For Residents

• Know your rights.
• Tell the nursing facility or assisted living facility staff of concerns as soon as possible, and follow up with the appropriate staff.
• Be familiar with your admission agreement, resident handbook, facility policies and other information provided at move-in.
• As a resident, stay involved with family and friends. Make them aware of your care and activities.
• Understand and use the care planning process. Ask for a care plan or service plan meeting and invite your ombudsman if you need help.
• Participate actively in the facility's resident council. Your family is encouraged to participate in the family council. The voice of many residents can be more influential than one person. The facility should:
  • Provide a private space to meet.
  • Designate staff to assist and respond to written requests.
  • Listen to the views and act upon grievances and recommendations affecting resident care and life.
• Consult your physician with any concerns about medical care. A physician directs the medical care of each resident.
• Support community involvement and interaction. You have the right to participate in activities in and out of the facility.
• Talk to your ombudsman and HHS surveyors when they visit.

• There are several levels of intervention, and attempts to resolve problems may be informal or formal, inside or outside of the facility. The following options can happen one at a time or simultaneously.
• Talk with staff in the facility.
• Ask for a facility grievance form and turn in a written grievance.
• Call or write to the owner of the home.
• Bring your concern to the resident council if you are a resident.
• Bring your concern to the family council if you’re a family member or a friend of the resident.
• Call an LTC ombudsman for help with any of these options, or to work on the problem with you. Find an ombudsman.
• Contact the Office of the State LTC Ombudsman by email at ltc.ombudsman@hhs.texas.gov or call 800-252-2412.
• Call Complaint and Incident Intake (Regulatory) at 800-458-9858 or email a complaint to ciicomplaints@hhsc.state.tx.us.

Nursing facilities

Some people enter a nursing facility as private pay residents, using a combination of resources to pay their expenses and eventually "spend down" their resources and meet the requirements for Medicaid to pay for care.

Some nursing facilities require payment upon admission. If a resident pays for nursing facility care with personal funds and depletes their resources, they may then qualify for Medicaid. In such cases, the state of Texas reimburses the nursing facility for up to three months before Medicaid approval. The nursing facility then refunds personal payments according to specific time limits.

Assisted living facilities

People who live in assisted living facilities typically pay for their care with personal funds. The facility's cost is based on the resident's needs. Charges are explained and agreed upon in the resident contract prior to the resident moving into the facility.

Read more about why someone may need long-term care, where you can receive services, and how to pay for it on the Long-Term Care page.

Long-term care insurance is sold by private insurance companies to cover costs of care in a nursing facility, some assisted living facilities, your own home, or a day activity and health services facility (also called adult daycare).

Medicaid provides health care services for low-income people. In Texas, Medicaid may pay all or part of nursing facility and assisted living costs for eligible clients. However, residents contribute toward their care, based on income and other considerations.

• Find information about qualifying for nursing facility Medicaid.
• Apply for Medicaid.
• Get help completing your Medicaid application from a benefits counselor.

Medicare is a federal health insurance program for people 65 years of age or older and certain people with disabilities. If you need skilled nursing facility care, sometimes called rehabilitative care, Medicare may pay for limited time periods. It doesn’t pay for ongoing long-term care, such as extended nursing facility stays.

Medigap is a supplemental Medicare insurance policy designed to fill in the "gaps" in Medicare coverage. This means that Medigap can help you cover Medicare co-payments and deductibles, which could include a portion of your daily payments during a short-term stay at a skilled nursing facility.

Like Medicare, Medigap policies generally don’t cover long-term stays in a nursing facility, nor do they cover things like vision or dental care, hearing aids, eyeglasses or private-duty nursing.

If you are part of an employee group plan, a member of a Medicare HMO or on Medicaid, you probably don’t need a supplemental Medicare insurance policy, so consider these options before you buy a Medigap policy.