Moving to assisted living or a nursing home in Texas: what to bring
Admission day goes better when the papers are ready. Texas assisted living needs a recent doctor's exam and a short list of facts about you. A nursing home asks who can pay from your money and who speaks for you. Here is what each item is for, and how to get it ready.
Assisted living or a nursing home?
In Texas, an assisted living facility gives food, shelter and personal care, like help with bathing, dressing and medicines. A nursing facility (nursing home) gives that plus nursing care under a doctor's direction. Most nursing home care is custodial care, help with daily activities. Original Medicare doesn't pay for that kind of long-term care. It may cover a short stay of skilled care after an illness or injury. Medicaid can help pay for nursing home care for people who qualify. Sources: Tex. Health & Safety Code ch. 247 (assisted living), Tex. Health & Safety Code ch. 242 (nursing facilities), Medicare.gov, nursing homes, Medicare.gov, long-term care.
What Texas assisted living asks for at admission
A Texas rule, 26 TAC §553.259, says what an assisted living facility must collect at admission. Here is each item and how to have it ready. Source: 26 Tex. Admin. Code §553.259, assisted living admission.
- A doctor's exam. You need a health exam by a physician from within 30 days before move-in, or within 14 days after. If you come from a hospital or another facility that has a physical exam in your record, that can count. Ask your doctor's office for a copy of your latest exam.
- Your full legal name and Social Security number. Keep your card, or at least the number, with your papers.
- Where you lived before, plus your sex and marital status.
- Date and place of birth. A birth certificate settles the spelling and the details.
- Your usual occupation, the work you did most of your life. Write it the way you'd say it.
- Emergency contacts: family, other people you name, and your doctor.
- Your pharmacy. The name and phone are on any prescription bottle.
- Your Medicare and Medicaid numbers, if you have them.
Source: 26 Tex. Admin. Code §553.259, assisted living admission.
The disclosure statement and your service plan
Before you move in, staff must explain the facility's disclosure statement and give a copy to you, your family or the person responsible for you. There must also be a written admission agreement that lists the services and what they cost. Within 14 days of admission, the facility does an assessment and writes your service plan. You, or the person responsible for your health care decisions, sign that plan. The assessment covers your primary language, your sleep, how you like to bathe, your activities and whether you go to religious services. That is why it helps to write down how you like your days. Source: 26 Tex. Admin. Code §553.259, assisted living admission.
Nursing homes: who signs to pay
A nursing home that takes Medicare or Medicaid can't require a third party, like a son or daughter, to guarantee payment as a condition of admission or of staying. It can ask a representative who has legal access to the resident's income or savings to sign the contract, to pay the facility from the resident's money. That person doesn't become personally liable. The facility also can't ask you to give up your rights or promise not to apply for Medicare or Medicaid. Source: 42 CFR §483.15, admission.
Who handles your spending money
You have the right to manage your own money. A nursing home can't make you deposit it with them. If you choose to, you give written permission, and the facility must keep your money separate from its own, keep a full record and give you statements every quarter and when you ask. If you have Medicaid, it must tell you when your balance gets close to the limit that could affect your eligibility. After a resident dies, the facility must send the money and a final accounting within 30 days to the person or probate court handling the estate. Ask the business office how their resident account works and who is on it. Source: 42 CFR §483.10, resident rights.
Your daily life is your choice
In a nursing home you have the right to choose your activities, your schedule, including when you sleep and wake up, your health care and your providers. The facility must tell you, call your doctor and notify your representative when your health changes in a serious way. Name the one person your family calls first, and a backup. Source: 42 CFR §483.10, resident rights.
Who speaks for you: the powers of attorney
- Medical power of attorney. Names the person who makes health care decisions if you can't. Read the medical power of attorney in Texas.
- Statutory durable power of attorney. Texas has a form for money matters in Estates Code §752.051. It lets your agent handle your finances, and it does not cover medical decisions. To count as durable, it must be signed and acknowledged before a notary. Sign it while you can still decide.
- Guardianship order. Only if a court named a guardian. Bring a copy of the order.
Sources: Tex. Health & Safety Code ch. 166, Tex. Estates Code §751.0021 (durable power of attorney), Tex. Estates Code §752.051 (statutory durable power of attorney).
Get your cards ready
- [ ] Medicare card. Print an official copy from your Medicare account, or call 1-800-MEDICARE (1-800-633-4227) to get one in the mail.
- [ ] Medicaid card. Texas gives each member one permanent Your Texas Benefits card. To replace it, log in at YourTexasBenefits.com, or call 2-1-1 (pick your language, then option 2, then option 1). You can also print a temporary card from your account.
- [ ] Social Security card. A replacement is free, and you may be able to ask online. See how to replace a Social Security card.
- [ ] Birth certificate. Texas Vital Statistics issues certified copies. See how to get a birth certificate in Texas.
- [ ] Any Medicare Advantage, drug plan or supplement card.
Sources: Medicare.gov, your Medicare card, Texas HHS handbook R-2300, Your Texas Benefits Medicaid card, SSA, replace your Social Security card, Texas DSHS, birth records.
Paying with Medicaid
If your parent will need Medicaid for nursing home care, apply early. Read Texas Medicaid for a nursing home for the form, the limits and the papers to gather. Source: Medicare.gov, long-term care.
Compare places before you choose
- Medicare Care Compare. Gives each nursing home an overall rating of 1 to 5 stars, plus separate ratings for health inspections, staffing and quality.
- Texas HHS Long-term Care Provider Search. Helps you learn more about long-term care providers and facilities in Texas.
- Visit in person. Nothing replaces seeing the place and meeting the staff.
Sources: Medicare Care Compare, CMS, Five-Star Quality Rating System, Texas DSHS, options for care.
A free advocate: the long-term care ombudsman
Texas long-term care ombudsmen are advocates for people who live in nursing homes and assisted living. They listen to residents and families, explain residents' rights, help families learn about long-term care and how to pay for it, and help solve problems. They are independent of the facilities, and their help is free and confidential. Call 800-252-2412 to reach one in your area. Source: Texas State Long-Term Care Ombudsman.
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Frequently asked questions
How recent does the doctor's exam need to be for Texas assisted living?
Within 30 days before admission or 14 days after, unless a transferring hospital or facility already has a physical exam in the record.
Do I have to sign as guarantor for my parent's nursing home?
No. A Medicare or Medicaid nursing home can't require a third-party guarantee. It can ask a representative with legal access to your parent's money to sign to pay from that money, without personal liability.
What happens to the money in a resident's facility account after they die?
The nursing home must send the funds and a final accounting within 30 days to the person or probate court handling the estate.
Is this legal advice?
No. It is general information from Texas and federal rules. For your situation, talk to an elder law attorney or call the long-term care ombudsman.
Sources
- statutes.capitol.texas.gov/Docs/HS/htm/HS.247.htm
- statutes.capitol.texas.gov/Docs/HS/htm/HS.242.htm
- medicare.gov/providers-services/original-medicare/nursing-homes
- medicare.gov/coverage/long-term-care
- law.cornell.edu/regulations/texas/26-Tex-Admin-Code-SS-553-259
- ecfr.gov/current/title-42/section-483.15
- ecfr.gov/current/title-42/section-483.10
- statutes.capitol.texas.gov/Docs/HS/htm/HS.166.htm
- statutes.capitol.texas.gov/Docs/ES/htm/ES.751.htm
- statutes.capitol.texas.gov/Docs/ES/htm/ES.752.htm
- medicare.gov/basics/get-started-with-medicare/using-medicare/your-medicare-card
- fhb.hhs.texas.gov/book/export/html/308566
- ssa.gov/number-card/replace-card
- dshs.texas.gov/vital-statistics/birth-records
- medicare.gov/care-compare/
- cms.gov/medicare/health-safety-standards/certification-compliance/five-star-quality-rating-system
- dshs.texas.gov/alzheimers/options.shtm
- ltco.texas.gov/
General information, not legal or financial advice. Rules change; check the official sources above or talk to a licensed professional about your situation.
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