Last updated 2026-07-26
TL;DR
Texas requires assisted living facilities to have staff awake and on-site 24 hours a day if residents need help at night, per HHSC rules under 26 TAC Chapter 553. Small facilities (16 beds or fewer) still must meet the same round-the-clock supervision standard, though staffing ratios flex with resident acuity and facility type (Type A vs Type B).
What is assisted living, exactly?
Assisted living is a licensed residential setting where people who need help with daily activities, bathing, dressing, medication, mobility, live in a home-like environment and get personal care support, but not the level of medical care you'd find in a nursing home. Texas Health and Human Services Commission (HHSC) licenses these as Assisted Living Facilities (ALFs) under Texas Health and Safety Code Chapter 247 [1]. A small residential assisted living home usually means a converted single-family house or a purpose-built small facility with somewhere between 4 and 16 beds, as opposed to a 60-unit apartment-style building. The care model is the same either way. What changes is the scale, and often the intimacy of staff-to-resident relationships. HHSC defines two license types that matter here: Type A and Type B. Type A serves residents who can evacuate the building without physical assistance from staff during an emergency. Type B serves residents who need staff help to evacuate, including people who are non-ambulatory or who have conditions that impair their judgment in an emergency [2]. This distinction drives a lot of your staffing math, which we get into below. If you're comparing this model to other terms floating around online, like assisted living facility or facility assisted living, they're generally referring to the same licensed category. Texas doesn't have a separate "residential care home" license category distinct from ALF; small homes just apply under the same Chapter 247 rules as larger buildings.
What is a group home, and how is it different from assisted living?
"Group home" is a catch-all term, not a specific Texas license type. People use it loosely to describe small residential settings for seniors, people with intellectual or developmental disabilities (IDD), or people in mental health or recovery housing. In Texas, what license you actually need depends entirely on who lives there. If your residents are primarily seniors or adults needing help with activities of daily living, you're licensing as an Assisted Living Facility under HHSC Chapter 247 [1]. If your residents have intellectual or developmental disabilities and you're delivering services through a Medicaid waiver, you're more likely looking at a Home and Community-based Services (HCS) provider enrollment through HHSC, a different track entirely with its own provider agreement and standards [3]. Mental health and recovery residences in Texas often operate without a state license at all, though many voluntarily certify with the Texas Recovery Housing Association or Oxford House standards, and some counties or cities have their own zoning overlays for these. That's a genuinely different regulatory universe from ALF licensing, so if your business plan mixes populations, get clarity early on which license (or none) applies before you sign a lease.
What does 24-hour care actually require in a Texas ALF?
Texas rule requires that ALFs have staff "awake and on duty" at all times when residents need overnight supervision or assistance, and staff must be present in the facility 24 hours a day, 7 days a week regardless of resident count [4]. This isn't a suggestion; it's baked into the minimum standards under 26 TAC Chapter 553. The specific staffing rule states facilities must have sufficient staff on duty to meet the needs of the residents, with at least one staff member awake and on duty in a Type B facility at all times, since Type B residents can't self-evacuate [4]. For Type A facilities, some flexibility exists for staff to be asleep during overnight hours if all residents are assessed as needing minimal or no overnight assistance, but even then a staff member must be present in the building and reachable. In practice, most small ALFs run 24-hour awake staffing regardless of license type, because resident needs change, and an inspector finding a resident who needed help at 3 a.m. with no awake staff on hand is a fast way to get a deficiency citation or worse. If you're building a staffing plan, budget for awake overnight coverage as your default assumption, not an exception. HHSC's minimum standards also require the facility to maintain enough staff to respond to emergencies and provide supervision "consistent with residents' needs as identified in individual service plans" [4], meaning your staffing ratio isn't a fixed number in statute so much as a moving target tied to how many high-acuity residents you have on any given night.
How many staff do I actually need overnight in a small facility?
| 4-8 beds | 1 staff member | Type A, ambulatory residents | |
|---|---|---|---|
| 9-16 beds | 1-2 staff members | Mix of Type A/B, some assist needs | |
| 16+ beds, any Type B residents | 2+ staff members | Type B, non-ambulatory or evacuation assist | These numbers come from operator practice and HHSC's individualized-needs standard [4], not from a fixed ratio in the Administrative Code. Confirm your specific staffing plan against your Type A/B designation with your HHSC regional licensing office before finalizing a budget. |
There's no single statewide numeric ratio like "1 staff per 8 residents" written into Texas ALF rule. Instead, HHSC requires staffing sufficient to meet each resident's assessed needs, documented in an individual service plan, plus a minimum of one staff member on-site and responsive at all times [4]. That said, in real-world small facility operations (8 to 16 beds), most Texas operators run one awake direct care staff member overnight for every 10 to 15 residents, sometimes two if the facility has Type B residents with dementia, wandering risk, or physical transfer needs. If you have any resident who needs two-person transfers or has a wandering/elopement risk, you likely need at least two staff overnight regardless of total census, because one person alone can't safely handle an emergency and a transfer at the same time. A good rule of thumb: staff your smallest facility as if the worst night happens, not the average night. Inspectors evaluate your staffing plan against your residents' actual assessed acuity, documented in the service plan, not against an industry average. | Facility size | Typical overnight awake staff (practice, not statute) | License type driver |
What is an assisted living facility license, and how do I get one in Texas?
An ALF license in Texas is issued by HHSC's Health Care Regulation division after you submit an application, pay licensing fees, pass a life safety code inspection, and complete a pre-licensure survey confirming your policies, staffing plan, and physical plant meet 26 TAC Chapter 553 standards [2][4]. The general steps: form your business entity, secure a location that meets zoning and building code for residential care use, submit your license application and required attachments (staffing plan, admission policy, emergency preparedness plan, fire marshal approval, sanitation inspection) to HHSC, pay the application fee, and schedule your initial licensing survey. HHSC publishes its current fee schedule and application forms on its Assisted Living Facilities licensing page [2]. Expect the process to take a few months from application submission to license issuance, longer if your building needs fire or life-safety retrofits. Nobody should promise you a guaranteed timeline; HHSC's own workload and your facility's readiness both affect it. If you want a structured walkthrough of forms and checklists rather than piecing this together from HHSC's site alone, the State Group Home Licensing Kit organizes the Texas ALF application requirements, staffing plan templates, and policy manual starting points into one package for $299, a one-time cost rather than an ongoing subscription.
How to start a group home in Texas, step by step
Starting any residential care home in Texas, whether you call it a group home or an assisted living facility, follows a similar sequence regardless of population served. 1. Decide your population and confirm which license applies (ALF for seniors/general assist needs, HCS provider enrollment for IDD waiver services, no state license for many recovery residences) [1][3]. 2. Check local zoning. Residential care homes with 6 or fewer residents are generally protected as a permitted residential use under the Fair Housing Act's reasonable accommodation provisions, but always confirm with your city or county planning department directly, since larger facilities (7+) may need a specific use permit or conditional use approval. 3. Secure your property and confirm it meets fire marshal and life safety code requirements for residential care occupancy. 4. Write your policy and procedure manual: admission/discharge criteria, medication management, emergency preparedness, staffing plan, resident rights. 5. Submit your license application to HHSC with all required attachments and fees [2]. 6. Hire and train staff before your licensing survey; HHSC will check personnel files, training records, and background check documentation (Texas requires criminal history checks through the Department of Public Safety for all direct care staff) [4]. 7. Pass your initial licensing survey and life safety inspection. 8. Get your license, then start admitting residents according to your approved capacity and license type. This is the general shape of "how to start a group home," but the details on fees, specific form numbers, and timelines change periodically. Confirm current requirements with your HHSC regional office before you commit to a lease or a hire.
What's the difference between assisted living and a nursing home in Texas?
Assisted living and nursing homes both provide residential long-term care, but they serve different acuity levels and answer to different regulatory chapters. Assisted living (Chapter 247) is for people who need help with daily activities but not ongoing skilled nursing care. Nursing homes (Chapter 242) are licensed for residents who need daily skilled nursing, rehabilitation, or complex medical management [5]. Staffing is the clearest practical difference. Nursing homes must have a licensed nurse (RN or LVN) on duty and federal rule requires an RN on-site for at least 8 consecutive hours per day, 7 days a week, with licensed nursing coverage 24 hours a day, per CMS conditions of participation [6]. Assisted living facilities in Texas are not required to have a nurse on staff at all; medication management can be handled by trained unlicensed staff following HHSC's medication aide or delegation rules, with a nurse involved only for delegation oversight, not daily hands-on care [4]. Cost structure differs too, though exact numbers vary a lot by region and facility. Genworth's Cost of Care Survey, one of the most cited private industry sources on long-term care costs, has historically shown nursing home care running notably higher per month than assisted living in most states, reflecting the higher staffing intensity and medical equipment nursing homes carry. Check current regional numbers directly rather than relying on a national average, since Texas metro costs vary widely from rural county costs. If you're deciding which license to pursue as an operator, the honest advice is: don't chase a nursing home license unless you're prepared to staff licensed nurses around the clock and meet Chapter 242's much heavier compliance burden. Most small residential operators are far better matched to the ALF model.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of assisted living, including room, board, or personal care assistance. CMS is explicit that Medicare covers medically necessary services like doctor visits, some home health care, and short-term skilled nursing facility stays after a qualifying hospital stay, but "Medicare doesn't cover room and board when the primary reason you need help is for non-medical personal care" [7]. Medicaid is a different story, though it's not universal either. Texas Medicaid's STAR+PLUS program can help cover some assisted living costs for financially and medically eligible residents through home and community-based services waivers, but coverage varies by program, waiting list status, and individual eligibility, so operators shouldn't market Medicaid coverage as guaranteed for prospective residents [8]. Most small ALF residents in Texas pay privately, through long-term care insurance, or through a mix of personal funds and family contribution. If you're building a business plan around Medicaid-funded residents, budget for waiver waiting lists and confirm your facility's provider enrollment status with HHSC and your local Medicaid managed care organization before assuming steady referral flow.
What policies does a 24-hour facility need for inspections?
HHSC surveyors inspect against 26 TAC Chapter 553's minimum standards, and 24-hour care compliance shows up in several specific documentation areas, more than physical staffing counts. Your facility needs a written staffing plan showing coverage for every shift, including how you handle a call-out at 2 a.m. Surveyors ask for time sheets or sign-in logs matching your posted schedule, so gaps between paper and practice are a common citation source. You need individual service plans for every resident, updated per HHSC's required reassessment schedule, that document the resident's actual overnight supervision and assistance needs, matched against your staffing plan. If a resident's plan says "needs assistance with toileting at night" and your staffing plan has one person covering 20 residents alone, that's a mismatch surveyors will flag. Emergency preparedness plans must show how you'll manage an evacuation with your actual overnight staff count, not a daytime staff count, since fires and medical emergencies don't wait for shift change. Fire marshal inspections check exits, alarms, and sprinkler systems appropriate to your resident mobility level (Type A vs Type B). Medication administration records need to show 24-hour coverage consistency, since missed doses documented at odd hours (or suspicious gaps) draw scrutiny. If you're building your compliance binder from scratch, this is one of the areas where a state licensing guide template saves real time over building every form from a blank page.
How much does 24-hour staffing cost to run, and how do I budget it?
There's no official state-published labor cost figure specific to ALF staffing, so any number you see quoted online is an estimate, not a regulatory fact. What you can budget with confidence is the structure: overnight shifts (typically 11pm-7am) need coverage 365 days a year, which means you're paying for roughly 2,920 staff-hours annually per single overnight position (8 hours x 365 days), before accounting for PTO coverage, sick day backfill, or a second staff member if you have Type B residents. Most small operators underestimate the true cost of "24-hour care" by budgeting for a single staffing line without building in relief coverage for the inevitable call-outs, holidays, and turnover. A tighter budget approach: calculate your baseline overnight staffing cost, then add 15-20% for relief/PRN coverage, because an unstaffed overnight shift is both a life-safety risk and a licensing violation waiting to happen. Don't forget training costs baked into your staffing budget. Texas requires direct care staff to complete initial orientation and ongoing training hours per HHSC rule, and untrained staff working an overnight shift alone is exactly the scenario surveyors flag hardest during complaint investigations.
Small facility vs large facility: does 24-hour care work differently?
The regulatory requirement for 24-hour supervision doesn't change based on facility size, but the practical experience of delivering it does. A 100-bed ALF can run three or four overnight staff covering different wings or floors, absorbing a single call-out without much disruption. A 12-bed small residential home often has exactly one overnight staff member scheduled, meaning any single absence is a crisis, not an inconvenience. This is the real operational tradeoff of the small facility model people search for under terms like senior assisted living facilities near me or assisted living at home: smaller homes offer more individualized attention and a genuinely home-like setting, but they have thinner staffing margins and less redundancy when something goes wrong at 3 a.m. If you're planning a small facility, build a relief staffing pool (cross-trained part-time or PRN staff) before you open, not after your first no-call-no-show. HHSC doesn't care that your one overnight aide had a family emergency; the rule requiring staff presence applies regardless of your excuse [4].
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care setting where people who need help with daily activities like bathing, dressing, and medication management live in a home-like environment with staff support, but without the intensive medical care of a nursing home. In Texas, HHSC licenses these under Health and Safety Code Chapter 247 [1].
What is a group home?
"Group home" is a general term, not a specific Texas license category. It usually describes a small residential setting for seniors, people with IDD, or people in recovery. The actual license required, ALF, HCS provider enrollment, or none at all, depends on the population served, not the term used to describe the home.
What is an assisted living facility?
An assisted living facility is a state-licensed residential care home providing personal care assistance, supervision, and support with daily activities for residents who don't need skilled nursing care. Texas HHSC licenses ALFs as either Type A (residents can self-evacuate) or Type B (residents need evacuation assistance) under 26 TAC Chapter 553 [2].
What does assisted living provide?
Assisted living provides help with activities of daily living (bathing, dressing, mobility, toileting), medication management or oversight, meals, housekeeping, social activities, and 24-hour supervision or awake staff availability as needed. It does not typically provide skilled nursing care, IV therapy, or complex medical treatment, which fall under nursing home licensure instead [1][5].
What is assisted living vs nursing home?
Assisted living serves residents needing help with daily activities but not skilled medical care; nursing homes serve residents needing daily skilled nursing or rehabilitation. Nursing homes must have licensed nurses on duty around the clock under federal rule; assisted living facilities don't require a nurse on staff at all under Texas rule [4][6].
How do I start a group home in Texas?
Decide your population and confirm the correct license (ALF, HCS provider, or none), check local zoning, secure a compliant property, write your policy manual and staffing plan, submit your application and fees to HHSC, hire and train staff, then pass your licensing survey and fire marshal inspection before admitting residents [2][4].
Does Medicare cover assisted living facilities?
No. Medicare does not cover assisted living room, board, or personal care costs. CMS states Medicare doesn't cover room and board when the primary need is non-medical personal care [7]. Texas Medicaid programs like STAR+PLUS may cover some costs for eligible residents, but coverage isn't universal or guaranteed [8].
Does a small assisted living home in Texas need 24-hour staff?
Yes. HHSC requires staff to be present in the facility 24 hours a day and awake and on duty whenever residents need overnight assistance, regardless of facility size [4]. Type B facilities (non-ambulatory or evacuation-assist residents) require awake staff at all times without exception.
What's the difference between Type A and Type B assisted living licenses in Texas?
Type A facilities serve residents who can evacuate the building without physical staff assistance during an emergency. Type B facilities serve residents who need staff help to evacuate, including non-ambulatory residents or those with impaired judgment in emergencies. Type B carries stricter staffing and physical plant requirements [2].
How many residents can a small assisted living facility in Texas have?
There's no fixed statewide cap defining "small" in statute; operators commonly build homes with 4 to 16 beds. Facility size affects zoning classification and staffing plan detail, but the same Chapter 247 licensing requirements apply whether you have 6 beds or 60 [1][2].
What training do overnight staff need in a Texas ALF?
Texas requires direct care staff to complete initial orientation and ongoing training hours specified under HHSC minimum standards, plus criminal background checks through DPS before working unsupervised. Specific hour requirements and topics are set by HHSC rule; confirm current training hour requirements with your HHSC regional office before hiring [4].
Can one staff member cover an overnight shift alone in a small facility?
It depends on resident acuity, not a fixed legal number. HHSC requires staffing sufficient to meet residents' assessed needs; a single awake staff member may be adequate for a small group of ambulatory Type A residents but is often not enough if any resident needs two-person transfers or has elopement risk [4].
How much does it cost to get an assisted living license in Texas?
HHSC publishes current application and licensing fees on its Assisted Living Facilities licensing page, and fees vary by facility size and license type. Because fee schedules change periodically, confirm the current fee amount directly with HHSC before budgeting rather than relying on a fixed number online [2].
Sources
- Texas Health and Safety Code, Chapter 247: Assisted living facilities in Texas are licensed under Health and Safety Code Chapter 247
- Texas HHSC, Assisted Living Facilities licensing page: HHSC defines Type A and Type B assisted living license categories and publishes application/fee information
- Texas HHSC, Home and Community-based Services (HCS) Program: IDD residential services delivered through Medicaid waivers use HCS provider enrollment rather than ALF licensing
- Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Staffing must be sufficient to meet residents' needs, with staff present 24 hours a day and awake staff required based on resident evacuation ability
- Texas Health and Safety Code, Chapter 242: Nursing homes in Texas are licensed under a separate chapter (242) with different acuity and staffing standards than assisted living
- CMS, State Operations Manual Appendix PP (Nursing Home requirements, 42 CFR 483.35): Federal rule requires nursing homes to have RN coverage at least 8 consecutive hours daily and licensed nursing coverage 24 hours a day
- Medicare.gov, Long-term care coverage: Medicare does not cover room and board when the primary need is non-medical personal care, meaning it does not cover assisted living costs
- Texas HHSC, STAR+PLUS Program: Texas Medicaid's STAR+PLUS program may cover some assisted living-related services for eligible residents through home and community-based waivers