Alexander moved to El Paso for health reasons in 1913 after contracting tuberculosis. Her brother-in-law, Robert B. Homan, Sr., was a physician and ran a sanatorium in El Paso called Homan's San. Alexander stayed at the sanatorium for four years where she worked in the office and didn't feel that she would be able to go back to teaching music. Eventually, Alexander began to give piano lessons for her niece and word began to spread and soon Alexander had many students. There were times when she had more students than she could teach and in those situations, she would refer them to other teachers.
