Texas assisted living rules: what you must document about each resident

Texas is one of the states that spells out personal routines and activity preferences in the assessment itself. Its list of 20 required assessment items reads partly like a clinical intake and partly like a getting-to-know-you interview. This page walks through that list, the service plan, activities, and the additional rules for Alzheimer's certified facilities, using rule text checked on September 28, 2026 against the Cornell Legal Information Institute's copy of the Texas Administrative Code.

Who these rules cover

26 TAC Chapter 553, Licensing Standards for Assisted Living Facilities, is issued by the Texas Health and Human Services Commission. Texas licenses two types of assisted living facility, Type A and Type B. A Type B facility, or a unit within one, can be certified to provide specialized care for residents with Alzheimer's disease and related disorders (§ 553.27)⁶. Certified facilities follow the general standards in Subchapter E plus the added standards in Subchapter F.

Any facility that advertises memory care must give residents the Assisted Living Facility Memory Care Disclosure Statement and say whether it is Alzheimer's certified; certified facilities also provide HHSC Form 3641¹.

The comprehensive assessment: what it covers and by when

Within 14 days of admission, a resident comprehensive assessment and an individual service plan for providing care, which is based on the comprehensive assessment, must be completed.26 TAC § 553.259(b)

The assessment is completed by appropriate staff on a form the facility develops. If the facility cannot get some information, it should document its attempts. The rule lists 20 required items, (A) through (T). Several go well beyond clinical status:

• (B) primary language
• (C) sleep-cycle issues
• (E) psychosocial issues, including adjustment, signs of depression and anxiety
• (F) Alzheimer's disease/dementia history
• (G) activities of daily living patterns
• (H) involvement patterns and preferred activity pursuits
• (J) communication

Items (G) and (H) are the ones that ask about the person's life:

activities of daily living patterns (e.g., wakened to toilet all or most nights, bathed in morning/night, shower or bath);26 TAC § 553.259(b)(1)(G)

involvement patterns and preferred activity pursuits (e.g., daily contact with relatives, friends, usually attended religious services, involved in group activities, preferred activity settings, general activity preferences);26 TAC § 553.259(b)(1)(H)

The remaining items cover cognitive skills, physical functioning, continence, nutrition, dental status, diagnoses, medications, special treatments, recent hospitalizations and preventive health needs.

So Texas requires daily routines and activity preferences by name. It does not require a full life history, occupation, or "what brings comfort" in the general assessment. Those appear only in the certified Alzheimer's rules, as social history and dislikes.

The service plan

The individual service plan is based on the comprehensive assessment and due within the same 14 days. The resident, or the person responsible for the resident's health care decisions, approves and signs it, and the facility "must provide care according to the service plan"¹:

The service plan must be updated annually and upon a significant change in condition, based upon an assessment of the resident.26 TAC § 553.259(b)(2)

Emergency admissions must also be assessed and have a service plan. For respite clients, a service plan can be kept for six months.

The general rule does not list the plan's contents item by item. Because it must be based on an assessment that includes routines and activity preferences, a plan that ignores them is harder to defend.

Activities and social programming

For facilities that are not Alzheimer's certified, the activities rule is minimal²:

The facility must provide an activity or social program at least weekly for the residents.26 TAC § 553.261(d)

Residents also have the right to participate in activities of social, religious or community groups, and to practice the religion of their choice (§ 553.267)⁵. Many facilities offer far more than weekly programming. The assessment's "preferred activity pursuits" item is the natural source for deciding what to offer.

Alzheimer's certified facilities

Subchapter F raises the bar considerably. The comprehensive assessment is required within 14 days of admission and annually, covering the same 20 items. The service plan is developed by staff "with input from the family, if available," and³:

The service plan must address the individual needs, preferences, and strengths of the resident. The service plan must be designed to help the resident maintain the highest possible level of physical, cognitive, and social functioning.26 TAC § 553.307(d)

The activities rule, § 553.309, is one of the most detailed in any state⁴. Activities must be "individualized, based upon the resident assessment," and the program must balance cognitive, recreational and ADL activities. Cognitive activities are defined to include "storytelling, poetry readings, writing, music, reading, discussion, reminiscences, and reviews of current events." The rule also requires:

The activity director or designee must review each resident's medical and social history, preferences, and dislikes, in determining appropriate activities for the resident. Activities must be tailored to each resident's unique requirements and skills.26 TAC § 553.309(e)

• On weekdays, each resident is offered at least one cognitive, two recreational and three ADL activities daily; structured activities last at least 30 minutes and total at least six and a half hours a week, plus an hour and a half on weekends.
• Residents who skip a large group activity must be offered at least one small-group or one-on-one activity per day.
• A designated employee (16 or fewer residents) or a qualified activity director for at least 20 hours a week (17 or more) plans the program, with a monthly schedule and a consistent weekly routine.

What surveyors tend to look for

Based on what the rules say to document:

• A comprehensive assessment within 14 days that addresses all 20 items, including ADL patterns and preferred activity pursuits, or documents attempts to get missing information.
• A signed service plan based on that assessment, updated annually and after significant changes.
• Care delivered according to the plan.
• For Alzheimer's certified facilities: family input in the plan, a record that the activity director reviewed social history, preferences and dislikes, and a monthly schedule that meets the daily and weekly minimums.

Gathering routines, preferences and life history well

• Use the full 14 days. Items (G) and (H) are easier to answer after a week of watching the resident's real routine than at the admission desk.
• Ask open questions. "Tell me about a normal morning at home" answers the ADL-pattern item better than "morning or evening bath?"
• Bring in family. They know the church, the friends, the card game, and the radio station.
• Record dislikes and comfort. The Alzheimer's rule asks for dislikes explicitly. Note what soothes the resident and what topics to avoid.
• Revisit annually and at every significant change, when the plan is updated anyway.

How Porchlight can help

Porchlight helps you gather and keep the routines, activity preferences and social history that Texas's assessment and Alzheimer's activity rules ask for, in the resident's own words. A resident taps one large button on a tablet, a life question is read aloud and shown in large type, and the answer is recorded and transcribed. The 800+ human-written questions are organized by life chapter; any question can be skipped and nothing is scored. Staff can record profile facts, including topics to avoid, and receive a "Know Your Resident" briefing with conversation starters and a printable life-story biography. Families get a private page to listen, leave voice replies and add their own questions and photos. The assessment, service plan and compliance remain your facility's responsibility.

Frequently asked questions

How long does a Texas assisted living facility have to complete the resident assessment?

Within 14 days of admission, the facility must complete a comprehensive assessment and an individual service plan based on it. Emergency admissions must also be assessed and have a service plan.

Does the Texas assessment include resident preferences and routines?

Yes. The 20 required items include activities of daily living patterns, such as bathing in the morning or at night, and involvement patterns and preferred activity pursuits, such as daily contact with relatives and friends, religious services attended, group activities and general activity preferences. It also covers primary language, sleep-cycle issues and psychosocial issues.

When must a Texas service plan be updated?

The service plan must be updated annually and upon a significant change in condition, based on an assessment of the resident. The resident or the person responsible for health care decisions approves and signs it.

What activities must a Texas assisted living facility provide?

A facility that is not Alzheimer's certified must provide an activity or social program at least weekly. Alzheimer's certified facilities must run a daily structured program of cognitive, recreational and ADL activities with weekly minimums and an activity director or designated employee.

Do Texas Alzheimer's certified facilities have to use a resident's social history?

Yes. The activity director or designee must review each resident's medical and social history, preferences and dislikes when determining appropriate activities, and the service plan must address the resident's individual needs, preferences and strengths, with family input if available.