Starting a residential assisted living facility in Texas

Last updated 2026-07-25

What is assisted living?

Assisted living is a licensed residential setting where people who need help with daily activities like bathing, dressing, medication reminders, and meal preparation live in a home-like environment rather than a hospital-like one. It sits between fully independent senior living and a nursing home. In Texas, the legal term is "assisted living facility," and it covers everything from a single converted house with three residents to a 100-bed building with dedicated memory care wings. The Texas Health and Safety Code defines it as an establishment that "furnishes food and shelter to four or more persons who are unrelated to the proprietor" and provides personal care services, or that holds itself out as providing such care ^[1]. The key legal distinction from a plain rental home or boarding house is that assisted living facilities provide supervision and personal care, more than a room. That's what triggers licensing. If you're comparing this model against other residential paths, our overview on assisted living walks through how states categorize these homes generally, which is useful context before you get into Texas specifics.

What is a group home?

A group home is a small residential facility, usually in a single-family style house, where a handful of unrelated residents live together and receive some level of supervision or care. The term gets used loosely across sectors: intellectual and developmental disability (IDD) group homes, mental health group homes, recovery residences, and small assisted living homes for seniors all get called "group homes" in casual conversation. In Texas, there isn't one single license called "group home." Instead, the license type depends on who lives there and what care they need. A home serving seniors needing personal care falls under HHSC's Assisted Living Facility license (Chapter 247). A home serving people with intellectual or developmental disabilities may fall under HHSC's Home and Community-based Services (HCS) or Intermediate Care Facility for Individuals with an Intellectual Disability (ICF/IID) programs instead ^[1]. That distinction matters a lot when you're filling out paperwork, because applying under the wrong program wastes months. If your target population is elderly residents who need help with activities of daily living but not skilled nursing care, Assisted Living Facility licensure is almost always the right path in Texas.

What is an assisted living facility, exactly, under Texas law?

Type A	Residents who can evacuate independently with minimal physical assistance and do not need nighttime attendance	Lower staffing overnight, no nighttime supervision requirement in some configurations
Type B	Residents who need staff assistance to evacuate, may be non-ambulatory, or need overnight attendance	Awake overnight staff required
Type C (small facility, 4-16 residents)	Small, home-like settings, often IDD or specialized populations under separate rule provisions	Additional structural and staffing rules under 26 TAC 553	This table is a simplified summary; confirm current subtype definitions and resident-capacity thresholds with your state licensing agency, since HHSC periodically updates rule language. The actual rule text in 26 TAC Chapter 553 governs, not any third-party summary [2].

Under Texas Health and Safety Code Chapter 247, an assisted living facility is a licensed establishment providing personal care services, supervision, and lodging to four or more unrelated residents who need help with daily living but not the level of medical care a nursing home provides ^[1]. HHSC regulates these facilities and sets minimum standards in Texas Administrative Code Title 26, Chapter 553 ^[2]. Texas uses a type-classification system, not a single blanket license. Facilities are licensed as Type A, Type B, or Type C depending on the mobility, cognitive status, and evacuation ability of residents: | License Type | Who it typically serves | Key requirement |

What does assisted living provide, day to day?

Assisted living provides help with activities of daily living (ADLs), which typically means bathing, dressing, grooming, toileting, transferring, and eating, plus supervision, medication administration or reminders, three meals a day, housekeeping, and some level of social or recreational activity. It does not provide 24-hour skilled nursing care. HHSC rules require facilities to have a written plan of care for each resident, updated periodically, that documents the specific services the resident needs and who provides them ^[2]. Staff must be trained in first aid, and facilities administering medications need staff who meet specific training requirements under Texas rule, including completion of a medication aide training program in many cases. Most operators budget for a dietary program (in-house cook or contracted meal service), a activities coordinator (sometimes part-time or shared with administrative duties in small homes), and a med-pass system, whether paper MAR or an electronic medication administration record. None of this is optional if you want to pass your initial licensing survey.

How do I start a group home / assisted living facility in Texas, step by step?

Starting a licensed assisted living facility in Texas generally follows this sequence: form your business entity, secure and prepare a compliant physical location, submit your HHSC license application with required fees and documentation, pass fire marshal and health inspections, hire and train staff, and undergo a pre-licensing survey before HHSC issues your license. Here's the realistic order of operations: 1. Business entity and planning. Form an LLC or corporation, get an EIN, and build a real budget. Assisted living build-outs and renovations run from tens of thousands of dollars for a small home conversion to well over a million for new construction; get quotes locally rather than relying on national averages, since Texas construction costs vary sharply by metro area. 2. Site selection and zoning check. Confirm your property is zoned for a residential care use, more than residential. Cities and counties in Texas handle this differently, some treat small assisted living homes (under a certain resident count) as a permitted residential use under the Fair Housing Act's reasonable accommodation principles, others require a conditional use permit. Check with your city or county planning department before you sign a lease. Our zoning guidance on assisted living at home covers common zoning fights operators run into. 3. Life safety and building code compliance. Your local fire marshal and HHSC will inspect for things like sprinkler systems (required in most licensed facilities per National Fire Protection Association 101 Life Safety Code adoption), exit width, smoke detection, and ADA-type accessibility depending on resident mobility needs. 4. File the HHSC license application. Submit HHSC's Assisted Living Facility application, including your entity documents, floor plan, staffing plan, policy and procedure manual, and the required license fee. Confirm current fee amounts with HHSC directly, since license fees change and vary by facility bed capacity ^[3]. 5. Background checks. Every owner, administrator, and staff member with direct resident contact must clear a criminal background check through the Texas Department of Public Safety and the HHSC-administered Employee Misconduct Registry check ^[2]. 6. Hire your administrator. Texas requires an assisted living facility administrator to be licensed separately in many cases, or to meet specific training and experience thresholds under HHSC rule. Confirm current administrator licensing requirements with HHSC, as these have been revised over time. 7. Pre-licensing survey. HHSC conducts an on-site survey before issuing the initial license, checking the physical plant, staffing documentation, resident record systems, and emergency preparedness plans. 8. Get your license, then start intake. Once HHSC issues the license, you can begin admitting residents, though many operators start marketing and pre-screening residents during the survey window to avoid empty beds on day one. If paperwork is where you're stuck, that's the whole reason a structured document kit exists. GroupHomePath's $299 State Group Home Licensing Kit gives you Texas-specific application checklists, a policy manual template, and a staffing plan framework you can adapt, available at /licensing-kit-builder. It doesn't replace legal advice or guarantee approval, but it saves you from building every document from a blank page.

What is the difference between assisted living and a nursing home?

Licensing authority	HHSC, Texas Health and Safety Code Ch. 247 [1]	HHSC + CMS certification for Medicare/Medicaid participation [4]
Staffing	Personal care aides, medication aides, admin	24-hour licensed nursing staff
Typical resident	Needs help with ADLs, stable medically	Needs skilled nursing, rehab, or complex medical management
Medicare coverage	Generally not covered	Short-term skilled stays covered under specific conditions
Setting	Home-like, smaller scale common	Institutional, hospital-adjacent model common	A resident whose needs exceed what assisted living staff are trained and licensed to provide has to transfer to a nursing home; Texas rule requires facilities to have a discharge and transfer policy for exactly this situation [2].

Assisted living provides help with daily activities and supervision in a residential, home-like setting. A nursing home (skilled nursing facility) provides 24-hour skilled nursing care, ordered and supervised by physicians, for people with significant medical needs, post-surgical recovery, or complex chronic conditions. The practical differences show up in staffing, licensing agency oversight intensity, and cost structure. Nursing homes must have licensed nurses on-site around the clock and are certified under federal Medicare and Medicaid conditions of participation set by the Centers for Medicare and Medicaid Services ^[4]. Assisted living facilities in Texas are licensed by HHSC under a different statutory chapter (247) and are not required to have RN coverage 24/7 in most configurations. | Factor | Assisted Living Facility (Texas) | Nursing Home (Skilled Nursing) |

Does Medicare cover assisted living facilities?

No. Medicare does not cover the room and board or personal care costs of assisted living. Medicare.gov states plainly that Medicare and Medicaid "generally don't pay for non-medical long-term care" services like help with daily activities in a residential setting ^[5]. Medicare Part A may cover short-term skilled nursing facility stays after a qualifying hospital stay, and Medicare Part B can cover physician visits, physical therapy, and some medical equipment delivered to a resident wherever they live, including an assisted living facility. But the facility's monthly rate itself, covering room, board, and personal care, is a private-pay or long-term-care-insurance cost in the overwhelming majority of cases. Texas Medicaid does have a Home and Community-based Services waiver program (STAR+PLUS and related waivers) that can help cover personal care costs for eligible low-income residents in certain community settings, but eligibility rules, waiver waitlists, and covered services are complicated and change. Confirm current waiver availability and covered services with HHSC and Medicaid.gov directly before telling prospective residents what's covered ^[5][6]. Don't make coverage promises to families based on general information; get it from a caseworker or benefits counselor.

How do you handle zoning and property requirements for a Texas assisted living facility?

Zoning is one of the most underestimated hurdles in opening a Texas assisted living facility, and it varies enormously by city and county. Some Texas municipalities treat small assisted living homes (typically under 6 to 8 residents) as a permitted use in single-family residential zones, following the federal Fair Housing Act's protection for people with disabilities living in community settings. Larger facilities almost always need commercial or institutional zoning, or a specific conditional use permit. Before signing a lease or purchase contract, get zoning confirmation in writing from the city or county planning office. Verbal assurances from a leasing agent are not enough; zoning enforcement happens after you've already invested in renovations, and reversing that is expensive. Beyond zoning, your physical plant has to satisfy HHSC's physical environment standards under 26 TAC Chapter 553, covering things like minimum square footage per resident bedroom, bathroom-to-resident ratios, emergency lighting, and evacuation route width ^[2]. Local fire marshals apply National Fire Protection Association life safety code provisions on top of that, and requirements differ meaningfully between a Type A facility (residents who can self-evacuate) and a Type B facility (residents needing evacuation assistance), since Type B triggers stricter sprinkler and alarm requirements in many jurisdictions. If you're evaluating a property before you've settled on which state or even which part of Texas to operate in, our broader assisted living facility resource compares zoning patterns across markets.

What staffing plan do you need for a Texas assisted living facility?

Texas requires assisted living facilities to staff according to resident need, not a flat ratio that applies to every home. HHSC rule requires "sufficient staff on duty to meet the 24-hour needs of the residents," a needs-based standard rather than a fixed number-per-resident formula in most cases ^[2]. In practice, that means your staffing plan has to map to the actual acuity of the residents you admit. A Type A home with mobile, low-need residents can run leaner during overnight hours than a Type B home with residents needing hands-on assistance to evacuate. You'll need to document, in writing, how you calculated staffing for each shift and how that plan adjusts as resident needs change over time; this document is part of what HHSC reviews during licensing and inspections. Key staffing roles operators typically need to plan for: - Administrator, meeting HHSC's licensing or qualification requirements (confirm current requirements, since Texas periodically updates administrator licensing rule under Chapter 247)

• Direct care staff / personal care attendants, trained in first aid, resident rights, and abuse/neglect reporting
• Medication aides, completing a state-approved medication aide training program if the facility administers medications
• Overnight staff, awake and responsive for Type B facilities, with clear rules on whether Type A facilities can use a sleeping night attendant depending on resident evacuation capability Background checks apply to everyone with direct resident contact, run through the Texas Department of Public Safety and the Employee Misconduct Registry ^[2]. Skipping this step, or fudging documentation to speed up hiring, is one of the fastest ways to get a licensing action against you.

What happens during a Texas assisted living facility inspection?

HHSC conducts an initial pre-licensing survey before issuing your license, then unannounced periodic surveys after you're operating, generally on a cycle set by rule, plus complaint-driven investigations whenever a complaint is filed against the facility. Surveyors check the physical plant, staff files, resident care plans, medication administration records, and emergency preparedness documentation against 26 TAC Chapter 553 standards ^[2]. Common citation areas in assisted living surveys nationally, and in Texas specifically, tend to cluster around: incomplete or outdated resident care plans, medication administration record errors, staff training documentation gaps, and life-safety issues like blocked exits or missing fire drill records. None of these are exotic; they're paperwork and follow-through failures, which is exactly why a written policy and procedure manual matters so much before your first survey, not after. If a survey finds deficiencies, HHSC issues a statement of deficiencies and requires a plan of correction with a timeline. Serious or repeated violations can lead to enforcement actions ranging from administrative penalties to license revocation, so a pattern of quick, documented correction matters more than a spotless first survey (which is rare anyway; most facilities get some citations on their first look). Our assisted living facilities guide covers what inspectors commonly flag across states if you want a broader pattern before your first Texas survey.

What's a realistic budget and timeline for opening in Texas?

There's no single honest number here because it depends heavily on whether you're buying an existing licensed home, converting a house, or building new, and on your local market. What's realistic to say: expect the licensing and pre-opening process, from application submission to license issuance, to take several months in most cases, and expect it to take longer if your physical plant needs significant renovation to meet fire and life-safety code. Cost drivers worth budgeting for honestly: - Property acquisition or lease-up (highly variable by Texas metro)

• Renovation to meet 26 TAC 553 physical plant standards, including sprinkler retrofits if the building doesn't already have them
• HHSC license application fee (confirm the current fee schedule directly with HHSC, since it's tied to licensed bed capacity and changes periodically) ^[3]
• Staff hiring and training before your resident count justifies full staffing costs
• Insurance (general liability, professional liability, workers' compensation)
• Working capital to cover the gap between opening and reaching stable occupancy Don't treat the license fee as your real cost driver; it's usually a small fraction of what renovation, staffing ramp-up, and working capital actually cost. The single biggest source of budget blowouts operators report anecdotally is underestimating renovation costs to meet fire marshal requirements on an older building. Get your fire marshal walkthrough before you sign a purchase contract, not after.

Who actually licenses and inspects assisted living facilities in Texas?

The Texas Health and Human Services Commission (HHSC) is the sole state agency responsible for licensing and regulating assisted living facilities in Texas, under authority granted by Texas Health and Safety Code Chapter 247 ^[1]. HHSC's Long-term Care Regulation division handles applications, surveys, complaint investigations, and enforcement actions. There is no separate county-level licensing layer for the assisted living license itself, though counties and cities retain zoning, building permit, and local fire code authority, which operate independently of HHSC's process. That means you're dealing with at least two separate government bodies before you open: HHSC for the care license, and your local city or county for zoning and building permits. If you operate in Texas and also plan to expand into another state, don't assume anything transfers. Licensing structures, staffing ratios, and physical plant standards are set state by state, and what satisfies HHSC in Texas won't automatically satisfy another state's agency. Our senior assisted living facilities near me resource is useful if you're comparing where demand and licensing burden intersect across markets.

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 supervision, but not the round-the-clock skilled nursing care a nursing home provides. In Texas it's regulated under Health and Safety Code Chapter 247.

What is a group home?

A group home is a small residential facility housing unrelated residents who receive supervision or care, a term used loosely across senior care, IDD, mental health, and recovery settings. In Texas, the specific license you need depends on the population served; seniors needing personal care fall under HHSC's Assisted Living Facility license.

What is an assisted living facility?

Under Texas Health and Safety Code Chapter 247, it's a licensed establishment providing food, shelter, and personal care services to four or more unrelated residents who need help with daily activities but not nursing-home-level medical care. Texas classifies these as Type A, Type B, or small facilities under Type C rules.

What does assisted living provide?

Assisted living provides help with bathing, dressing, grooming, toileting, and eating, plus medication reminders or administration, three daily meals, housekeeping, supervision, and activities. Texas rule requires a written, individualized plan of care documenting exactly what services each resident receives.

What is the difference between assisted living and a nursing home?

Assisted living helps with daily activities in a residential setting with no requirement for 24-hour licensed nursing staff in most Texas configurations. A nursing home provides 24-hour skilled nursing care under physician orders and is certified separately for Medicare and Medicaid participation under CMS conditions of participation.

Does Medicare cover assisted living facilities?

No. Medicare.gov states Medicare generally doesn't pay for non-medical long-term care like assisted living room, board, and personal care costs. Medicare can cover related medical services (physician visits, therapy) delivered to a resident there, but not the facility's monthly rate itself.

How do I start a group home in Texas?

Form your business entity, confirm zoning with your local city or county, secure a property that can meet fire and life-safety code, submit HHSC's Assisted Living Facility license application with your floor plan, staffing plan, and policy manual, pass background checks and the pre-licensing survey, then admit residents once HHSC issues your license.

How much does it cost to open an assisted living facility in Texas?

Costs vary enormously by whether you're converting a house or building new, and by local market. Budget for property, renovation to meet 26 TAC 553 physical plant standards, HHSC license fees (confirm current amounts directly with HHSC), staffing ramp-up, insurance, and working capital until occupancy stabilizes.

How long does it take to get an assisted living license in Texas?

Expect the process from application submission to license issuance to take several months in typical cases, longer if your property needs significant renovation to meet fire marshal or HHSC physical plant requirements. Timelines aren't guaranteed and depend on your local fire marshal's schedule and how complete your initial application is.

What's the difference between Type A and Type B assisted living licenses in Texas?

Type A facilities generally serve residents who can evacuate independently or with minimal assistance and don't require overnight attendance in some configurations. Type B facilities serve residents who need staff help evacuating or require overnight attendance, triggering stricter staffing and life-safety requirements. Confirm current subtype rules with HHSC.

Do Texas assisted living staff need background checks?

Yes. Every owner, administrator, and staff member with direct resident contact must clear a criminal background check through the Texas Department of Public Safease and be checked against the HHSC-administered Employee Misconduct Registry before working with residents.

Does Texas Medicaid pay for assisted living?

Texas Medicaid doesn't generally cover assisted living room and board, but Home and Community-based Services waiver programs like STAR+PLUS can help cover personal care costs for eligible low-income residents in some community settings. Eligibility and waitlists vary; confirm current details with HHSC and Medicaid.gov.

Do I need a special zoning permit to open an assisted living home in Texas?

It depends on your city or county and the size of your facility. Small assisted living homes are sometimes treated as a permitted residential use under Fair Housing Act protections, while larger facilities often need commercial or institutional zoning or a conditional use permit. Get zoning confirmation in writing before signing a lease.

Sources

1. Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of an assisted living facility and HHSC's licensing authority in Texas
2. Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Physical plant standards, staffing requirements, background check rules, and care plan requirements for Texas assisted living facilities
3. Texas Health and Human Services, Long-term Care Regulation licensing fees: HHSC administers assisted living facility licensing, fees vary by facility bed capacity and change periodically
4. Centers for Medicare and Medicaid Services, Nursing Home Conditions of Participation: Nursing homes must be certified under federal Medicare and Medicaid conditions of participation with 24-hour licensed nursing staff
5. Medicare.gov, Long-term care coverage: Medicare generally does not pay for non-medical long-term care services like assisted living
6. Medicaid.gov, Home and Community Based Services: Medicaid HCBS waiver programs can help cover personal care costs for eligible residents in community settings