Last updated 2026-07-25
TL;DR
To start a group home for the elderly in Texas, you need an Assisted Living Facility license from the Texas Health and Human Services Commission under Texas Health and Safety Code Chapter 247, a building that passes life-safety and zoning review, written policies, and qualified staff. Small (fewer than 17 resident) facilities have a separate license type but the same core process.
What is assisted living?
Assisted living is housing that combines a private or semi-private living space with help for daily tasks like bathing, dressing, medication reminders, and meals, without the round-the-clock skilled nursing you'd get in a nursing home. It sits between independent living and skilled nursing on the care spectrum. In Texas, the state doesn't use the term "group home for the elderly" as a license category. If you're picturing a small residential house with a handful of seniors getting help with daily living, what you're actually building is an Assisted Living Facility (ALF) under Texas Health and Safety Code Chapter 247, regulated by the Texas Health and Human Services Commission (HHSC) [1]. Some operators also use "residential care home" informally, but the legal license is the ALF license. HHSC licenses ALFs in different size and service types, called Type A, Type B, and Type C, based on resident mobility and level of care needed, plus a separate small-house category for fewer than 17 residents. Knowing which type fits your model determines your staffing ratios, physical plant rules, and inspection checklist from day one.
What is a group home?
A group home, in the general sense, is a licensed residential setting where a small number of unrelated people live together and receive support services, usually with paid staff on site rather than family. The term gets used across very different populations: intellectual and developmental disability (IDD) group homes, mental health residential settings, addiction recovery homes, and elder care homes. For seniors specifically, Texas regulates this through the ALF license described above, not a separate "elder group home" statute. If you're also considering serving adults with IDD instead of or alongside seniors, that's a different license track (HCS or ICF/IID through HHSC), and mixing populations under one roof usually isn't allowed without separate licensing for each service type. Confirm with your state licensing agency before assuming you can combine categories. Size matters a lot here. A true small group home model, roughly 3 to 16 residents in a converted single-family house, generally falls under the small ALF or Type A/Type B rules with reduced staffing and building requirements compared to a 50-bed facility. If your business plan is built around the small residential house model, say so explicitly in your license application; HHSC reviews physical plant requirements differently for small facilities [1].
What is an assisted living facility, exactly?
An assisted living facility in Texas is defined in Texas Health and Safety Code Sec. 247.002 as an establishment that furnishes food, shelter, and personal care services to four or more people not related within the third degree of consanguinity to the owner, on a 24-hour basis [2]. That "four or more" threshold is the line between an unlicensed private caregiving arrangement and a facility that must be licensed. ALFs are divided by type. Type A facilities serve residents who don't need routine attendant care during nighttime hours and are capable of evacuating with minimal staff assistance. Type B facilities serve residents who need staff assistance to evacuate, may be non-ambulatory, and need overnight attendant care. There's also a Type C category tied to certain adult foster care arrangements, and a Small ALF designation for homes under 17 beds. Each type carries its own staffing, fire safety, and physical plant rules, so pick your target population before you design the building or write your budget [1]. HHSC's licensing rules live in Texas Administrative Code Title 26, Chapter 553, which spells out the specific standards inspectors use: staffing ratios, medication management, resident rights, food service, and building code cross-references [3].
What is assisted living vs nursing home?
Assisted living gives residents help with daily activities like bathing, dressing, and medication management while they keep a good degree of independence. A nursing home (skilled nursing facility) provides 24-hour licensed nursing care for people with serious medical needs, post-hospital rehab, or conditions requiring a registered nurse on site around the clock. The regulatory split matters for your business plan. Nursing homes in Texas are licensed under Texas Health and Safety Code Chapter 242 and typically must have a registered nurse director of nursing and meet federal Medicare/Medicaid Conditions of Participation if they take those payers [4]. Assisted living facilities under Chapter 247 have lighter staffing requirements and don't require an RN on site 24/7, but they also can't legally provide the level of skilled medical care a nursing home does. Cost differs too. National median assisted living cost was $5,900 a month in 2024 according to Genworth's Cost of Care Survey, versus $9,733 a month for a semi-private nursing home room, a gap of roughly $3,800 a month that reflects the added nursing staff and medical equipment [5]. If your prospective residents need ventilators, wound vac management, or IV therapy daily, you're building a nursing home business, not an assisted living one, and that's a much heavier license.
What does assisted living provide, day to day?
Assisted living typically covers three meals a day, help with activities of daily living (bathing, grooming, toileting, transferring), medication reminders or administration depending on staff licensure, housekeeping, laundry, social activities, and 24-hour staff availability for emergencies. It is not the same as skilled nursing care. Texas HHSC rules require ALFs to have a written plan of care for each resident, updated regularly, and to keep enough staff on duty to meet residents' scheduled and unscheduled needs based on facility type [3]. Medication administration by unlicensed staff is allowed under specific conditions and training requirements spelled out in the administrative code; you can't just assign a random aide to hand out pills without documented training. Many operators build in additional services beyond the state minimum: transportation to medical appointments, on-site hair care, family communication apps, or a dedicated activities director. These aren't required by HHSC but they're often what separates a facility that fills beds from one that doesn't.
How to start a group home (the licensing steps)
Starting a licensed elder care group home in Texas runs through roughly seven stages, and skipping the order costs people the most money and time. 1. Decide your facility type and capacity (Type A, Type B, Small ALF) based on the population you want to serve and the building you have or plan to get [1]. 2. Check zoning before you sign a lease or purchase. Residential care use in a single-family zoned neighborhood can trigger a variance or special use permit fight with your city or county; call the local planning department before spending money on a building. 3. Secure the building and pass a life safety code review. Texas ALFs must meet fire and life safety standards referenced in 26 TAC Chapter 553, which for many small facilities means sprinkler systems, smoke detection, egress width, and fire drills documented monthly [3]. Older houses often need real construction work here; budget for it upfront rather than discovering it during inspection. 4. Submit your license application to HHSC, including the facility's ownership disclosure, floor plan, staffing plan, and policy manual. HHSC publishes application forms and a licensing standards checklist through its Long-Term Care Regulation division [1]. 5. Write your policy and procedure manual covering admission and discharge criteria, medication management, emergency preparedness, abuse/neglect reporting, resident rights (Chapter 247 requires a written resident bill of rights), staff training, and infection control [2][3]. This is the document inspectors will pull apart line by line, so build it around the actual rule text, not a generic template. 6. Hire and train staff to meet minimum ratios for your facility type, and designate a qualified administrator; Texas requires ALF administrators to be licensed separately through the Texas Health and Human Services Commission's administrator licensing program in most cases. 7. Pass your pre-licensure inspection. HHSC surveyors will check the physical plant, review resident records if you have any residents already (usually you can't admit before licensure), verify staff files, and confirm your policies match practice. If you want a structured way to assemble the policy manual, staffing plan, and forms package without starting from a blank page, the licensing kit builder walks through a state-specific document set; we also sell a one-time $299 State Group Home Licensing Kit built around this same structure for operators who want a head start on the paperwork rather than building every policy from scratch.
What is the difference between assisted living and nursing home licensing?
Licensing track is the biggest practical difference. Assisted living facilities in Texas are licensed under Health and Safety Code Chapter 247 through HHSC's Long-Term Care Regulation division, with rules in 26 TAC Chapter 553 [2][3]. Nursing homes are licensed under Chapter 242, with a heavier federal overlay if they participate in Medicare or Medicaid, including the Code of Federal Regulations Conditions of Participation for long-term care facilities at 42 CFR Part 483 [6]. Staffing requirements diverge sharply. Nursing homes must have a licensed nurse on duty and meet federally mandated staffing hour minimums (a 2024 CMS final rule set a national minimum of 3.48 total nurse staffing hours per resident day, including a 0.55 RN hour minimum, though implementation timelines and rural exemptions have shifted after legal challenges) [7]. Assisted living facilities have no equivalent federal staffing mandate; Texas sets its own minimums by facility type under 26 TAC 553. Inspection frequency and survey scope also differ, with nursing homes facing the federal survey process on top of state licensing surveys, while ALFs answer to state inspection alone unless they're also enrolled in a Medicaid waiver program.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room and board or personal care costs of assisted living. Medicare.gov states plainly that Medicare "doesn't cover long-term care (also called custodial care)" if that's the only care you need, and assisted living falls squarely into that custodial category [8]. Medicare will cover short-term skilled nursing or rehab stays (under specific hospital-stay and certification conditions) and medical services like doctor visits or physical therapy that happen to occur while someone lives in an assisted living facility, but it will not pay the facility's monthly rent-and-care fee. Medicaid is a different story, though still limited. Texas Medicaid does not pay for room and board in assisted living either, but the STAR+PLUS Home and Community Based Services waiver can help cover personal care and habilitation services for eligible low-income seniors and people with disabilities living in community settings, administered through HHSC [9]. Coverage and eligibility rules are detailed and income-tested; if your business model depends on Medicaid waiver residents, get familiar with the STAR+PLUS HCBS program requirements before you build your pro forma, and confirm current waitlist status with your state licensing agency's Medicaid waiver division, since Texas HCBS waivers have historically carried multi-year interest lists.
How do I start a group home if I'm starting from zero?
If you have no facility, no license, and no staff yet, sequence your first 90 days around information gathering, not construction. Start with a call to your regional HHSC Long-Term Care Regulation office to confirm current application forms, fee amounts, and which facility type fits your plan; fee schedules and forms change, so treat anything you read online (including this article) as a starting point to verify, not a locked number [1]. Next, talk to a commercial real estate agent who has handled group home or ALF conversions in your target city, because zoning and life-safety retrofit costs vary enormously by building age and municipality. A 1990s ranch house zoned for single-family residential in a city with a permissive home-occupation ordinance is a very different project than an older commercial building needing full sprinkler retrofit. Then build your written policy manual and staffing plan in parallel with your building search, because HHSC wants to see both in your application packet, and lenders or investors will ask for them too. Don't wait until the building is ready to start writing policies; that's the step most first-time operators leave until last and it delays licensure by months. Finally, budget real money for pre-licensure costs: legal review of your lease or purchase contract, a fire marshal walkthrough, background checks for staff, and administrator licensing fees, on top of the HHSC application fee itself. None of these numbers are fixed nationally; get current figures directly from HHSC and your local fire marshal's office before finalizing your budget.
Frequently asked questions
What is assisted living?
Assisted living is housing that provides help with daily activities like bathing, dressing, and medication management, plus meals and 24-hour staff availability, without the intensive skilled nursing care of a nursing home. In Texas, this is licensed as an Assisted Living Facility (ALF) under Health and Safety Code Chapter 247, regulated by HHSC.
What is a group home?
A group home is a licensed residential setting where a small number of unrelated people live together with paid staff support. For seniors in Texas, the legal license category is Assisted Living Facility, not a separate "group home" statute; IDD and mental health group homes fall under different license types entirely.
What is an assisted living facility?
Under Texas Health and Safety Code Sec. 247.002, an assisted living facility is an establishment that provides food, shelter, and personal care services on a 24-hour basis to four or more people unrelated to the owner within the third degree of consanguinity. Facilities are classified as Type A, Type B, or Small ALF depending on resident mobility and care needs.
What is the difference between assisted living and nursing home?
Assisted living helps with daily activities and personal care while residents stay largely independent; nursing homes provide 24-hour skilled nursing care for serious medical needs. Nursing homes need an RN on site and follow federal Conditions of Participation if Medicare/Medicaid certified; Texas ALFs follow lighter state-only staffing rules under 26 TAC Chapter 553.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room, board, or personal care costs of assisted living because that's classified as custodial care. Medicare.gov states it doesn't cover long-term custodial care alone. Medicare may cover unrelated medical services (doctor visits, short-term skilled rehab under specific conditions) that happen while someone lives there.
How do I start a group home for the elderly in Texas?
Decide your facility type (Type A, Type B, or Small ALF), confirm zoning with your local planning department, secure a building that can pass life-safety review, submit an HHSC license application with your floor plan and staffing plan, write policies matching 26 TAC Chapter 553, hire qualified staff, and pass the pre-licensure inspection before admitting residents.
How many residents can I have before I need a license in Texas?
Texas Health and Safety Code Sec. 247.002 sets the threshold at four or more residents not related to the owner within the third degree of consanguinity receiving food, shelter, and personal care on a 24-hour basis. Below that number, you generally aren't operating a licensed facility, though you should confirm classification specifics with HHSC directly.
What's the difference between Type A and Type B assisted living in Texas?
Type A facilities serve residents who can evacuate with minimal staff help and don't need routine nighttime attendant care. Type B facilities serve residents who need staff assistance to evacuate, may be non-ambulatory, and require overnight attendant care, which means higher staffing ratios and stricter physical plant requirements.
Does Medicaid pay for assisted living in Texas?
Texas Medicaid does not cover room and board at assisted living facilities. The STAR+PLUS Home and Community Based Services waiver, administered by HHSC, can help cover personal care and habilitation services for eligible low-income residents, but eligibility is income-tested and waitlists have historically run for years.
How long does it take to get an assisted living license in Texas?
There's no single fixed timeline; it depends on how quickly your building passes life-safety and fire marshal review, how complete your application packet is, and current HHSC processing volume. Building out or retrofitting a facility often takes longer than the license review itself. Confirm current processing timeframes directly with HHSC's Long-Term Care Regulation division.
Can I combine a senior group home with an IDD group home in the same house?
Generally no, without separate licensing for each population and service type. Texas regulates elder assisted living under Chapter 247 and IDD residential services under different program rules (such as HCS). Confirm with your state licensing agency before assuming you can serve mixed populations under one license.
What staff do I need to run a small assisted living home in Texas?
At minimum you need a licensed administrator and enough direct care staff to meet the ratio required for your facility type under 26 TAC Chapter 553, plus documented training in medication assistance if unlicensed staff will administer medications. Exact ratios depend on whether you're Type A, Type B, or Small ALF, and on resident acuity.
What does assisted living cost compared to a nursing home?
Genworth's 2024 Cost of Care Survey put the national median assisted living cost at $5,900 a month versus $9,733 a month for a semi-private nursing home room, a difference of roughly $3,800 a month tied to the added skilled nursing staff and medical services nursing homes provide.
Sources
- Texas Health and Human Services, Assisted Living Facilities licensing overview: Texas licenses assisted living facilities through HHSC, with facility types (A, B, Small ALF) based on resident mobility and care needs
- Texas Health and Safety Code Sec. 247.002: Definition of assisted living facility and the four-or-more resident threshold requiring licensure
- Texas Administrative Code Title 26, Chapter 553: State licensing standards for staffing, physical plant, life safety, and resident rights in assisted living facilities
- Texas Health and Safety Code Chapter 242: Nursing homes are licensed under a separate chapter with different staffing and medical care requirements
- Genworth Cost of Care Survey 2024: National median monthly cost of assisted living ($5,900) versus semi-private nursing home room ($9,733) in 2024
- Code of Federal Regulations, 42 CFR Part 483: Federal Conditions of Participation apply to Medicare/Medicaid certified nursing homes
- CMS, Minimum Staffing Standards for Long-Term Care Facilities final rule: 2024 CMS rule set national minimum nurse staffing hours per resident day for nursing homes, including RN hour minimum
- Medicare.gov, Long-term care coverage: Medicare does not cover long-term custodial care, which includes assisted living room and board
- Texas HHSC, STAR+PLUS Home and Community Based Services program: STAR+PLUS HCBS waiver can help cover personal care services for eligible residents in community settings, not room and board