Long-Term Care Planning Lawyer in Houston, Texas

Quick Answer

Long-term care can become one of the biggest expenses a family faces, especially when care is needed for months or years. Planning ahead can help you understand your options, protect your assets, and avoid making rushed decisions when the time comes. We help Houston families plan for long-term care with a clear strategy that fits their needs and goals.

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Long Term Care Planning in Houston, Texas

Most Houston families plan for retirement and forget to plan for the part that comes after retirement — the years when one or both spouses can no longer manage on their own. The years when somebody needs help bathing, dressing, taking medications, or simply remembering to eat. The years that, in the Greater Houston area, cost between $7,500 and $11,000 a month for nursing facility care, and not much less for around-the-clock care at home.

The math is brutal and most families don’t run it until they are already inside it. Medicare doesn’t cover long-term care. Health insurance doesn’t cover long-term care. The kids can rarely afford to pay for it out of their own income, and most retirees’ savings don’t last more than 18 to 36 months at the actual cost of care. By the time the question becomes urgent, the answer is usually the same one nobody wanted: spend down the savings until the family qualifies for Medicaid.

It doesn’t have to be that way.

Long-term care planning is the legal and financial work of preparing for those years before they arrive. Done five or more years ahead, it can preserve the family home, protect the well spouse from impoverishment, qualify the parent for Texas Medicaid without devastating the inheritance, and take the worst part of the decision out of the family’s hands at exactly the moment they’re least equipped to make it.

Your Legacy Legal Care® has been doing this work in Houston for over 25 years. Attorney Kim Hegwood is a Certified Dementia Practitioner and a member of the National Academy of Elder Law Attorneys. We work with families who are five years out and families whose parent is being discharged from rehab. The firm holds the Houston Chronicle’s Best Trust & Estate Law Firm award and operates from five offices across Greater Houston.

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Average Cost of Long-Term Care in Houston

The Greater Houston area runs below the national average for long-term care costs, but the numbers are still substantial — and rising fast. According to the most recent Genworth/CareScout Cost of Care Survey (2024):

• A private room in a Houston nursing facility averages around $7,600 per month — roughly $91,000 per year. A semi-private room runs about $5,700 per month, or $68,000 annually. Premium facilities and higher-acuity care can push these numbers significantly higher.
• Assisted living in Texas averages around $5,250 per month, with memory care units serving residents with dementia typically costing 10–30% more.
• Home health aide services in Houston average around $26 per hour. A common care plan of 8 hours per day, 7 days per week runs roughly $1,450 per week — more than $75,000 per year — and that’s still less coverage than a nursing facility provides.
• Adult day care in Texas averages around $70–$100 per day, useful for daytime relief for family caregivers but not a complete care solution.

These numbers are climbing faster than general inflation. Genworth’s most recent survey showed long-term care costs rising 3–10% in a single year, depending on the service type, and AARP’s 2025 analysis found that home care and assisted living costs jumped nearly 50% between 2019 and 2024 — far outpacing the 22% growth in household income for adults 65 and older over the same period. A nursing facility that costs $7,600 per month today could easily cost $11,000–$13,000 per month a decade from now. Most families who planned for a year or two of care end up needing three to five.

Does Medicare Cover Long-Term Care?

This is the single most expensive misconception in American retirement planning. Medicare does not cover long-term care. Medicare covers up to 100 days of skilled nursing facility care after a qualifying hospital stay (and only the first 20 days at 100%; the remaining 80 days require a substantial daily copay usually 80% of the daily rate). After that, Medicare stops paying. Custodial care — help with bathing, dressing, eating, toileting, and the activities of daily living that most long-term care actually involves — is not covered by Medicare at all, regardless of where it’s provided.

The federal program that does pay for long-term care for the majority of Americans who need it is Medicaid. About two out of every three nursing home residents in Texas are on Medicaid. The catch is that Medicaid is means-tested — to qualify, an applicant has to meet both medical need and strict financial eligibility rules. Without planning, those rules often require spending down a lifetime of savings before Medicaid takes over.

That’s the gap long-term care planning is designed to close.

How Houston Families Pay for Long-Term Care

There are four main ways Houston families pay for long-term care, and most families end up using some combination of all of them:

• Out of pocket. From savings, retirement accounts, the sale of investments or property. This is what families do by default and the most expensive way for the family overall — partly because the spend-down is uncoordinated, partly because every dollar spent on care is a dollar lost from the inheritance.
• Long-term care insurance. Premiums vary widely depending on age at issue, health status, daily benefit amount, benefit period, inflation rider, and elimination period. A typical traditional LTC policy for a 60-year-old in good health runs $2,500 to $4,500 per year for moderate coverage. Hybrid life-insurance/LTC policies and annuity-LTC products have largely replaced traditional standalone LTC insurance for new buyers. The right time to buy is your mid-50s to early 60s — earlier is cheaper, but waiting risks being declined for health reasons.
• Veterans Affairs benefits. Wartime veterans and their surviving spouses may qualify for VA Aid and Attendance, a tax-free monthly benefit that helps pay for in-home care, assisted living, or nursing home care. The benefit can be substantial — often $1,800 to $2,800 per month for a single veteran or surviving spouse, more for a married couple — but the rules are technical and the application process is long. See our overview of VA Aid and Attendance for Houston veterans.
• Texas Medicaid. The largest single payer of long-term care in Texas. Medicaid pays for nursing facility care, certain home and community-based services, and assisted living through specific waiver programs. Eligibility requires meeting both the medical need test (typically nursing-facility level of care) and the financial test (countable assets of $2,000 or less for an individual, with the homestead and other categorical exemptions; a community spouse can keep up to $157,920 in countable assets). Medicaid planning — done right and done in time — is what allows Texas families to qualify without spending down everything they own.

The right combination depends on the family’s age, health, assets, income, and timeline. We help families work through the math — and we coordinate with insurance professionals, financial advisors, and care managers when the situation calls for it.

What Long-Term Care Planning Actually Looks Like

Long-term care planning is not a single document. It’s a coordinated set of decisions and structures that need to be in place before they’re needed.

Asset structuring to preserve eligibility for Medicaid and protect the well spouse. The Medicaid Asset Protection Trust (MAPT) is the most powerful tool — funded at least five years before any Medicaid application, it removes assets from the applicant’s estate while preserving them for the family. Lady Bird deeds keep the family home outside Medicaid estate recovery. Spousal transfers, properly timed, redirect assets to the well spouse without triggering transfer penalties. Annuities purchased to convert countable assets into an income stream for the well spouse. Caregiver agreements that compensate adult children for care provided to a parent. Each of these has technical requirements that have to be met to work.

Insurance review and (when appropriate) acquisition of long-term care insurance, hybrid life-insurance/LTC products, or annuity-LTC products. We don’t sell insurance — we coordinate with the family’s existing advisors or refer to professionals we trust, and we make sure the legal structures complement rather than conflict with the insurance.

Powers of attorney with the specific authority to do Medicaid planning. Most generic powers of attorney do not include the gifting authority, trust funding authority, or beneficiary change authority needed to do Medicaid planning when the principal can no longer act. We draft them so the agent can actually do the planning if it becomes necessary later.

Medical powers of attorney and Directive to Physicians that handle the medical decision-making that comes with long-term care — including end-of-life decisions that families don’t want to be making in a hospital corridor.

Care preference documentation — where the parent wants to receive care, what trade-offs they are willing to make, who they want involved in decisions, what they consider an acceptable quality of life. We provide a framework for these conversations because family conflict over a parent’s care is far more common than family conflict over money.

Coordination with the estate plan. Long-term care planning that conflicts with the will or trust creates problems — the wrong beneficiary structure can disqualify Medicaid applications, the wrong trust language can blow up the asset protection. The plan has to be one plan.

Crisis Planning vs. Proactive Planning

The work looks completely different depending on when the family starts.

Proactive long-term care planning — five or more years before any care is needed — opens up every option. The Medicaid Asset Protection Trust, gifting strategies, long-term care insurance, well-coordinated estate planning, comprehensive document preparation. Done well, the family preserves nearly all of the assets they’ve built while still qualifying for Medicaid if and when it’s needed.

Crisis Medicaid planning — when a parent is already in a facility or about to be admitted — operates on a much shorter timeline with much narrower tools. The five-year window is closed. The strategies become spousal-refusal planning, Medicaid-compliant annuities, the “gift and loan” strategy, caregiver agreements executed during an active care need, aggressive use of every Texas Medicaid exemption that applies, and proper structuring of the application itself to avoid penalty periods. These are the cases where a few weeks of bad decisions can cost the family $100,000 or more in unnecessary spend-down. They are also the cases where good legal work pays for itself many times over.

We handle both. The honest message we give families: the work is much easier and the outcomes much better when planning starts before the crisis. But if you are already in the crisis, there is still meaningful planning that can be done — sometimes more than families assume.

When Houston Families Need Long-Term Care Planning

The textbook answer is “by age 55.” The realistic triggers we see most often:

A parent has been diagnosed with Alzheimer’s, dementia, Parkinson’s, ALS, or another progressive condition. A parent has had a stroke, a serious fall, or a major hospitalization that’s revealed they can no longer live alone safely. A long-term care insurance application has been declined for health reasons. A spouse has been diagnosed with a condition likely to require care. The family has just watched a friend or relative go through a Medicaid spend-down and decided they’re not letting that happen to their own parents. The parents are turning 65 and the conversation about “what if one of you can’t take care of the other” is happening for the first time.

If any of these is true, this is the planning conversation worth having now. The cost of doing nothing is measured in tens of thousands to several hundred thousand dollars. The cost of planning is a fraction of that.

Why Houston Families Choose Your Legacy Legal Care®

Long-term care planning sits at the intersection of estate planning, elder law, Medicaid law, tax planning, and family dynamics. Most law firms handle one or two of these well. We handle all of them, because that’s the entire focus of our practice. Attorney Kim Hegwood holds the Certified Dementia Practitioner designation and has authored books for caregivers in the Houston community. Our team includes people who have walked their own families through long-term care and through Medicaid. The advice we give reflects the reality of what families actually face — not just the technical rules on paper.

The firm has been doing this work for over 25 years. We hold the Houston Chronicle’s Best Trust & Estate Law Firm award. We operate from five offices across Greater Houston: Clear Lake, the Galleria, Katy, Bay City, and Sugar Land. Most engagements are quoted as a flat fee in writing before the work begins.

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Five offices serving the Greater Houston area and clients across Texas.

Houston Long-Term Care Planning FAQ

What Is Long-Term Care?

Long-term care is a range of services that help people who can no longer manage the activities of daily living — bathing, dressing, eating, toileting, transferring, continence — independently. It can be provided at home (home health care), in the community (adult day care), in assisted living, or in a skilled nursing facility. The defining feature is that it’s custodial care rather than acute medical care — which is why most health insurance, including Medicare, doesn’t cover it.

What Are the Three Types of Long-Term Care Facilities?

The three main facility types are: independent living communities (housing for seniors who don’t need care assistance, sometimes with optional services); assisted living facilities (housing combined with assistance with activities of daily living, but not skilled nursing care); and skilled nursing facilities or nursing homes (24-hour skilled nursing care plus all custodial assistance, the highest level of facility-based care). Some communities offer all three on a single campus, allowing residents to move between levels of care as needs change.

How Much Does a Nursing Home Cost in Houston?

A private room in a Houston-area nursing facility averages $8,500 to $11,000 per month. A semi-private room runs $7,500 to $9,500 per month. Costs vary by location, facility quality, and level of care required. Memory care units typically cost more than standard nursing care. Long-term care prices in the Houston area have risen 4–6% annually for the past several years.

Does Medicare Cover Nursing Home Costs?

Only briefly. Medicare covers up to 100 days of skilled nursing facility care following a qualifying hospital stay — the first 20 days at 100%, the next 80 days with a substantial daily copay. After 100 days, Medicare stops paying. Medicare never covers custodial care. For long-term care that lasts more than 100 days, families pay out of pocket, use long-term care insurance, qualify for Medicaid, or some combination.

How Long Will Medicaid Pay for a Nursing Home in Texas?

Indefinitely, as long as the resident continues to qualify medically and financially. Texas Medicaid has no time limit on long-term care benefits the way Medicare does. Recipients have to recertify periodically, but if eligibility remains in place, Medicaid keeps paying.

What Disqualifies You From Long-Term Care Insurance?

The most common disqualifying conditions are dementia or Alzheimer’s diagnosis, recent stroke, Parkinson’s disease, multiple sclerosis, ALS, current use of a wheelchair or walker, recent significant cardiac events, certain mental health conditions, and several other progressive conditions. Insurance underwriting tightens significantly after age 65. The honest take is that the right time to apply for LTC insurance is in your mid-50s to early 60s, while you’re still likely to qualify.

Should I Buy Long-Term Care Insurance in Texas?

For families with $500,000 to $2.5 million in assets and the cash flow to support premiums, traditional or hybrid LTC insurance can be the right choice. Below that range, the premiums often don’t make sense relative to other planning options — Medicaid planning tends to dominate. Above that range, self-insuring with proper trust structures and asset protection is often more efficient than insurance. The decision should be made with both an insurance professional and an attorney who can compare the insurance against the alternatives.

What Happens If You Don’t Have Money for Long-Term Care?

You apply for Medicaid. Texas Medicaid pays for nursing facility care for qualifying residents with no time limit on coverage. The application process is technical and the financial eligibility rules are strict — but Medicaid is the safety net that ensures no one is denied care for inability to pay. The work of Medicaid planning is to qualify for that safety net while preserving as much of the family’s savings as legally possible.

Can I Avoid the Five-Year Medicaid Lookback in Texas?

The five-year lookback applies to long-term care Medicaid in Texas — HHSC reviews all asset transfers from the previous 60 months when reviewing an application. There’s no general way to “avoid” the lookback, but several planning structures (Medicaid-compliant annuities, certain spousal transfers, the gift-and-loan strategy, and others) can mitigate or eliminate transfer penalties even within the lookback window. These are the tools used in crisis Medicaid planning when the family didn’t have the luxury of starting five years early.