Assisted Living Service Plan Requirements

Every assisted living community is required to perform an extensive assessment of each resident within 14 days of admission and fill-out an individualized service plan (ISP). The assessment must be performed by qualified staff, and the findings must be recorded on community documentation. Each resident’s ISP should outline individual requirements, likes and dislikes, and strengths and weaknesses to help the resident maintain a healthy degree of function.

Assisted Living Admission Requirements

Texas state regulations outline some common qualities of residents in assisted living communities, including the need for assistance with daily living tasks, assistance with medication administration, reminders for toileting and exhibiting mild emotional or behavioral difficulties.

If a resident’s need cannot be met by the services provided at an assisted living community or secured through an outside provider, the community is not permitted to admit or retain the resident. If a resident’s status changes and is no longer an appropriate fit for the community, the community is not obligated to retain them.

Assisted Living Scope of Care

Assisted living communities in Texas provide broad supervision of residents’ mental, emotional and physical health, deliver aid in daily living tasks, handle or oversee personal care and supervise or directly administer medications. Communities are also required to arrange a social activity or event for residents at least once per week.

Skilled nursing services may be provided when deemed appropriate, for situations including medication administration, resident assessments to establish further services and administering short-term skilled care for mild illness or injury.

Residents are permitted to arrange or hire private health care services from community agencies or licensed home aids.

Assisted Living Medicaid Policy

The state of Texas has the STAR+PLUS program, which is for a Medicaid 1115 demonstration managed care waiver. The waiver can cover services at an assisted living community that has a contract with residents’ managed care providers. If an assisted living community offers services that could be covered by Medicare, it’s the community’s responsibility to inform the residents. Communities are prohibited from charging residents more than the federal SSI benefit less a stipend for personal needs for room and board. Families may supplement for additional amenities which are not include in the room and board rate.

Assisted Living Facility Requirements

Some assisted living communities in Texas offer private units, but state licensing does not require it. Units may provide occupancy for up to four residents, however, no more than 50 percent of the beds in a community can be in rooms housing over two residents. There must be one sink and one toilet for every six residents on the property, and one shower or bathtub is required for every ten residents. For multi-level buildings, at least one sink, toilet and bathing provision is required on each sleeping floor for residents on that level.

Medication Management Regulations

Residents who self-administer their own medication should receive a counseling visit on a monthly visit to confirm that they are still capable of managing their own medications. Assisted living communities can provide supervision to residents who require assistance with their medication. Supervisory assistance includes reminders, help with opening and closing containers, dispensing the appropriate amount of medication according to a prescription and ensuring medications are returned to a safe spot.

If residents cannot or choose not to administer their own medication, the assisted living community must make sure medication is administered by a staff member who is licensed to do so, or possesses an up-to-date medication aid permit and is being supervised by a licensed nurse.

Staffing Requirements

There are no staff minimum ratios required by Texas state law. Each facility must have a manager, a designee authorized to act in the manager’s place when he or she is conducting off-site business and enough staff on every shift to meet the needs of residents as outlined in their individual service plans. In addition, adequate staffing is required to maintain the cleanliness, safety and supervision of the property and residents. In the event of an emergency, sufficient staff must be present to aid in the safe and timely evacuation of residents.

Small Type A communities must have night shift staff in the event of an emergency available, whereas night staff at large properties must be directly available and awake. Staff on the night shift at any Type B community must be awake and directly available at all times.

Staff Training Requirements

All staff must complete training and continuing education appropriate for the position they hold. Managers are required to finish a 24-hour course that includes topics such as resident evaluations, federal laws, accessibility conditions, financial management and ethics. Managers are required to complete 12 hours of continuing education each year. After 4 hours of orientation, staff may begin work at an assisted living community. Direct care staff is required to receive 16 hours of on-site training pertaining to resident care, safety procedures and techniques in managing behaviors. Additionally, 6 hours of continuing education is required annually for all direct care staff. Yearly in-service training must be provided by an assisted living community for any licensed nursing staff or aids on staff.

Background Checks for Assisted Living

Anyone seeking employment at a Texas assisted living community must submit themselves for a full background check. Any applicant with a disqualifying conviction on their criminal record will not be eligible for hire. Nurse aides must be listed in the nurse aide registry without marks of misconduct involving abuse, neglect, mistreatment, theft or fraud.

Requirements for Reporting Abuse

Anyone can file a report if they suspect neglect or abuse at an assisted living community. You can call the Texas Abuse Hotline at 800-252-5400, or use their secure website to file a complaint online at www.txabusehotline.org.