Dementia Care in Texas: A Caregiver's Guide (2026)

About 459,300 Texans aged 65 and older were living with Alzheimer's in 2020, according to the Texas Department of State Health Services. The state's Alzheimer's disease plan estimates 1.5 billion hours of unpaid care at a cost of approximately $23.9 billion per year. If you are one of the people giving that care, Texas has more support than you may realize.1

Dementia caregiving is its own kind of hard: the long arc, the behavioral changes, the safety worries, the grief that starts before any loss. This guide maps the Texas-specific help available in 2026, from the free 24/7 helpline to Medicaid respite to the programs that can pay you for the care you already provide.

You do not have to navigate this alone, and you do not have to fund all of it from your savings.

Texas Dementia Caregiving, by the Numbers

The scale of dementia caregiving in Texas is enormous. The Texas Department of State Health Services (DSHS) reports that about 459,300 Texans aged 65 and older were living with Alzheimer's in 2020, or 11.9 percent of Texas adults over 65; the department's 2024-2028 Texas State Plan for Alzheimer's Disease states the estimate as approximately 460,000. In absolute numbers, Texas ranks fourth in the nation in Alzheimer's cases and second in Alzheimer's deaths. The State Plan estimates 1.5 billion hours of unpaid care at a cost of approximately $23.9 billion per year. DSHS also reports a 227.8 percent increase in Alzheimer's deaths in Texas between 2000 and 2021. Nationally, the CDC described Alzheimer's as the sixth leading cause of death in the United States, accounting for 3.6 percent of all deaths in 2014.1

If the work feels overwhelming, that is not a personal failing. It is the reality of caring for someone through a long, changing illness.

Where to Start

When a diagnosis lands, or when caregiving starts to outpace what you can manage alone, a few phone calls open most doors in Texas.

Texas's Dementia Care Support Infrastructure

The Alzheimer's Association and Alzheimer's Texas

The Alzheimer's Association operates six chapters serving Texas: Houston and Southeast Texas, Dallas and Northeast Texas, North Central Texas, San Antonio and South Texas, Capital of Texas (Austin), and West Texas, which covers Amarillo, El Paso, Lubbock, the Permian Basin, and San Angelo. The Dallas and Capital of Texas chapters describe providing education and support services to families and caregivers, and the San Antonio chapter says it provides support services at no charge to individuals and families living with the disease. Alzheimer's Texas is a separate Central Texas organization, established in 1982 and known until 2016 as the Alzheimer's Association Capital of Texas Chapter, that provides information, referrals, and support programs.2

Texas DSHS Alzheimer's Disease Program

The Texas Department of State Health Services (DSHS) runs an Alzheimer's Disease program with resources for family caregivers, reachable toll-free at 800-242-3399.2

Area Agencies on Aging, ADRCs, and Take Time Texas

Texas's 28 Area Agencies on Aging serve people aged 60 and older, whose family members and caregivers can get information and assistance to locate and access community services.3 Through the federal National Family Caregiver Support Program, they offer information, help gaining access to services, individual counseling, support groups, caregiver training, respite care, and supplemental services on a limited basis.4

Texas Health and Human Services (HHSC) runs the Take Time Texas portal to help you find local respite providers, but it is a self-submitted directory, not a vetted referral. HHSC says inclusion on the list is not a recommendation or endorsement and does not mean the provider holds any license required for the services listed, so research a provider's licensure, background, qualifications, and quality yourself.2 ADRCs round this out by helping families through the maze of funding sources, intake systems, and eligibility processes.5

DPRIT: Texas's Dementia Research Investment

In November 2025, Texas voters approved Proposition 14, a constitutional amendment establishing the Dementia Prevention and Research Institute of Texas (DPRIT) and authorizing $3 billion to fund dementia, Alzheimer's, and related-disease research. The Alzheimer's Association has described it as the largest state-funded dementia research initiative in the nation.2

As of the most recent reporting available to us, from February 2026, the money was not moving yet, and that is worth knowing before you count on it. The governor had said he would not certify the November 2025 election until a voter lawsuit over it was resolved. A Travis County judge ruled against a request to stop DPRIT on February 4, 2026, but because the lawsuit was still in play, the fund could not go into effect. Whether it has taken effect since then is something to check before you plan around it. The $3 billion is authorized to fund research.2

Who Pays for Dementia Care in Texas

Texas Medicaid (STAR+PLUS)

For Texans who qualify, Medicaid STAR+PLUS Home and Community Based Services (HCBS) cover respite care on an emergency or short-term basis, to relieve the people who normally provide unpaid care for a member who cannot care for himself or herself. The annual limit is 30 days, equivalent to 720 hours, per service plan year, unless the managed care organization (MCO) approves more.3

Two conditions decide whether your family can actually use it. The member must live in his or her own home or with relatives or other individuals, not in an adult foster care or assisted living setting. And the respite provider must not be a primary caregiver, whether or not related to the member, and must not live with the member. Respite must be authorized on the member's individual service plan before it is delivered and cannot be authorized retroactively, so talk to the MCO service coordinator before you schedule a break.3

Getting Paid to Care for a Loved One With Dementia

Some Texas families can be paid for the care they provide, and Medicaid offers more than one way to do it. In Primary Home Care, Community Attendant Services and Family Care, a caregiver who wants to be the paid attendant would be an employee of a home and community support services agency, which makes the hiring decision; or the family can use the Consumer Directed Services (CDS) option those programs also offer. A spouse cannot be the paid attendant in Primary Home Care or Community Attendant Services, and under CDS a spouse cannot be hired except in the Consumer Managed Personal Attendant Services program.6 HHSC describes CDS as "a way to receive services instead of using a provider agency"; under it, the person receiving services or their legally authorized representative becomes the employer, may hire an eligible family member, and uses a Financial Management Services Agency to pay employees and file employment taxes. A participant can leave CDS and go back to a provider agency at any time.7 For veterans' families, VA's caregiver program is below. The pathways, who can be hired, and the pay are covered in detail in the Texas paid family caregiver guide.

VA Benefits (for Veterans)

If the person you care for is a veteran, the VA's Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays an eligible veteran's approved Primary Family Caregiver, who can be a spouse, a monthly stipend that VA, in the preamble to its 2020 proposed PCAFC rule, described as a nontaxable benefit. PCAFC also provides eligible caregivers education and training, mental health counseling, and at least 30 days of respite care a year. The stipend is not a flat national figure: it is calculated from the federal General Schedule grade 4, step 1 rate for the locality pay area where the veteran lives, so the amount depends on where the veteran lives. Approval alone does not start the payments: VA says the caregiver must be enrolled in direct deposit using the VA customer engagement portal to get the monthly stipend.8

Veteran eligibility: VA publishes four conditions, and they are the first screen rather than the decision. The veteran must meet all four:8

• A VA disability rating, individual or combined, of 70 percent or higher.8
• Discharge from the U.S. military, or a date of medical discharge.8
• A need for at least six months of continuous, in-person personal care services.8
• Enrollment in VA health care.8

Meeting those four is necessary, not sufficient. The binding test is 38 CFR 71.20(a), which states seven requirements and requires every one of them. Four of the seven have no counterpart in the four above, and VA assesses them during the application process, which you and the veteran apply for together:8

• Participating in the program is in the veteran's best interest.8
• The personal care services the family caregiver would provide are not simultaneously and regularly provided by or through another individual or entity.8
• The veteran receives care at home, or will do so if VA designates a family caregiver.8
• The veteran receives ongoing care from a primary care team, or will do so if VA designates a family caregiver.8

The no-other-provider condition is the one most likely to surprise a family, because a household already receiving regular personal care through another program or entity can fail PCAFC on that ground alone.8

Separately, the VA Aid and Attendance benefit adds monthly payments to a VA pension: a veteran or survivor may be eligible if they get a VA pension and meet at least one of VA's listed requirements, such as needing another person's help with daily activities like bathing, feeding, and dressing.8 VA's Veterans Pension itself requires qualifying active-duty service that includes at least one day during wartime, a discharge that is not dishonorable, at least one of being 65 or older, having a permanent and total disability, being a nursing home patient for long-term care because of a disability, or getting Social Security Disability Insurance or Supplemental Security Income, and yearly income and net worth within the limits Congress sets.9 Call the VA Caregiver Support Line at 1-855-260-3274, Monday through Friday, 8 a.m. to 8 p.m. ET.5

Medicare

Medicare does not pay for long-term custodial care, meaning ongoing non-medical help with daily activities such as bathing, dressing, and using the bathroom when that is the only care a person needs, and it does not pay a family caregiver for their time. What it does cover is narrower. If your loved one shows signs of cognitive impairment at a routine or yearly Wellness visit, Medicare Part B covers a separate visit to assess cognitive function and develop a written care plan, for which you pay 20% of the Medicare-approved amount after the Part B deductible. Medicare also covers certain home health services when a person is homebound and needs part-time or intermittent skilled services, and hospice when a hospice doctor and the person's regular doctor certify a life expectancy of six months or less and the person accepts comfort care instead of care to cure the illness.10

The GUIDE (Guiding an Improved Dementia Experience) Model, a voluntary nationwide CMS Innovation Center model that began July 1, 2024, adds care navigation, a 24/7 support line, caregiver training, and respite, but only for patients aligned to a participating provider. To be aligned, a patient must have dementia confirmed by a participant's clinician, be enrolled in both Medicare Part A and Part B with Medicare as primary payer, not be in Medicare Advantage or another Medicare health plan (including Special Needs Plans and PACE), not be in the Medicare hospice benefit, and not be a long-term nursing home resident. Beginning in performance year 2026, the patient must also live in a private residence or in a residential care community that CMS has approved as a partner organization of that provider, and a patient living in a memory care unit cannot be aligned. GUIDE respite is narrower still. For the performance year that began July 1, 2026, CMS pays the participating provider, not the family, up to $2,625 a year per patient for respite. Only aligned patients with moderate or severe dementia whose primary caregiver is a relative or an unpaid nonrelative, such as a friend, are eligible for GUIDE respite, and aligned patients living in assisted living or another residential care community are not. Not every provider participates, so ask your loved one's doctor whether they are enrolled in GUIDE.10

Respite for Dementia Caregivers

Respite is not optional for dementia caregivers; it is what makes the long haul survivable. In Texas, respite comes from several places. STAR+PLUS Home and Community Based Services cover it for members who live at home or with relatives or others, up to 30 days per individual service plan year unless the MCO approves more, from a provider who is not a primary caregiver and does not live with the member, once it is authorized on the member's service plan.3 The National Family Caregiver Support Program, through your AAA, serves adult family members and other informal caregivers of a person of any age with Alzheimer's disease and related disorders.4 The Take Time Texas provider list can help you find local options, but providers list themselves, so vet any you find.2 For the full picture, see Respite Care in Texas.

Safety, Behavior, and Planning

Dementia caregiving often brings questions about wandering, driving, sundowning, and legal and financial planning. The Alzheimer's Association 24/7 Helpline (1-800-272-3900) can offer information, crisis assistance, emotional support, and local resources.2 For practical safety steps, see Dementia, Wandering, and Home Safety.

Learn More

Find personalized help caring for a loved one with dementia in Texas at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.