Long Term Care Plan

The Texas Declaration of Guardian You Sign in Advance

Published on: August 21, 2026 | By McCulloch & Miller, PLLC

estate planning with a cognitive decline

Last updated August 23, 2026 · Reviewed by Thomas W. McCulloch

Texas law lets an adult decide ahead of time who would serve as guardian if incapacity ever made a guardian necessary. The instrument that does it is a declaration of guardian, signed while capacity is intact and set aside until someone needs it. It also lets the person signing name an individual who may never serve, and that second power is written far more strictly than the first.

The designation carries real weight. Under Texas Estates Code § 1104.202(a), a court shall appoint the person named in a valid declaration in preference to anyone else otherwise entitled to serve, unless it finds that person disqualified or that the appointment would not serve the ward’s best interests. Those two findings are the only routes around the designation. That makes a declaration of guardian in Texas substantially stronger than a letter of wishes, a note in a file, or a conversation the family half-remembers. Estate planning at McCulloch & Miller pairs it with the documents meant to keep the question from arising at all.

What a Declaration of Guardian in Texas Actually Does

A declaration of guardian is a signed written instrument in which a competent adult designates who should serve as guardian of that person’s person or estate if a guardian is later needed. It operates only if the need arises, and it can name alternates in order under § 1104.212, so that the next eligible person named takes over if the first choice has died, declines, cannot qualify, or later resigns.

The declaration does not need to look like a form. Section 1104.204(a) says it may be in any form adequate to clearly indicate the declarant’s intention, and while the statute supplies a sample, subsection (b) states plainly that the form may be used but is not required. The statute tests the declarant’s intention and the execution of the document rather than its layout.

Medicare Nursing Home Coverage in Texas and When It Ends

Published on: August 8, 2026 | By McCulloch & Miller, PLLC

Last updated August 23, 2026 · Reviewed by Thomas W. McCulloch

A hospital stay that ends in a transfer to a skilled nursing facility puts most families in contact with Medicare’s rehabilitation benefit for the first time. The coverage is genuine but narrow, and it rests on conditions decided during the hospital stay rather than at the nursing home. By the time someone is told coverage is ending, the facts that decided it are already fixed.

Medicare nursing home coverage in Texas runs under Part A as what the statute calls post-hospital extended care services, and two limits account for most of the denials families encounter. The stay has to follow a qualifying hospital admission, and the benefit is capped at 100 days per spell of illness under 42 U.S.C. § 1395d(a)(2)(A). Neither limit is within the facility’s discretion. McCulloch & Miller works with families in Austin, Houston, and across Texas on Texas elder law questions that begin at exactly this moment.

What Medicare Nursing Home Coverage in Texas Pays For

Post-hospital extended care services are skilled nursing or rehabilitation services furnished in a skilled nursing facility after a qualifying transfer from a hospital, covered by Medicare Part A for a limited number of days rather than as ongoing long-term care.

Protecting the Healthy Spouse When One Spouse Enters a Texas Nursing Home

Published on: July 11, 2026 | By McCulloch & Miller, PLLC

Last updated July 11, 2026 · Reviewed by Thomas W. McCulloch

Federal Medicaid law treats a married couple differently from a single applicant the moment one spouse enters a nursing facility. The governing provisions are the spousal impoverishment rules at 42 U.S.C. § 1396r-5, and they decide how much of a Houston couple’s savings and monthly income the spouse who stays at home may keep while the other qualifies for long-term care coverage. What is at stake is the financial survival of the spouse who remains at home.

Congress wrote those rules so that no family would have to be reduced to nothing to get a husband or wife into care. Section 1396r-5 splits the couple into an institutionalized spouse and a community spouse, protects a share of the couple’s countable resources for the community spouse, and allows part of the institutionalized spouse’s monthly income to be diverted to the community spouse when that spouse’s own income falls below a federal floor. Texas administers the calculation through its own eligibility rules, but the architecture is federal, which is why Medicaid crisis planning in Texas begins with those same two definitions.

VA Aid and Attendance for Texas Veterans Facing Long-Term Care Costs

Published on: July 3, 2026 | By McCulloch & Miller, PLLC

Last updated July 3, 2026 · Reviewed by David W. Miller

Long-term care costs in the Houston area routinely outrun what a monthly Social Security check covers, and families across Harris, Fort Bend, and Montgomery counties end up closing that gap out of savings meant to last another decade. Veterans who served during a wartime period have access to a federal VA benefit that can absorb part of the monthly cost, and a surviving spouse may qualify as well. Very few Texas families ever claim it.

Aid and Attendance is an increased monthly payment added to the VA’s needs-based wartime pension for a claimant who requires the regular help of another person with everyday activities, or who is housebound, blind, or residing in a nursing home. The benefit is authorized under the improved pension statute at 38 U.S.C. § 1521, and it is not tied to a service-connected injury. That last point explains most of the underclaiming.

Planning for Long-Term Care in Dallas

Published on: July 8, 2025 | By McCulloch & Miller, PLLC

The cost of long-term care in Dallas can topple even solid retirement plans. Private-pay nursing homes run well over $7,500 a month, and assisted-living facilities are not far behind. Without a strategy, you risk draining savings meant for your spouse or children. Taking proactive steps today protects your nest egg and provides peace of mind for tomorrow.

Assess Your Likelihood of Needing Care

Start with family history and current health. Even healthy adults have a 70 percent chance of needing some long-term assistance after age 65. Knowing the odds pushes you to act early, when premiums and planning options remain affordable.

Evaluate Long-Term Care Insurance

Traditional policies reimburse daily care expenses, while hybrid life-insurance products offer death benefits if you never file a claim. Shop carriers that provide inflation protection, especially if you’re under fifty-five. Review elimination periods and maximum benefit caps so you understand out-of-pocket exposure.

What Houston Families Need to Know When It Comes to Planning for Long-Term Care

Published on: February 16, 2025 | By Thomas W. McCulloch

health savings accounts in estate planning

There’s no way around it: long-term care in the United States is expensive. At McCulloch & Miller, we help families plan for the later years of their loved ones’ lives, and for many clients, this can be a daunting process. After several decades of working in the industry, there are several things that we believe Houston families need to know when it comes to planning for long-term care.

Long-Term Care Costs

To find out a realistic estimate of what long-term care might cost you and your loved ones, we recommend using this resource from carescout.com. The unfortunate reality is that you should expect to spend a minimum of approximately $100,000 per year on long-term care, if you are paying out of pocket. This cost is rising every year, but it is important to note that your cost will depend on factors like the level of care you might need.

Payment Options

There are three basic options when it comes to financing a nursing home, a retirement community, assisted living, or a live-in aide: paying out of pocket, using long-term care insurance, or applying for Medicaid. Paying out of pocket allows the greatest amount of flexibility, but it is unrealistic for most individuals given the rising costs of long-term care. Long-term care insurance is a viable option, but it requires paying into the insurance early on. It also involves some risk, in that if you do not end up needing the care your insurance would cover, you lose the money you have invested.

A Primer on Long-Term Care for 2024/2025

Published on: October 7, 2024 | By Thomas W. McCulloch

As time goes on, long-term care gets more and more costly for Americans. Unfortunately, it is all too common that we have clients come to us, worried about how they will pay for the long-term care facility they might eventually need. Today, we review the basics of what you need to know in this day and age about planning for long term care. As always, with more specific questions, speak with a Houston estate planning attorney that can help you figure out the best path forward for you.

Start Your Planning Early!

We cannot emphasize this point enough: plan early and often for your long-term care needs. If you are wondering: is now too early to start saving for my old age? The answer is, definitely not! With rising prices and an uncertain economy, it is more important than ever to begin thinking now (no matter how old you are) about how you might pay for your long-term care.

Think Through Ways to Fund Your Long-Term Care

The basic options are as follows for funding your long-term care: you can pay privately, electing to pay a nursing facility out of pocket. This is, of course, the most expensive option, but it also provides for maximum flexibility. Secondly, you can pay with some kind of long-term care insurance. This means that you need to get a policy in place early, which can be expensive and requires planning far in advance. Thirdly, can access Medicaid or other public benefits to pay for your long-term care. To access Medicaid, you need to position your assets in a way that allows you to qualify for this government funding – again, this can require careful planning and expert advice.

How to Pay for Long Term Care in 2024 and Beyond

Published on: September 15, 2024 | By David W. Miller

In Texas and in other states, long term care is expensive; nursing homes, private care, and health aides are costly, and as Americans age, they face the issue of figuring out how to unlock crucial medical services. In general, there are three main ways to pay for long term care, all of which we will review in today’s blog. The reality is that each person’s financial circumstances will be different, and each person will have a slightly different method that allows them to access important long term care resources.

Option 1: Pay Out of Pocket

First, you could pay out of pocket for long term care. This, of course, is difficult for most Americans. It also requires significant financial planning prior to old age. Paying out of pocket does allow for maximum flexibility in both how you access your services and in choosing the services you access. If you are financially able to choose this option, it is the best course of action to take.

Option 2: Use Long Term Care Insurance

Second, you could use long term care insurance to pay for your nursing home or care facility. The insurance company will subsidize your care, offering significant savings. Of course, this option requires that you opt into a specific kind of insurance. To access the insurance, you must 1) pay a significant cost and 2) plan to enroll in the insurance early on.

Signs of Elder Abuse: How to Look Out for Your Loved Ones

Published on: March 10, 2023 | By Thomas W. McCulloch

When we speak to clients who have elderly parents, grandparents, or friends, one of their biggest concerns is that their loved ones will be taken advantage of through financial abuse. Financial abuse is incredibly common among elder individuals, and the most important thing that others can do is closely monitor how and when their loved ones’ money is being spent. If friends and family keep a watchful eye, this can greatly reduce the odds that their loved ones will be subject to financial abuse from other less trusted individuals in their lives.

It is important to know what to look for when monitoring for possible financial elder abuse. An obvious red flag is a large or unexplained withdrawal or, even worse, a pattern of large or unexplained withdrawals. If your loved one’s bank account is fluctuating in a way that you know is not in alignment with their spending patterns, it is always better to investigate instead of leaving things to chance.

A rapid loss of money can also indicate possible financial elder abuse. Sometimes, we see elderly individuals who face unexplained taxes during tax season or a large number of complaints on FINRA’s broker check site. If your loved one has a broker who is difficult to contact or who has been exhibiting evasive behavior, this is also a sign to look into how that person’s money is being handled.

Rising Long-Term Care Costs in Texas

Published on: October 21, 2021 | By McCulloch & Miller, PLLC

With more Americans than ever reaching retirement age, the number of people requiring long-term care will only intensify too. According to the Department of Health and Human Services, 7 in 10 seniors are now expected to need long-term care before they pass away. However, the price of long-term care has only been increasing, making it more difficult for seniors to pay for this necessary service. Elder law attorneys can advise seniors and their loved ones on how to save for future long-term care expenses, along with potential senior housing options.

Are Long-Term Care Costs Increasing?

With more seniors requiring long-term care, the prices for these services have similarly increased. Recent data has shown that prices for nursing home care increased an average of 2.4 percent annually in the past ten years. In the same time period, home health care prices rose 11.1 percent. And these costs are only going to escalate further: per the National Health Expenditure, spending on home health care will climb 83 percent in the next ten years.
Additionally, these figures do not account for the unpaid care loved ones provide to seniors every year. Millions of individuals take care of their senior loved ones and are not paid for these services.

Paying for long-term care services is difficult enough for many families. In 2019, the average cost of a home health aide was over $45,000 per year, while placing a loved one in an assisted living facility costs a similar sum. On the other hand, nursing home care is, on average, double this price.