The three primary residential care settings — assisted living, memory care, and skilled nursing (nursing homes) — differ significantly in who they can legally serve, what care services they provide, how they are staffed, and what they cost. Choosing the wrong level can mean either paying for care that isn’t needed, or placing a loved one in a setting that cannot safely meet their needs.
This guide compares each option using Texas-specific regulatory standards and Houston market data.
Assisted Living
Who It’s For
Assisted living communities serve adults who need support with Activities of Daily Living (ADLs) — bathing, dressing, grooming, medication management, and meals — but who do not require continuous nursing supervision. In Texas, Type A facilities serve lower-acuity residents capable of self-evacuation; Type B can serve residents who need evacuation assistance.
What Care Is Provided
- ADL assistance (bathing, dressing, grooming, toileting)
- Medication administration by trained staff
- Three meals daily plus snacks
- Housekeeping and laundry
- Social programming and activities
- Transportation to medical appointments
- Emergency call systems
What It Does NOT Provide
Assisted living is not equipped for: intravenous medication administration, wound care requiring licensed nurses, 24-hour clinical monitoring, or residents requiring mechanical ventilation.
Staffing
Texas requires a licensed manager and trained direct care staff; no licensed nurse required on-site 24/7. Most communities have RN or LVN oversight available but not continuously on the floor.
Average Houston Cost (2026)
$2,800–$6,500/month depending on location, room type, and care level. See our cost calculator for city-by-city estimates.
Memory Care
Who It’s For
Memory care communities specialize in caring for residents with Alzheimer’s disease, vascular dementia, Lewy body dementia, and other cognitive conditions. They operate under Type B ALF licenses in Texas, enabling them to serve residents who cannot safely self-evacuate or who require continuous supervision due to cognitive impairment.
What Distinguishes Memory Care
- Secured environment: All exits are secured to prevent wandering; residents cannot leave unsupervised
- Higher staff ratios: Typical ratio 1:6 or better vs. 1:8–1:12 in standard assisted living
- Dementia-specific programming: Structured activities designed for cognitive stimulation, reminiscence therapy, sensory programming
- Staff training: All direct care staff trained in dementia care, behavioral management, and de-escalation
- Simplified environment: Reduced clutter, consistent routines, and cueing systems that support orientation
When to Consider Memory Care vs. Assisted Living
If a resident with dementia is wandering or at risk of leaving the building unsafely, requires redirection for basic care tasks, exhibits behavioral symptoms (aggression, agitation, sundowning) that standard ALF staff are not equipped to manage, or has progressed to moderate-to-severe dementia, memory care is the appropriate level.
Average Houston Cost (2026)
$4,800–$9,000/month. Memory care is almost always all-inclusive (no care level add-ons).
Nursing Homes (Skilled Nursing Facilities)
Who It’s For
Nursing homes serve adults who require 24-hour skilled nursing care: post-hospitalization rehabilitation, complex wound care, IV therapy, ventilator management, feeding tube management, or long-term care with chronic medical complexity.
What Care Is Provided
- 24/7 licensed nursing staff (RN + LVN) on every unit
- Physical, occupational, and speech therapy (for rehabilitation residents)
- Complex wound care and IV medication administration
- Clinical monitoring for unstable or post-acute medical conditions
- All ADL care, meals, and social programming
- Hospice partnership arrangements
Medicare Coverage
Medicare Part A covers skilled nursing facility care for up to 100 days following a qualifying hospital stay of 3+ nights. Days 1–20 are fully covered; days 21–100 require a daily co-pay ($204.00/day in 2026). After 100 days, private pay or Medicaid applies.
CMS Five-Star Ratings
Unlike assisted living facilities, nursing homes are rated by the Centers for Medicare & Medicaid Services (CMS) on a 1–5 star scale across three domains: health inspections, staffing, and quality measures. Learn how to interpret CMS Five-Star ratings before choosing a nursing home.
Average Houston Cost (2026)
$5,300–$11,400/month (semi-private to private room). Most residents are Medicaid- or Medicare-funded for at least part of their stay.
Side-by-Side Comparison
| Feature | Assisted Living | Memory Care | Nursing Home |
|---|---|---|---|
| 24/7 nursing staff | No | Sometimes | Yes (required) |
| Secured exits | No | Yes | Varies |
| Medicare coverage | No | No | Up to 100 days |
| Medicaid (STAR+PLUS) | Some facilities | Some facilities | Most facilities |
| IV therapy / wound care | No | No | Yes |
| CMS Five-Star rating | No | No | Yes |
| Houston cost range | $2,800–$6,500/mo | $4,800–$9,000/mo | $5,300–$11,400/mo |