Texas · nursing homes
Texas nursing home staff requirements: what you have to hold on every person
A Texas nursing facility has to hold thirty dated things on file for the people it employs. Twenty-eight of them are federal and are the same in every state. Two are Texas's own. The one that catches buildings is not the check you run before somebody starts. It is that Texas makes you run two of those checks again, on everybody, every year.
What Texas adds
Two things, on top of everything every nursing home in the country already holds. Each one names the section of Texas law it comes from, so you can read it yourself rather than take our word for it.
| What we track | How often | Where the rule comes from |
|---|---|---|
| A criminal history check, and a look at the nurse aide list and the misconduct listThe yearly repeat is the part people miss. It covers employees, and it covers anyone else you let near a resident. | Before they have any contact with a resident, and the two lists again every year | Tex. Health & Safety Code 250.003 |
| A TB check that follows the national approachTexas points at the 2019 national guidance rather than writing its own schedule, so a Texas building does far less TB testing than a California one. | Once when they start. After that it is a set of questions and some teaching, not a test, unless your own risk review says otherwise. | 26 TAC 554.1601 |
The yearly repeat is the whole story
Most states check a person once, on the way in. Texas checks twice on the way in and then again every twelve months, for as long as the person works for you.
That turns a hiring task into a tracking task, and it is a different kind of work. A hiring task has a natural trigger: somebody new starts, you do the thing. A yearly task on 90 people has 90 triggers scattered through the year and no natural reminder attached to any of them, which is exactly the shape of work that a paper file loses.
If one of those yearly checks is missed and the person turns out to be on either list, the finding is not a training issue. It is a person who should not have been on your floor, on a date you can point to.
What Texas does not add
Texas does not carry a state TB testing schedule of its own. It reads the national guidance, which means a test when somebody starts and questions after, and it means a Texas building has far fewer TB dates to hold than a California one.
Texas does not add a state training list for staff outside the nurse aide hours. The eleven teaching topics further down this page are federal and cover everybody.
What every nursing home in the country holds
These twenty-eight are the same in Texas as they are everywhere else, and they are most of the job. Each one names a CMS tag, a piece of the federal code, or both. The guides go through the ones that get cited most.
Licences and certificates
| What we track | How often | Where the rule comes from |
|---|---|---|
| A current RN license | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| A current LPN license | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| Nurse aide certification, still active on the state list | When it runs out. Most last a year. | F728 · 42 CFR 483.35(d) |
| A current license for therapy, social work and pharmacy staff | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| A current administrator license | When it runs out. Most last a year. | F836 · 42 CFR 483.70(a) |
| Proof the food service director is qualified, where no dietitian works full time | When it runs out. Most last 3 years. | F801 · 42 CFR 483.60(a)(2) |
| Proof the activities lead is qualified | When it runs out. Most last 2 years. | F680 · 42 CFR 483.24(c)(2) |
Checks you run on a person
| What we track | How often | Where the rule comes from |
|---|---|---|
| A look at the state nurse aide list before the first shift | Before their first shift, then every 2 years | F729 · 42 CFR 483.35(d)(4) |
| A check for any finding of abuse or neglect against them | Every year | F606 · 42 CFR 483.12(a)(3) |
Health and safety
| What we track | How often | Where the rule comes from |
|---|---|---|
| A first TB check: history, symptoms and a test | Once, in their first two weeks | CDC 2019 via 42 CFR 483.80(a)(2) |
| The hepatitis B shot offered free, and their answer written down | Once, within ten working days of starting | 29 CFR 1910.1030(f) |
| A mask fit test for anyone who wears an N95 | When it runs out. Most last a year. | 29 CFR 1910.134(f) |
| A current CPR card at the healthcare level | When it runs out. Most last 2 years. | F678 · 42 CFR 483.24(a)(3) |
Teaching and in-service
| What we track | How often | Where the rule comes from |
|---|---|---|
| Orientation, before they work on their own | Once, in their first week | F940 · 42 CFR 483.95 |
| Teaching on abuse, neglect and dementia care | Every year | F943 · 42 CFR 483.95(c) |
| Teaching on residents' rights | Every year | F942 · 42 CFR 483.95(b) |
| Teaching on stopping infection spreading | Every year | F945 · 42 CFR 483.95(e) |
| Teaching on the quality program | Every year | F944 · 42 CFR 483.95(d) |
| Teaching on the compliance and ethics program, if your company runs five or more buildings | Every year | F946 · 42 CFR 483.95(f) |
| Teaching on mental health and behavior needs | Every year | F949 · 42 CFR 483.95(i) |
| Teaching on talking with residents, for hands-on staff | Every year | F941 · 42 CFR 483.95(a) |
| Teaching on what to do in an emergency | Every year | 42 CFR 483.73(d)(1) |
| Teaching on blood and needle safety | Every year | 29 CFR 1910.1030(g) |
| Teaching on the chemicals they handle | When they start, and again when a new chemical arrives | 29 CFR 1910.1200(h) |
| Twelve hours of teaching for each nurse aide | 12 hours every year, counted from their own start date | F947 · 42 CFR 483.95(g) |
| A written look at how each nurse aide is doing | Every year | F730 · 42 CFR 483.35(d)(7) |
| Teaching on keeping resident information private | When they start, and again whenever your privacy policy changes | 45 CFR 164.530(b)(1) |
Employment paperwork
| What we track | How often | Where the rule comes from |
|---|---|---|
| Form I-9, filled in and kept | Once, in their first three days of work | 8 CFR 274a.2(b)(1)(ii) |
Three more that nearly every building does anyway
These three are not on the tables above, and the reason is narrow: they rest on federal guidance or on a reporting program rather than on a rule with a section number. Almost every nursing home does all three, several state Medicaid programs have made the first one a condition of payment, and a page that called them law would be a page a surveyor would stop trusting.
- A check against the federal list of people barred from Medicare and Medicaid work. Every month. A name that was clear in January can be on it in February, so this is one to run on employees and contractors alike.
- Teaching on the signs of TB. Every year. What the signs are, who is at risk, and what to do about it. Teaching, not a test.
- A flu shot, or their reason for saying no. Every year. Their answer either way, written down. The count of who said yes is what goes in the yearly report.
What you still have to check yourself
Real in Texas, and not on the tables above, because we could not put a section number next to them without guessing. Guessing at a citation is worse than admitting the gap, because the guess is the thing somebody quotes back.
- Twenty-four hours of teaching for every nurse aide over two years, including hours on caring for older people and on dementia. The rule is real and HHSC publishes it. We could not pin it to a section number, so it is not in the table above.
- The yearly HHSC infection control course for nurse aides. Same position as the line above.
- Extra dementia hours if you run an Alzheimer's certified unit. These attach to the unit, not to the building, so a building without one does not carry them.
Where the Texas rows came from
Read on .
Questions Texas buildings ask
Does Texas require an annual background check on nursing home staff?
Texas requires the nurse aide registry and the Employee Misconduct Registry to be checked before hire and again every year, under Tex. Health & Safety Code 250.003. The criminal history check itself is run before the person has contact with a resident. So the answer is that two of the three repeat yearly, and that yearly repeat is the part most buildings do not have a date for.
What is the Employee Misconduct Registry?
It is a Texas list of people found to have abused, neglected or exploited a resident in a setting the state regulates, kept separately from the nurse aide registry. A name on it bars the person from working in a facility Texas licenses. You check both lists, not one.
Does Texas require an annual TB test?
No. 26 TAC 554.1601 points at the national 2019 approach, which is one test when somebody starts and then a yearly set of questions and some teaching rather than a repeat test. Your own risk review can ask for more. This is one of the clearest differences between working in Texas and working in California.
How many training hours does a Texas nurse aide need?
Twenty-four over two years, including named hours on caring for older people and on dementia, on top of the federal twelve a year. HHSC publishes the requirement. We have kept it off the table on this page because we have not pinned it to a section number, and a page that cites things loosely is not worth citing at all.
Does every Texas nursing home need dementia training hours?
Only if you run an Alzheimer's certified unit. The extra hours attach to that unit rather than to the building, so a facility without one carries the federal dementia content inside the abuse and neglect topic and nothing further.
Where to go next
- How Credolex works in a nursing home
- F726: nurse aide competency, the guide behind the tag Texas leans on
- What California asks for
- What Florida asks for
- What North Carolina asks for
- Every state we have read so far