How to Open a Personal Care Home in Texas

Opening a personal care home isn’t easy. In Texas, personal care homes (also known as residential care homes) are licensed assisted-living facilities, and with that license comes loads of confusing, highly specific rules and regulations. There are gray areas, you’ll need a good lawyer and you’ll definitely need to have some conversations with the Department of Health and Human Services, but don’t let that dissuade you. This is a career that can change someone’s life and really make a difference to some of the most vulnerable people in society.

If you want to open a care home of your own, you’ll need to swiftly get acquainted with personal care home licensing laws in Texas. You’ll have to consult the Department of Health and Human Services about some of the more nuanced rules, but there are some basics requirements you should know beforehand.

The Texas Department of Health and Human Services licenses assisted-living facilities and personal care homes based on two things:

• The residents’ mental and physical ability to evacuate in the event of an emergency
  
  
• Whether or not it is necessary to have nighttime staff. 

Taking this into account, care homes are split into two categories: type A and type B. If you want to open a home in the state, you’ll have to determine which category fits your business plan. Each category has different rules, regulations and requirements, but it's really based around emergency evacuation.

At the time residents are admitted, they must be appropriate for your care home based on your specific license. There are additional regulations if a resident’s condition changes.

Type A facilities admit residents who don’t typically require assistance during sleeping hours. These types of residents can follow directions in case of an emergency and don’t have any sort of physical or mental hindrance that would prevent them from evacuating on their own. In other words, patients who are severely handicapped or suffer from Alzheimer's disease or dementia would not be admitted to a type A facility.

Type B facilities handle residents who need more round the clock care. These residents require overnight assistance from staff and cannot evacuate on their own. They're either handicapped enough to need assistance in an emergency or not capable of following evacuation directions. This typically includes patients suffering from Alzheimer's disease or dementia or those who need assistance getting out of bed and into a wheelchair.

The Texas Department of Health and Human Services also categorizes personal care homes by size. Each size has specific requirements:

• Small facilities have 16 residents or less.
  
  
• Large facilities have 17 residents or more. 

If your care home hosts three or less residents, it does not need to be licensed. However, you can’t advertise an unlicensed care home as an assisted-living facility.

Decide how many residents your care home will have before searching for an appropriate location. Finding a location that meets Texas licensing requirements isn’t an easy task.

Finding a great location for your personal care home can be a roadblock unless you know what you're looking for. There are various laws that dictate everything from room size and number of bathrooms to access to backup generators.

The easiest way to launch a personal care home with licensing in Texas is to purchase or rent a facility that already was a personal care home. If not, you’ll have to make some adjustments to allow for handicap access, reliable backup generators and full legal compliance.

Bedroom size is regulated by the state. For type A facilities, rooms must be a minimum of 80 square feet to accommodate a single bed. Rooms with multiple beds must have no less than 60 square feet per bed. For a type B facility, rooms with a single bed must be at least 100 square feet. Rooms with multiple beds must have 80 square feet per bed.

Bathrooms are also tightly regulated. In short, there has to be at least one bathroom for every six residents and one bathtub for every 10 residents. These bathrooms must be separated by gender, and every floor must have at least one closet, lavatory and bathing unit.

In addition to bedroom and bathroom requirements, a maximum of four residents are allowed per room, but at least half of your rooms must be limited to single or double occupancy. There are also extensive fire safety requirements and life code requirements. For example, type B facilities need an approved automated sprinkler system. You can contact the Department of Health and Human Services for a full list, but it may serve you well to find a great real estate agent who specializes in commercial real estate and personal care homes.

Every business has certain legal requirements that need to be smoothed out before you can open up shop. This includes getting a business license and making your business a legal entity, like an LLC or S corp. You must also obtain an employer identification number from the IRS and the necessary insurance. An insurance agent specializing in business insurance should be able to point you in the right direction.

Once you have a location set, you’ll need to obtain a license to operate. You can do this through the Texas Department of Health and Human Services. You’ll have to:

• Complete a pre-survey
  
  
• Complete computer-based training
  
  
• Complete and submit your application with the required documents, including ownership documents and a letter proving you’ve passed a fire marshal inspection
  
  
• Submit written notice that your building is in compliance with the laws for both the state’s life-safety code and assisted-living facilities

Licenses cost between $100 and $200 with an additional $10 per bed and are approved within 30 days. At this phase, you'll also need to pass a life-safety code inspection, with a health inspection to be completed after you admit your first resident.

According to the laws that dictate personal care home licensing in Texas, each facility must have a designated manager who oversees the operation and is on-site 40 hours per week. This can be you or someone you hire, but anyone who takes on the role has to have the proper training and education. This varies based on the size of your facility. The requirements are as follows:

• Small facilities: Managers of small facilities must have a high school diploma or a GED.
• Large facilities: Managers of large facilities must have either an associate degree in a field related to nursing and health care management, a bachelor’s degree or a high school diploma with a minimum of years of experience in management or health care management. 

All managers must complete a 24-hour assisted-living course within the first year of the job and maintain 12 hours of continuing education each year. This continuing education can include subjects like management, accounting, first aid, resident and provider rights, community resources and federal law, among others.

Unless your care home has fewer than three residents, it’s a safe bet that you’ll need to hire some full-time staff. While personal care home licensing in Texas does not dictate a specific staff-to-resident ratio, you do need to hire enough staff to keep your residents safe, clean and well cared for. The duties vary from administering medicine and serving meals to bathing residents, doing laundry and ensuring evacuation.

Texas does have requirements regarding who is legally allowed to work at your care facility. Full-time attendants must be 18 years or older and have a high school diploma. There are also separate requirements for licensed nurses, nurse aids and employees who administer medication. For example, an employee who administers medication must hold a medication aide permit, have a license to administer medication or have been trained by a registered nurse in accordance with the Nursing Practice Act.

You can get a full list of staffing requirements from the state’s Department of Health and Human Services.

Before you can open a personal care home in the state of Texas, you’ll need to make sure your staff is properly trained. Each staff member must complete four hours of orientation that at a minimum covers:

• Reporting abuse and neglect
• Resident rights
• Emergency and evacuation procedures
• Resident information confidentiality
• Universal precautions
• Conditions that must be reported to a manager

Direct-care staff must also complete 16 hours of additional on-the-job training that includes things like safety measures, emergency first aid, de-escalation techniques if a resident exhibits aggressive behavior and what to do in the event that a resident falls, gets cut or has a sudden change in condition. All direct-care staff must also complete six hours of additional education every year.

Personal care homes that admit residents who suffer from Alzheimer’s disease or other dementia have additional licensing requirements that other facilities do not. For starters, these types of facilities must always be licensed as type B and must have an activity director in addition to a manager. This person is responsible for enacting an activity plan that encourages socialization, cognitive awareness, self-expression and physical activity catered to each resident’s specific ability. If a resident does not wish to participate in a large-group activity, you must also plan one small-group or one-on-one activity per day, so write this into your business plan.

Care homes that admit residents with Alzheimer’s and dementia must have an established set of procedures including things like a standard application process, interviews and home visits. This helps evaluate whether or not you can meet a prospective resident’s needs. Be prepared to have this down before you open your facility. Your facility must also meet additional requirements, including having an 800-square-foot outside area, a monitoring station and two approved exits.

In addition to the standard training, all staff members must receive four hours of dementia-related orientation before you open your care facility. After that, they will need 16 hours of on-the-job supervision and must complete 12 hours of Alzheimer’s disease training every year.

Once you have your staff in place and have passed the life-safety code survey, you need to admit your first resident. Send the Department of Health and Human Services written notification that you’ve admitted at least one resident but no more than three. After that, they'll be able to give you a health survey and inspection. Once you pass the health inspection, your license will be issued within 45 days, and you'll be able to open your care home to more residents.