El Paso Senior AdvisorWhat is the main difference between assisted living and a nursing home in Texas?
A nursing facility provides 24-hour licensed nursing care and rehab under a Texas nursing facility license and CMS certification, while assisted living provides housing, meals and personal care with limited health services and cannot keep a resident who is permanently bedfast.
HHSC lists 22 licensed nursing facilities in the metro with 2,585 beds; CMS rates 22, and in the October 1, 2026 release 10 hold one star overall while 1 hold four or five. Nursing homes are rated by CMS; assisted living is not.
When does a parent need a nursing facility instead of assisted living?
A nursing facility is needed when a person needs continuous skilled nursing, is permanently bedfast, needs more than a facility's staff can safely provide, or needs short-term rehab after a hospital stay.
Many El Paso residents use both: rehab in a nursing facility after a hospital stay, then assisted living. Ask the hospital case manager whether long-term nursing care is truly needed or whether rehab followed by assisted living with home health would work.
Which costs more in El Paso, assisted living or a nursing home?
Private-pay nursing facility care usually costs more than assisted living for comparable rooms; the Texas medians show $5,666 a month for assisted living, $5,627 for a semi-private nursing room and $7,604 for a private nursing room, but the semi-private figure reflects Medicaid-heavy pricing.
Medicaid pays nursing facility care for eligible residents without a room-and-board gap, which makes a nursing facility more affordable than assisted living for people with little income. STAR+PLUS can pay assisted living care services only.
How do we compare quality between the two?
Compare nursing homes using CMS star ratings, inspections, staffing and fines, and compare assisted living using HHSC's TULIP inspection findings and penalties; both records are on our facility pages.
Visit both at unannounced times. In a nursing facility, ask about nurse staffing at night and turnover; in assisted living, ask how many staff are awake at night and how the facility handles a fall.
Can a parent move from assisted living to a nursing home later?
Yes, and it is common; ask the assisted living facility which nursing facilities it works with, and whether a hospital stay will be needed first for Medicare to cover rehab.
Keep a current medication list and advance directives on file so a transfer goes smoothly, and choose a nursing facility certified for Medicaid if long-term care may be needed.
Side by side
| Assisted living | Nursing facility | |
|---|---|---|
| Care | Personal care, supervision, medication help | 24-hour nursing and rehab |
| Residents | Not permanently bedfast | Any level of nursing need |
| Ratings | TULIP findings, no stars | CMS star ratings |
| Medicaid | STAR+PLUS pays care, not room and board | Medicaid pays the full cost for eligible residents |
Sources: Texas Health and Safety Code chapters 142, 242 and 247; 26 Texas Administrative Code chapters 553, 554, 558 and 559; HHSC program handbooks; CareScout, CMS and VA rate tables, as cited above. See our editorial standards.
