• Residential Care Homes

Licensing concerns: Small residential care homes are not required to be licensed under Texas law. Many elect to be licensed as assisted living or Alzheimer's facilities, and thus subject themselves to regulation and inspections, and are to be commended for doing so. Licensed homes are monitored by the state, as are larger assisted living or dementia facilities.

Unlicensed homes may be excellent care providers, but the burden is on the family to determine if that is so and to monitor care since there is no official oversight. Unfortunately, some unregulated residential care homes have been found to be negligent care providers, with inadequate staffing, unclean conditions and inadequate care and nutrition for residents. This is the exception, and not the rule, but these few "bad apples" in the barrel make it absolutely necessary for an individual or family considering use of a residential care home to inspect that facility (and at least once on a "surprise" visit), observe the cleanliness, activities and relative contentment of current residents, eat a meal with the residents, observe the home for cleanliness and safety factors, and ask for references. If possible, meet the families of other residents and arrange to talk with them in private away from the home. Be sure this is a place where your loved one will be safe and content before moving him or her into the facility. Take the time before making a decision to ensure this will be a good move.

Services: That very important warning having been given, the majority of residential care homes provide safe, clean, supportive and secure environments for older adults who can no longer live alone at home and they are a cozy alternative to larger facilities. Residents are generally encouraged to participate in normal household tasks, such as cooking, folding laundry or dusting, so they feel more at home. They can putter around in the garden or flower beds, just as they would have in their own homes. These homes often have a house dog, cat or bird to provide affection to residents (and to receive love from them in return). The homes may offer private bedrooms or semi-private bedrooms. Some have individual bathrooms and some are shared. Residents receive three nutritious meals per day and snacks. Their medications are administered to them. Many homes can take residents to their medical appointments if family members cannot do so. Residents receive assistance with bathing, dressing and grooming. Most residential care homes are secured, which means that a code is required to enter or leave the property. This keeps residents from wandering away, but permits family members ready access to the home. Most secure the outdoor areas as well, so residents can be indoors or outdoors, but are always safe. Activities should be offered throughout the day and should be designed for the functional level of the residents in the particular home. Residents should NOT be left in front of a television all day long, they should be kept busy and active. If the home accepts dementia residents, staff should be specially trained in dementia care.

About listings on our web site: Because of the lax licensing and supervision of residential care homes in Texas, E-Senior Services is selective about the residential care homes listed on the site. This is one service category where our staff wants to meet owners or home staff, learn about their homes and perhaps even visit before listing a home on the site. A listing on our web site does not mean an endorsement of any specific home, nor does it imply in any way that E-Senior Services guarantees the quality of care in a home. It does mean that at the time the home was added to our listings, we felt the home was worthy of consideration, keeping in mind the warnings and recommendations stated above. For that reason, while there are a large number of residential care homes in the DFW metro area, our provider listings for them may be small. Any home that would like to included is invited to contact us for consideration as a listed care home. If you have a particularly good or bad experience with a residential care home, we would be interested in hearing your opinion.

Payment: Many residents are very content in good residential care homes, and the costs can be equal to or lower than larger assisted living or dementia care facilities. If the home is unlicensed, then generally residents will be "private pay", meaning that the resident or family pays for care from their own funds. Long-term care policies may pay for care in licensed residential care homes, but generally not for care in unlicensed homes. These homes generally do not qualify for the Medicaid program, with some exceptions.

What to look for: If you or your family member is interested in the smaller, more personal environment of a residential care home, identify several in your area. Inspect each home in which you are interested. Look at the layout -- will it cause any mobility problems for the resident? Are the services offered adequate to support the resident (read the contract and ask for a listing of specific included services)? Is there awake staff in the home at night or simply a sleeping staff member on call? Will your resident have a private or semi-private room and what is the cost difference? Will he have a private bathroom or will he share? What is a typical menu and does it meet any dietary restrictions he has? How are medications secured and administered? What are typical activities offered during the week? If you cannot take your resident to a medical appointment, can the staff do so, and is there a charge if they do? What is the monthly rate for care and are there any potential add-on charges? Does the family or the staff do the resident's laundry? Ask if there are pets in the home and, if so, arrange for your family member to meet them to see if he is comfortable having them in his new home. Can your resident bring his dog or cat with him? Observe other residents and staff in the home and ask to talk to family members of other residents; get their candid opinions of the home, good and bad. Ask if the home is licensed and, if so, for what (assisted living at what level and/or Alzheimer's care). If it is licensed, check with the state to see if there are recent complaints or violations recorded.

What if physical or cognitive needs increase? It is critical to ask what levels of care the home will provide if your resident's physical or cognitive function declines. If your family member becomes incontinent, can he stay there? If he becomes more confused and a little belligerent, can the staff deal with him? If he develops greater problems with mobility, and perhaps needs a wheelchair to move about the home, can the physical structure, the staff and other residents accommodate that? If he needs help getting on or off the toilet, or in or out of bed, can they provide that assistance? Some homes may offer these higher levels of care and others may request that residents leave if their needs reach a higher level. Both are legitimate policies for a residential care home, but the resident and family need to know before moving in whether a move to a higher level of care may still be needed in the future so that a plan can be developed.

Visit frequently to monitor care: When a loved one moves into a care facility, whether it is large or small, it is always important that family and friends visit often. This is important to lift the spirits of the individual and to keep him or her a vital part of the family. It is also important to monitor the level of care the individual receives. This is perhaps even more important in a residential care home than in some larger facilities, particularly if it is unlicensed, because regulation and oversight are lax or nonexistent and, with fewer residents, fewer family members visit the home regularly. If there is no family close by who can visit frequently, it may be helpful to find a neighbor, or perhaps someone from the church or synagogue, who can do so and who will report back to the family regularly. Alternatively, you can hire a geriatric case manager (see the Geriatric Case Manager section of our site under Medical Specialists) who can visit and monitor care for the family. It is hard to manage someone's care needs long distance and it can be reassuring to have a professional available locally to monitor your family member's health, mood and care, to make recommendations to the family and to respond to medical emergencies.