By Austin Senior Advisor Care Team · July 4, 2026
A week-by-week sequence for Austin families who just realised a parent cannot manage alone. Assessment first, reversible causes second, free local resources third, money fourth. Housing decisions come last, not first.
The mistake almost every family makes in week one
Something happened. A fall, a scorched pot, a bank statement with three withdrawals nobody can explain, a call from a neighbor. Suddenly the vague worry becomes a problem that has to be solved, and within about seventy-two hours most families are touring assisted living communities.
That is the wrong first move, and it is expensive in both directions. Families who move a parent too fast sometimes move them into more care than they need and pay for it for years. Families who move too fast in the other direction sign a lease at a Type A community and are asked to move out nine months later when the care need exceeds what the license permits.
The reason to slow down is not sentiment. It is that you do not yet have the two things a good decision requires: an accurate picture of what your parent can and cannot do, and a clear answer on whether the decline is permanent. Both are knowable within a few weeks. Neither is knowable from a hospital hallway.
What follows is a sequence. It assumes you have thirty days, which most families do, even when it does not feel that way. If you genuinely do not, because a hospital is discharging your parent on Friday, skip to the last section.
Week 1: write down what is actually happening
Before any calls, spend a few days building a factual record. Not impressions. Specifics, with dates. Which activities of daily living need help, and how much: bathing, dressing, toileting, transferring, eating, walking. Which instrumental activities are failing: cooking, cleaning, laundry, driving, managing money, managing medications, using the phone.
Medications matter more than anything else on the list. Put every bottle on the kitchen table, including over the counter items and supplements, and write down the name, dose and prescriber for each. Count pills against fill dates. Overmedication and missed doses are the two most common causes of a decline that looks like dementia.
Track the pattern of bad days. Are the confused episodes worse in the late afternoon, worse after a poor night's sleep, worse after a urinary infection, worse on certain days for no visible reason? A parent who is sharp in the morning and lost at 6pm has a different problem than one who is uniformly impaired.
Ask your parent what they think is going on and what they want. Do this early, while they can still participate, and take the answer seriously even if it is inconvenient. Almost every older adult says they want to stay home. That does not settle the question, but a plan built without their voice will be resisted, and resistance is what makes these plans fail.
Week 1-2: rule out the reversible causes first
A large fraction of what families interpret as sudden dementia is something else, and most of the something-elses are treatable. Urinary tract infections in older adults frequently present as confusion, agitation or falls with no fever and no pain. Dehydration does the same, and in Central Texas summer it is common. So does a new medication, or an old one at a dose that no longer suits an aging kidney.
The rest of the list: thyroid dysfunction, low vitamin B12, depression that looks like apathy and withdrawal, poor sleep, undiagnosed sleep apnea, uncorrected hearing loss that makes someone look confused when they simply cannot hear, and vision loss that makes someone stop cooking and stop reading mail.
Book a long appointment with the primary care physician and bring your written record. Ask specifically for a medication review, basic labs, a cognitive screen, and a hearing and vision check. Bring the list of every prescriber, because a parent seeing four specialists often has four people prescribing without one of them seeing the whole picture.
If the answer is genuinely cognitive decline, ask for a referral to a geriatrician or a memory clinic rather than accepting a hallway diagnosis. Austin has academic medicine: Dell Seton Medical Center at UT, at 1500 Red River Street, is the Level I trauma center and the teaching hospital for Dell Medical School. Ascension Seton Medical Center Austin at 1201 West 38th Street, St. David's Medical Center at 919 East 32nd Street, and Baylor Scott and White Medical Center Austin at 5245 West US Highway 290 Service Road round out the major systems. A proper workup takes weeks, not one visit.
Week 2: the free Austin resources almost nobody finds
There is a real public infrastructure for this in Central Texas and most families never touch it, because nothing advertises. Start with the Aging and Disability Resource Center of the Capital Area at 855-937-2372, weekdays 8 to 5. This is the front door for long-term services and supports in this region. One call, a real person, and no sales motive.
The Area Agency on Aging of the Capital Area, a division of CAPCOG, is at 512-916-6062 and administers benefits counseling and caregiver support programs. The Long-Term Care Ombudsman for our region sits in the same organization, at 512-916-6054 or 888-622-9111 option 3, 6800 Burleson Road, Building 310, Suite 165, Austin TX 78744, covering Travis, Williamson and Hays plus seven more counties. Call them before you have a problem, not after.
AGE of Central Texas at 512-451-4611, 7640 Guadalupe Street, is the single most underused organization in the metro. They run adult day health care in both Austin and Round Rock with a nurse on site at all times. They run a free early-stage memory loss program. They run free CaregiverU courses. And they lend medical equipment for free, including wheelchairs, walkers and shower benches, which means you should not buy any of that until you have called them.
Two more. Meals on Wheels Central Texas at 512-477-2273 does weekday delivery with medically tailored options and, importantly, assigns case management at enrolment, so the meal is also a wellness check and a route into other services. Family Eldercare at 512-483-3580 handles guardianship, money management and service coordination. And 2-1-1 Texas is both a general referral line and the entry point for Medicaid long-term services interest lists.
Week 2-3: solve transportation, because driving is the real fight
Taking away the car keys is usually the hardest conversation in the whole process, and it goes far better when you can name what replaces the car. In Austin you can. Senior Access, formerly Drive a Senior, provides free volunteer-driver rides. The City of Austin Parks and Recreation Department runs senior transportation for residents 60 and older inside city limits.
CapMetro Access is the ADA paratransit service, and it requires an eligibility determination in advance. Start that application before you need it, because the determination takes time and a parent who is suddenly not driving cannot wait weeks for a ride to dialysis. Separately, a CapMetro Reduced Fare ID halves fares at 65 and takes minutes to get.
Map the actual trips your parent takes in a month. Cardiology in one direction, the pharmacy, church, the grocery store, a standing lunch with friends. Then assign each one to a specific solution. A vague promise that the family will drive collapses within six weeks; a written schedule with named services does not.
Do this before housing. A parent who can still get to their doctor, their pharmacy and their friends often does not need to move at all, and the family that solves transportation first frequently discovers the crisis was mostly a logistics problem wearing a medical costume.
Week 3: the money and the paperwork
Two documents matter more than everything else: a durable power of attorney for finances and a medical power of attorney. Without them, if your parent loses capacity, the family's only route is guardianship through the courts, which is slow, public and expensive. These have to be signed while your parent still has capacity, which is exactly why this belongs in week three and not month six.
While you are at it, get HIPAA authorizations so doctors can talk to you, locate the deed, list every account and every income source, and find out whether a long-term care insurance policy exists. Old policies get forgotten. Check the filing cabinet and check the bank statements for premium payments.
Now the real numbers. The 2025 CareScout Cost of Care Survey, released March 2, 2026, gives Texas medians: assisted living $5,666 a month, non-medical home care $30 an hour or about $5,720 a month, adult day health care $90 a day or about $1,950 a month, a private duty nurse at $90 an hour, nursing home private room $7,604 a month and semi-private $5,627 a month or $185 a day. That semi-private figure is the lowest in the nation and reflects a Medicaid-weighted market rather than what a private-pay family is quoted. Austin runs above the state median across the board, and there is no published memory care median for Texas or Austin at all.
Understand what Medicare will not do, because this is where budgets break. Medicare covers limited skilled nursing after a qualifying inpatient hospital admission, intermittent skilled home health, and hospice, but not room and board. It does not cover assisted living, memory care, long-term custodial care, non-medical home care or adult day care. And observation status nights do not count toward the qualifying inpatient stay, which is why families get surprise bills after what felt like a hospital admission. Ask, in the hospital, out loud: is my parent admitted as an inpatient or under observation?
If money is tight, get on interest lists now. The STAR+PLUS HCBS waiver covers assisted living care services but not room and board, requires income under $2,982 a month for a single person in 2026, assets under $2,000 and a Nursing Facility Level of Care, and it is interest-list driven, meaning waits are long and there is no penalty for being on a list you never use. Texas nursing home Medicaid in 2026 uses the same $2,982 income and $2,000 asset figures, with a Community Spouse Resource Allowance reported at $162,660 and a $75 monthly personal needs allowance. And if there is a veteran in the family, read our page on VA Aid and Attendance this week, not next quarter.
Week 4: only now, housing
By week four you know what help is needed, whether the decline is fixable, what free services are already in place, what the family can afford and who is legally authorized to act. That is the entire basis for a housing decision, and you did not have any of it on day three.
Often the answer at this point is not a move. It is home care hours at the times of day that are actually hard, adult day health two or three days a week to give a spouse a break, Meals on Wheels, a transportation plan and a medication management system. That package costs less than assisted living and keeps someone in their own house, which is usually what they wanted.
When a move is the right answer, tour properly rather than fast. Verify the license type, check inspection history, eat a meal there, and go back once unannounced. Our tour question list and the Austin community directory are built for exactly this stage.
One caution specific to this metro. Williamson County has grown 23.6 percent and Hays County 26.3 percent since 2020, against 7.7 percent in Travis, and the senior population has grown with it: roughly 161,000 older adults in Travis, 103,000 in Williamson and 41,000 in Hays, about 305,000 across the three. New buildings open constantly in Round Rock, Georgetown, Cedar Park, Buda and Kyle. New is not the same as good. A brand-new building with a first-year staff and no inspection history is a genuine unknown, and there is no federal star rating for Texas assisted living to fall back on.
If you do not have 30 days
Hospital discharge planning compresses all of this into about forty-eight hours, and it is where the worst decisions get made. If that is where you are, do three things. Ask the hospital case manager, in writing, whether your parent was admitted as an inpatient or held under observation, because that single answer determines whether Medicare will pay for skilled nursing afterward.
Second, ask for a home health evaluation and a physical therapy assessment before discharge rather than after. Medicare-covered intermittent skilled home health buys you weeks of professional eyes in the house, and those weeks are when you do the assessment work described above.
Third, treat whatever placement happens at discharge as temporary and say so out loud to everyone involved, including your parent. A short skilled nursing stay after a hospitalization is not a life sentence, and framing it as a trial changes the emotional weight enormously.
Then, in the first quiet hour you get, call 855-937-2372 and start the sequence over from week one. It works just as well running behind schedule as it does running on time.