility staff to ascertain if they

continue to be capable of self-administering their medications/treatments and if security

Supervision of a resident's medication regimen by facility staff may be provided to

residents who are incapable of self-administering without assistance. Supervision

includes and is limited to: reminders to take medications at the prescribed time, opening

containers or packages and replacing lids, pouring prescribed dosage according to the

authorized to act in the absence of the manager must be designated in writing. An

present. Attendants are not precluded from performing other functions as required by

the ALF.

policies that require staffing ratios based upon residents’ needs as identified in their

(2) assist with medication regimens; (3) prepare and serve meals that meet

requirements; (4) assist with laundry; (5) ensure that each resident receives the kind

prevention of aggressive behavior and de-escalation techniques, practices to decrease

the frequency of the use of restraint, and alternatives to restraints; and (6) fall

prevention.

Attendants must complete 6 hours of education annually, including 1 hour on fall

other topics suggested by the regulations, including: (1) promoting resident dignity,

independence, individuality, privacy, and choice; (2) resident rights and principles of

hearing, visual, or cognitive impairment; (4) communicating with families and other

Subject matter must address the unique needs of the facility.

Facilities that employ licensed nurses, certified nurse aides, or certified medication

aides must provide annual in-service training, appropriate to their job responsibilities, on

one or more of several suggested topics, including: (1) communication techniques and

skills useful when providing geriatric care (e.g., skills for communicating with the hearing

impaired, visually impaired and cognitively impaired; therapeutic touch; recognizing

communication that indicates psychological abuse); (2) assessment and interventions

related to the common physical and psychological changes of aging for each body

directives, abuse and neglect, guardianship, and confidentiality.

The Medicaid STAR+PLUS home and community-based services (HCBS) waiver

program pays for services in three types of settings: single-occupancy assisted living

apartments, residential care apartments, and residential care non-apartment settings.

private space with individual living and sleeping areas, a kitchen, a bathroom, and

adequate storage space. Double-occupancy units may be provided if requested.

occupant, with a shared kitchen and bathroom. Kitchens must be equipped with a sink,

have rooms with up to four residents.

self-determination; (6) care of elderly persons with physical, cognitive, behavioral and

psychotropic medications and side effects; and (9) local community resources.

Managers or supervisors and activity directors or their designees must annually

complete 6 hours of continuing education regarding dementia care.

Dementia Facility Requirements. A monitoring station must be provided within

the dementia care unit as well as access to at least two approved exits remote from

DADS employees who inspect ALFs. The training emphasizes the distinction between

an ALF and a nursing facility.

in licensed ALFs (and AFC homes) that contract with the resident’s managed care