Choosing the right senior care community is one of the most consequential decisions a family can make. Houston’s Greater Metro area has more than 650 HHSC-licensed care facilities — from intimate six-resident homes to large continuing-care communities — and the differences between them can matter enormously for quality of life.

This guide walks you through every step of the process, from understanding care levels to conducting on-site tours.

Step 1: Understand the Four Care Levels

Before comparing facilities, determine which level of care your loved one actually needs.

  • Assisted Living (Type A or B): Best for individuals who need help with activities of daily living (ADLs) — bathing, dressing, medication management — but do not require 24-hour skilled nursing. Texas licenses these under HHSC as Type A (lower acuity) or Type B (higher acuity, can serve some memory care residents).
  • Memory Care: Specialized secured communities for residents with Alzheimer’s disease, dementia, or other cognitive conditions. Secured exits, higher staff-to-resident ratios, and structured daily programming distinguish memory care from standard assisted living.
  • Nursing Homes (Skilled Nursing): Provide 24-hour care from licensed nurses. Appropriate for complex medical needs, post-hospitalization recovery, or long-term care requiring continuous clinical monitoring.
  • Residential Care Homes: Small, house-like settings serving 6–16 residents in a residential neighborhood. Higher staff ratios and a quieter environment suit seniors who feel overwhelmed in large institutional settings.

Step 2: Assess Your Loved One’s ADL Needs

Activities of Daily Living (ADLs) are the framework clinicians use to determine care level. Evaluate these six core functions:

  1. Bathing: Can the person bathe independently, or do they need partial or full assistance?
  2. Dressing: Can they choose clothing and dress without help?
  3. Eating: Can they feed themselves once food is placed in front of them?
  4. Transferring: Can they move from bed to chair, or in and out of a car, without assistance?
  5. Continence: Do they manage bladder and bowel function independently?
  6. Toileting: Can they use the toilet and maintain hygiene without help?

Two or more ADL dependencies typically indicate assisted living readiness. Severe cognitive impairment (moderate-to-advanced dementia) points toward memory care, even if physical ADLs remain partially intact.

Take our free care assessment quiz to get a personalized care level recommendation.

Step 3: Establish a Realistic Budget

Senior care costs in Houston vary widely by care type, location, and room configuration. Expect to discuss:

  • Base monthly rate: Covers housing, meals, housekeeping, and a baseline level of care assistance
  • Care level add-ons: Many communities use tiered pricing where more ADL assistance increases the monthly fee
  • Community fee: A one-time move-in fee ranging from $500–$5,000+ at many facilities
  • Medication management: Some facilities include this; others charge $100–$300/month additionally

Medicaid’s STAR+PLUS waiver covers some assisted living costs for qualifying Texans. Contact your local HHSC office or a Medicaid planning attorney to evaluate eligibility.

Step 4: Use HHSC Licensing Data to Filter Your List

Every assisted living facility and nursing home in Texas is licensed and inspected by the Texas Health and Human Services Commission (HHSC). Before touring any community, check:

  • License status: Active, suspended, or revoked. Only tour ACTIVE-licensed facilities.
  • License type: Type A vs. Type B for assisted living (affects which residents they can legally serve)
  • Recent inspection reports: Look for deficiency citations, scope/severity ratings, and correction plans
  • Enforcement actions: Fines, directed plans of correction, or license conditions

This site displays HHSC license type and capacity for every listed facility.

Step 5: Conduct On-Site Tours

No amount of online research replaces an in-person visit. Tour at least three facilities — visit one during a mealtime and one unannounced (early morning) when possible.

30-Point Evaluation Checklist

Environment & Physical Conditions

  • Does the building smell clean? Any persistent odors?
  • Are hallways and common areas free of clutter and fall hazards?
  • Are call-light response times visible or discussed by staff?
  • Is the outdoor space accessible and secure?
  • What are the room configurations and sizes?

Staff Interactions

  • Do staff greet residents by name as they pass?
  • Are residents dressed appropriately and groomed well?
  • What is the staff-to-resident ratio during day and night shifts?
  • What is the average staff tenure? Annual turnover rate?
  • How does the facility handle staff call-outs and shift gaps?

Dining Experience

  • Does the food look appealing and smell good?
  • Are dietary restrictions and preferences accommodated?
  • What are the dining hours? Can residents have snacks anytime?
  • Are residents actively engaged at the table, or isolated?

Activities & Social Life

  • Review the weekly activity calendar — is it varied and meaningful?
  • Are residents in common areas, or alone in rooms?
  • What transportation is available for medical appointments and outings?

Care Planning & Communication

  • How often are care plans reviewed and updated?
  • Who is the primary point of contact for family concerns?
  • How does the facility notify families of incidents or health changes?
  • What is the process for escalating to a higher level of care?
  • What conditions would require a transfer out of the facility?

Safety & Emergency Preparedness

  • Is there a backup generator? What systems does it power?
  • What is the hurricane evacuation plan for non-ambulatory residents?
  • Are all exits secured (memory care) or accessible (assisted living)?
  • What is the facility’s FEMA flood zone designation?

Financial & Contractual

  • Request the Resident and Family Agreement in writing before touring
  • What triggers a rate increase? How much notice is given?
  • What is the refund policy for community fees?
  • Does the facility accept Medicaid (STAR+PLUS)?

Step 6: Compare and Decide

After touring, rank each facility on your top 5 non-negotiables — typically safety, staff quality, location, price, and the “gut feeling” you get watching staff interact with residents. The right community should feel both safe and warm.

Browse Houston-area facilities by city or use the care assessment tool to narrow your search.