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Long-Term Care for Seniors: Where to Start

Planning for Loss of Health

This article covers resources for senior Texans' long-term care decisions.

Many senior Texans need help with care as they get older. This article discusses resources and agencies that can assist them and their families in deciding what kind of care is best. Here, seniors can get a head start on making long-term care decisions. 

Administration for Community Living (ACL) 

The Administration for Community Living (ACL) is a part of the federal government that provides information about, and assistance with, long-term services and support for elders in the community.  Some of these services include: 

The Administration for Community Living partners with many agencies, including the Centers for Medicare and Medicaid Services and the Veterans Health Administration.

Aging and Disability Resource Centers (ADRCs)

Older adults, people with disabilities, caregivers, and families can use the Aging and Disability Resource Centers (ADRCs) to enter the long-term services and support system. ADRCs help individuals and their families to enter the long-term services and support system.

ADRCs help individuals and their families: 

  • Identify their long-term services and support needs; 

  • Understand their options, including the publicly funded programs available to them; and 

  • Develop and activate a long-term care plan. 

What are some options that don’t include nursing homes?

Home care, accessory dwelling units, board-and-care homes, and assisted living facilities.

Home Care

Depending on your needs, you may be able to get help with your personal activities (like laundry, shopping, cooking, and cleaning) at home from family members, friends, or volunteer groups. 

If you think you need home care, talk to your family to see if they can help with your care or help arrange for other care providers.  

There are also some home health care agencies that can help with nursing or attendant care in your home.  Medicare may pay for home care if you meet certain conditions.  Go to Medicare's home-health services coverage page for more information.  

Accessory Dwelling Units (ADUs) 

If you or a loved one owns a single-family home, adding an accessory dwelling unit (ADU) to an existing home may help you keep your independence. Space like an upper floor, basement, attic, or space over a garage may be turned into an ADU. Check with your local zoning office to be sure ADUs are allowed in your area and if there are special rules. 

Board-and-Care Homes 

Board-and-care homes are sometimes called "group homes." Many of these homes aren't paid for by Medicare or Medicaid. The monthly charge is usually a percentage of your income (a sliding scale) that covers the cost of rent, meals, and other basic shared services. 

Assisted Living Facilities 

These facilities provide help with activities of daily living like bathing, dressing, and using the bathroom. They may also help with care most people do themselves like taking medicine or using eye drops, and additional services like getting to appointments or preparing meals. 

Residents often live in their own rooms or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some of these facilities have health services on site. 

In most cases, assisted living residents to pay a regular monthly rent and then pay additional fees for the services they get. The term "assisted living" may mean different things in different facilities. Not all assisted living facilities provide the same services. It's important that you contact the facility and make sure they can meet your needs. 

What if a nursing home is the best fit? 

Some more information about nursing homes will help older Texans and their families make decisions about long-term care.  

First, nursing home residents have certain rights.  The Centers for Medicare and Medicaid Services (CMS) require all nursing homes to provide certain rights, including: 

  • be informed in writing about services and fees before entering the nursing home; 

  • manage their own money (or choose their own financial manager); 

  • to keep and use their personal belongings and property; 

  • be informed about their medical conditions and medications, 

  • see their own doctors; 

  • refuse medications and treatments; 

  • have choices about their schedule (for example, when to get up and go to sleep; activities; and other preferences); 

  • a home-like environment that maximizes comfort and provides assistance to be as independent as possible. 

Learn more about nursing home residents' rights. Nursing homes must give all new residents a copy of the list of their rights.  

How do I choose a nursing home? 

By knowing what to look for, residents and their families can find the best nursing home possible. 

Many people choose the closest facility. Before making this decision, however, it is important to do careful research. Some facilities offer more appropriate care than others. Unfortunately, some facilities may violate state standards and subject their residents to poor care. Start by getting recommendations from friends living in nursing homes and their relatives. Ask your health care providers if there are places close to you that stand out as very good or very bad. 

Pick three or four facilities close to home and prepare to visit. Ask to talk to the administrator or the director of nursing.  

The following questions will help you decide whether a facility is right for your loved one. Pay attention if staff members don't give you straight answers. Notice when the answers are inconsistent with what you observe at the facility. 

You may also wish to speak with a Texas ombudsman.  Some good questions are:   

  • Have there been any proposed license terminations in the past two years? 

  • How many complaints have been filed in the past year? 

  • How many complaints have been found to be valid in the past year? 

  • How many deficiencies have been cited in the past two years? 

  • How many "quality of care" violations have been cited in the past two years? 

  • Has the owner of this facility had other facilities recommended for license termination? 

If I have issues with a nursing home, what do I do? 

If you have issues or questions about a nursing home, you should contact an ombudsman. Ombudsmen work to solve problems and make sure state regulations and laws protect residents. Long-term care (LTC) ombudsmen are advocates for resident rights. They help protect the quality of life and quality of care of anybody who lives in a nursing home or assisted living facility. They can be volunteers or paid employees of agencies that are independent of any long-term care facility. Services are free, confidential, and available statewide in Texas. 

Some of the ways LTC ombudsmen help nursing home and assisted living residents include: 

  • Listening to residents and family members when they have concerns or issues; 

  • Telling residents about their rights; 

  • Protecting resident health, safety, welfare, and rights; and 

  • Helping families learn about nursing homes and how to pay for them. 

For more information on the office of the long-term care ombudsman, visit their website: HHS Office of the Ombudsman

Rights of Older Texans

The Office of the Texas Attorney General summarizes seniors’ rights as set forth in Texas Human Resources Code chapter 102.  Keep these in mind when making decisions about long-term care:  

  • Right to be Free to Exercise Civil Rights Under the Law. “The elderly have the same civil rights as other adults under U.S. and Texas laws, except where lawfully restricted. They also have the right to use those civil rights free of interference, coercion, discrimination, and reprisal.” 

  • Right to Dignity and Respect. “An elderly person has the right to be treated with dignity and respect, without regard to race, religion, nationality, sex, age, disability, marital status, or source of payment.” 

  • Right to Designate a Guardian or Representative. “If protection for an elderly person is required, he or she has the right to designate a guardian or representative to ensure quality care over his or her affairs.” 

  • Right to be Free from Physical and Mental Abuse. “The elderly have the right to be free of both physical and mental abuse. Physical abuse includes corporal punishment, as well as physical or chemical restraints used to “discipline” a person, or used for the convenience of a person providing services. Restraints are only permitted in very specific circumstances, such as when authorized by a doctor, in case of emergency, or in certain circumstances when the court-appointed guardian of a person with an intellectual disability has given informed consent.” 

    Physical and mental abuse exists in many different forms. If you believe you or someone you know is suffering physical or mental abuse and in immediate danger, please call 9-1-1 or your local law enforcement agency. Abuse of a senior who is not in a health care facility can be reported to Adult Protective Services at (800) 252-5400. 

  • Right to Communicate and Complain Regarding Treatment, Care or Services. 
    “An elderly person may not be prohibited from communicating in his or her native language with others or employees for the purpose of acquiring or providing any type of treatment, care, or services.”   

  • Right to Privacy. An elderly person is entitled to privacy while attending to personal needs and a private place for receiving visitors or associating with other people, unless providing privacy would infringe on the rights of other people.  

See Senior Rights at the website of the Office of the Attorney General of Texas.

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