Type B assisted living Texas memory care requirements explained: Chapter 247 licensing, Alzheimer's certification, evacuation standards, and how to verify a San Antonio facility with HHSC.
By San Antonio Senior Advisor Care Team · July 14, 2026
If you are touring memory care in San Antonio, the single most important thing to understand about Type B assisted living Texas memory care requirements is that memory care is not its own license category. Texas licenses assisted living facilities under Chapter 247 of the Health and Safety Code, administered by Texas Health and Human Services Commission (HHSC), and every licensed ALF in the state is classified as either Type A or Type B. A Type A facility may only serve residents who are physically and mentally capable of evacuating the building unassisted, who do not require routine attendance during nighttime sleeping hours, and who are capable of following directions in an emergency. A Type B facility is licensed to serve residents who cannot do those things — residents who need staff assistance to evacuate, who may be unable to follow directions under emergency conditions, who require nighttime attendance, and who may need help transferring from a bed or chair. Because moderate-to-advanced dementia almost always compromises a person's ability to follow evacuation directions, a legitimate memory care community in Bexar County will hold a Type B license. That is the floor, not the ceiling.
The ceiling is the Alzheimer's certification. Texas allows a licensed ALF to hold an additional certification to advertise, market, or otherwise represent itself as providing specialized care for residents with Alzheimer's disease or a related dementia. That certification is layered on top of a Type B license — a Type A facility cannot hold it — and it carries additional obligations around the physical environment, secured egress, staffing patterns, dementia-specific staff training, and the resident's individualized service plan. So when a marketing director in Stone Oak or Alamo Heights tells you the building is a 'memory care community,' the correct follow-up question is narrow and specific: are you a Type B licensed facility with an Alzheimer's certification, and can I see the license? Families who ask that question in the first ten minutes of a tour save themselves months of grief later.
The distinction between Type A and Type B assisted living in Texas rests almost entirely on evacuation capability, and this is where San Antonio families are most often misled — usually not by dishonesty, but by a facility's optimistic read of a parent who was having a good day during the assessment. Under the Type A standard, a resident must be able to evacuate the building without physical assistance from staff. Under Type B, the facility is licensed and staffed to assist residents who cannot. Dementia complicates this because the impairment is cognitive, not physical. A 78-year-old with mid-stage Alzheimer's may be perfectly ambulatory — she can walk out of the building — but if the fire alarm sounds and she cannot process the instruction to leave, or she walks toward the noise instead of away from it, she does not meet the Type A standard. Physical mobility is not the test. The ability to respond appropriately in an emergency is the test.
This matters enormously for placement stability. If a family places a parent with early dementia in a Type A community in Helotes or Leon Valley because the price is lower and the parent 'still gets around fine,' the placement has a built-in expiration date. As the disease progresses and the resident begins wandering at night, requires nighttime attendance, or can no longer follow emergency directions, the Type A facility is not licensed to keep her. The family then faces an involuntary discharge and a second move — the exact disruption that dementia care experts warn causes the sharpest functional decline. Families planning a memory care placement in San Antonio should generally be looking at Type B communities from the start, even if the parent's current needs would technically fit a Type A license today, and should ask directly: at what point would you no longer be able to care for my mother, and what happens then?
The Alzheimer's certification is what separates a Type B building that happens to accept residents with dementia from a facility that is regulated as a dementia care provider. HHSC's requirements for certified facilities address several areas at once. The physical plant must support residents who wander — this typically means a secured unit with controlled or delayed-egress doors, an enclosed and accessible outdoor area, and interior wayfinding that reduces agitation and elopement risk. Staffing must be adequate to the population, with awake staff available during nighttime hours, since nighttime attendance is a defining feature of Type B licensure and dementia symptoms frequently escalate in the evening. And critically, direct-care staff must receive dementia-specific training — orientation before they work independently with residents, plus ongoing continuing education — rather than the generic ALF training that Type A staff receive.
Families should ask to see how these requirements translate into daily operations, because compliance on paper and quality in practice are different things. Reasonable questions on a tour: How many awake, direct-care staff are on the memory care unit at 3:00 a.m., not just at 3:00 p.m.? What specific dementia training did the caregivers on this hall complete, and when? How is the individualized service plan for a resident with dementia different from the plan for a resident with mobility needs? What is your protocol when a resident attempts to exit, and how many elopement attempts have you documented this year? Because the exact hour requirements and rule provisions are periodically updated by HHSC, families should verify current standards against the agency's assisted living rules directly at hhs.texas.gov rather than relying on a facility's summary of them.
Every claim a facility makes about its license is verifiable in about five minutes, and no San Antonio family should sign an admission agreement without doing it. HHSC operates a public Long-Term Care Provider Search — apps.hhs.texas.gov/HSPubDisclosure — that lists licensed assisted living facilities statewide. Search by facility name or by county (Bexar, Comal, Guadalupe, Kendall) and the record will show the license type, whether the facility holds an Alzheimer's certification, the licensed capacity, the administrator of record, and the license status and expiration. If the community that told you it provides memory care shows up as Type A, or shows no Alzheimer's certification, that is a discrepancy you need explained in writing before you go any further. If it does not appear at all, walk away — an unlicensed facility is not a facility, it is a liability.
The same HHSC disclosure system publishes inspection and survey history, including deficiencies cited and any enforcement actions. Read the deficiency narratives, not just the count. A single administrative citation for a paperwork lapse is very different from repeated findings involving resident supervision, elopement, medication administration errors, or failure to report an incident — and for a dementia resident who cannot advocate for herself or tell you what happened, supervision and reporting findings are the ones that matter most. Print the survey history and bring it to the tour. Ask the administrator to walk you through what was cited, what the plan of correction was, and what changed operationally. An administrator who answers that question openly and specifically is telling you something useful about the building. An administrator who is defensive or vague is also telling you something useful.
San Antonio's memory care market is shaped by the region's geography and demographics. Type B communities with Alzheimer's certification cluster in the northern and northwestern suburbs — Stone Oak, Sonterra, the Medical Center corridor near Methodist Hospital and UT Health University Hospital, and out toward Helotes and Boerne — with additional options in Alamo Heights, the Northeast side, and increasingly in New Braunfels and Schertz as Comal and Guadalupe county development pushes outward. Proximity matters more than families expect: adult children who can drop in unannounced twice a week are the single best quality-control mechanism a memory care resident has, and a community that is a beautiful 45-minute drive away tends to get visited less than an adequate one that is fifteen minutes from your office. With Bexar County roughly 65 percent Hispanic, bilingual capability is also a genuine clinical issue rather than a nicety. Residents with advancing dementia frequently lose their second language and revert to Spanish, their first — so a Spanish-speaking parent may be able to communicate her pain, fear, or needs only to a caregiver who speaks Spanish. Ask specifically how many Spanish-speaking direct-care staff work the memory care unit on nights and weekends, not just whether the facility 'has bilingual staff.'
On cost, Type B memory care in the San Antonio metro generally runs meaningfully above standard assisted living because of the higher staffing ratios, awake overnight coverage, and secured environment the certification requires — and pricing is often structured as a base rate plus a care-level fee that rises as the dementia progresses. Ask for the full care-level fee schedule in writing, not just the entry rate, and ask what triggers a move to the next level. For funding, three local resources are worth contacting early. AACOG, the Alamo Area Council of Governments and the region's Area Agency on Aging, provides benefits counseling and caregiver support at (210) 362-5200 or aacog.com. Texas Medicaid's STAR+PLUS HCBS waiver — administered locally through managed care organizations including Molina Healthcare, Superior HealthPlan (Centene), UnitedHealthcare, and Amerigroup — can cover assisted living services for those who qualify financially and functionally, though interest lists can be long, so get on them before you need them. And veterans and surviving spouses, particularly the large JBSA and Fort Sam Houston community served by the Audie L. Murphy VA Medical Center, should look at VA Aid and Attendance through the Texas Veterans Commission at tvc.texas.gov, which can add a substantial monthly pension benefit toward memory care costs.
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