Elderly day care requirements in Texas are set by the Texas Health and Human Services Commission (HHSC) under the Day Activity and Health Services (DAHS) licensing framework. Any facility that provides daytime supervision, socialization, and health-related services to adults with chronic conditions must hold a valid HHSC license under Texas Human Resources Code Chapter 103, and the operating rules live in Title 26 of the Texas Administrative Code, Chapter 559.1Legal Information Institute. 26 Texas Admin Code 559.205 – Criteria for Licensing Those rules cover licensing, staffing, building safety, medication handling, daily programming, and enforcement.
The License to Operate
No one can run a DAHS facility in Texas without a license from HHSC.2Legal Information Institute. 26 Texas Admin Code 559.201 – Purpose Applicants file through HHSC’s online licensure portal, upload the required documents, and pay a license fee based on the term: $25 for one year, $50 for two years, and $75 for three years.3Legal Information Institute. 26 Texas Admin Code 559.219 – License Fees HHSC uses staggered expirations, so terms vary.
Two inspections gate the license. First, HHSC conducts an on-site life safety code inspection to confirm the building meets physical plant standards. Once the facility admits one to three clients, the applicant notifies HHSC to schedule a separate health inspection covering operational and care standards. After that, an annual fire marshal inspection is required, and the report has to be uploaded when renewing the license.4Texas Health and Human Services. DAHS Standard Inspection Checklist
Centers receiving Medicaid funding must also meet federal compliance requirements on top of state licensing.
Staffing Ratios and Training
Texas sets a firm floor: at least one direct service staff member for every eight participants, maintained during all service hours. The only carve-out is facility-provided transportation.5Legal Information Institute. 26 Texas Admin Code 559.61 – Staffing Ratio and Hours Centers serving higher-acuity participants often staff above the minimum, but 1:8 is what HHSC enforces.
Every employee with direct participant contact, including administrators, care staff, and volunteers, must complete orientation and ongoing training. Required subjects include elder care techniques, communication, and how to recognize abuse or neglect. Training hours must be documented and produced for HHSC on request.
Background Checks
Before offering employment to anyone in a role involving direct participant contact, the facility must obtain criminal history information from the Texas Department of Public Safety.6Texas Health and Human Services. Appendix VIII, Criminal History Check of Employees in Certain Agencies Serving Elderly or Persons with Disabilities Applicants must be told upfront that a conviction check is required before any offer.
Two registries also have to be searched before hiring and again every year: the Employee Misconduct Registry (EMR) and the Nurse Aide Registry. Anyone listed on either has been found responsible for abuse, neglect, exploitation, or misconduct against a resident or consumer, and cannot be employed at a regulated facility.7Texas Health and Human Services. Employee Misconduct Registry (EMR) A clean record at hiring is not a permanent pass; the annual re-check is the point.
Building, Fire, and Food Safety
The physical plant has to work for adults with mobility limitations. HHSC checks accessible design, lighting, ventilation, temperature, and general maintenance during the life safety inspection and later surveys. Fire safety is a core requirement: working smoke detectors, fire extinguishers, marked emergency exits, a written emergency response plan for disasters, medical crises, and power outages, and documented fire drills on a regular schedule. The fire marshal report has to stay current.4Texas Health and Human Services. DAHS Standard Inspection Checklist
Kitchens serving meals must run a written sanitation and food preparation program that meets or exceeds state and federal standards, including Texas Administrative Code Chapter 228 and applicable USDA or FDA rules. Whoever oversees food preparation should hold a current certification from a Texas Department of State Health Services-approved food safety course.8Texas Health and Human Services. Area Agency on Aging Policies and Procedures Manual – F-1800 Food Service Requirements Restrooms need handwashing stations, and staff follow standard infection control when handling medical waste or assisting with hygiene.
Medication Rules
Medication handling is one of the most closely regulated areas. Only a person holding a current license under state law that authorizes medication administration may give prescription drugs to a participant who cannot or chooses not to self-administer.9Legal Information Institute. 26 Texas Admin Code 559.69 – Medications In practice that means a licensed nurse or trained medication aide.
All medications given at the facility must come from a pharmacy or the participant’s prescribing practitioner. Each participant’s medication profile has to list the medication name, strength, dosage, directions, route of administration, prescription number, pharmacy name, and date issued.9Legal Information Institute. 26 Texas Admin Code 559.69 – Medications Sample medications can be used only if prescribed to that specific participant with dosage instructions included.
When a nurse only assists with self-administration, that assistance is limited to reminding the participant at the prescribed time, opening containers, pouring the prescribed dosage, and returning medications to locked storage.9Legal Information Institute. 26 Texas Admin Code 559.69 – Medications Any missed dose has to be documented in writing with the date, time, and medication name. That paper trail is what surveyors read first.
Required Daily Activities
A DAHS center has to program the day, not just supervise it. The rules require at least three social activities daily, and a monthly activity calendar must be posted in a visible location at least one week before the scheduled activities.10Legal Information Institute. 26 Texas Admin Code 213.211 – Adult Day Services Activities must speak to participants’ social needs and interests and can happen at the facility or in the community.
Physical rehabilitative services are also required, including restorative nursing and both group and individual exercises such as range-of-motion work.10Legal Information Institute. 26 Texas Admin Code 213.211 – Adult Day Services Programming has to accommodate different levels of mobility and cognitive function, including participants with dementia.
Inspections and Enforcement
HHSC runs both scheduled and unannounced inspections. During a survey, inspectors review records, interview staff, observe care, and assess the physical environment. Facilities must make all books, records, and electronic documents available on request, and HHSC can photocopy documents, photograph conditions, and use recording devices.4Texas Health and Human Services. DAHS Standard Inspection Checklist
Violations are recorded as “Not Met” findings on the inspection checklist, and a copy is left with the facility at the exit conference.4Texas Health and Human Services. DAHS Standard Inspection Checklist Under Texas Human Resources Code Chapter 103, HHSC can impose administrative penalties. Publicly posted enforcement amounts have ranged from a few hundred dollars to several thousand per facility, and an uncollected original penalty can be tripled by statute. Repeated or serious violations can lead to license suspension or revocation. Medicaid-funded centers also risk losing that funding for federal noncompliance.
Criminal Liability for Abuse or Neglect
Administrative penalties are not the only exposure. Texas Penal Code Section 22.04 makes it a crime to intentionally, knowingly, recklessly, or with criminal negligence cause bodily injury, serious bodily injury, or serious mental impairment to an elderly individual, defined as someone 65 or older. Intentionally or knowingly causing serious bodily injury is a first-degree felony; doing so recklessly is a second-degree felony. Bodily injury caused with criminal negligence is a state jail felony. The statute specifically reaches facility owners, operators, and employees.
How to Verify a Facility and File a Complaint
Before enrolling a family member, check the facility’s standing with HHSC. The Texas Long-Term Care Provider Search lets anyone look up licensed DAHS facilities, view inspection histories, and see enforcement actions. It is available through the HHSC website, and the HHSC Licensing and Certification Unit can be reached at 512-438-2630.11Texas Health and Human Services. Day Activity and Health Services (DAHS) Ask to see the most recent inspection report during a tour; a reputable center will show it.
To report suspected abuse, neglect, or substandard care, call HHSC’s Complaint and Incident Intake line at 800-458-9858, staffed Monday through Friday, 7 a.m. to 7 p.m. Complaints can also be submitted online or by email, and after-hours voicemails receive a callback by the next business day.12Texas Health and Human Services. Complaint and Incident Intake HHSC investigates complaints and can send an unannounced inspection based on what it hears.