Most families don't know which professional handles which problem. A geriatric care manager is not the same as a placement advisor. An elder law attorney is not the same as an estate attorney. Getting this wrong costs time, money, and sometimes the window to act.
What they do: Assess your parent's current physical, cognitive, and social needs. Coordinate care across multiple providers. Serve as a day-to-day advocate. Develop and help implement a care plan.
When to call one: When you're not sure what level of care is actually needed. When managing a parent's care from another city. When the situation is complex — multiple conditions, family conflict, rapid decline. When you need someone who has the full picture and can translate it into action.
How to find a good one: The Aging Life Care Association (aginglifecare.org) maintains a national directory. Look for a member with the ALCA credential. Ask for references from families in similar situations.
Important distinction: A geriatric care manager is not the same as a placement advisor. A GCM assesses and coordinates. A placement advisor finds communities.
What they do: Know the local senior living community inventory — which communities have beds, what their care levels are, what they cost, and which ones are worth touring. They make introductions and often accompany families on tours.
When to call one: When you've established what care level is needed and are ready to find a specific community. When you're overwhelmed by options. When time is short.
How to find a good one: Ask your geriatric care manager, physician, or hospital social worker for a referral. Ask the advisor to explain how they're paid — most are compensated by the communities they place into, which is worth understanding.
Important distinction: A placement advisor is not a care coordinator. They find communities, not care plans. If the care situation is complex, work with a GCM first.
What they do: Draft and update durable and medical powers of attorney. Structure assets for Medicaid eligibility. Handle guardianship and conservatorship. Navigate the state-specific legal rules that affect seniors and their families.
When to call one: As soon as possible — ideally before there's a crisis. Specifically: when POA documents don't exist or need updating, when Medicaid may become relevant, when there's any question about who has legal authority to make decisions.
Important: An elder law attorney is not the same as a general estate attorney. The specialty matters — especially for Medicaid planning, which has state-specific rules that a general practitioner may not know well. Ask specifically about their elder law and Medicaid practice in your state.
How to find a good one: The National Academy of Elder Law Attorneys (naela.org) maintains a directory. Ask for referrals from your financial advisor or geriatric care manager.
⭐ Texas families: Texas has specific rules worth knowing here — the Medicaid income-cap rule (and the Qualified Income/Miller Trust it requires), Lady Bird Deeds, and a community-property step-up in basis that can dramatically reduce capital gains for a surviving spouse. Look for an attorney with a specifically Texas elder law and Medicaid practice, and a CPA who understands the community-property step-up.
What they do: Help families understand the full financial picture of a senior transition — income, assets, long-term care insurance, benefit eligibility, and how to sequence liquidation to minimize tax impact and preserve Medicaid eligibility.
When to call one: When the financial picture is complex. When significant assets are in play. When long-term care insurance is involved. When a home sale is being planned and the tax implications matter.
Coordination note: Financial advisors and elder law attorneys need to work together on Medicaid planning. Make sure yours know about each other.
⭐ Texas families: The Texas community-property step-up in basis at death is a significant planning opportunity. If the home is owned by a married couple, a knowledgeable CPA can help the family use it correctly — potentially eliminating capital gains taxes on a home that has appreciated significantly.
What they do: Handle the home sale component of a senior transition — which is typically the largest single financial transaction in the process. A senior real estate specialist understands care timelines, the emotional complexity, and the full range of options available to sellers in this situation.
When to call one: Earlier than you think. The home sale decision — when to sell, which approach to use, how to sequence it relative to the care move — affects the financial picture downstream. Having this conversation before the crisis is almost always worth it.
Three paths: Traditional listing (maximum proceeds, requires time), direct cash purchase (AS IS, 30 days or less, no cleanout required), or expanded buyer access (broader marketing and creative financing).
Disclosure note: When a licensed agent also purchases homes as an investor, they must disclose their licensed status in writing before any offer. Standard practice — not a red flag.
Houston-area families: The Houston edition of Senior Move Roadmap handles real estate directly — all three paths.
What they do: Help veterans and surviving spouses apply for VA benefits — including Aid and Attendance, which can provide significant monthly financial assistance for qualifying seniors in assisted living or memory care.
When to call one: Any time a senior is a veteran or surviving spouse of a veteran. Even if you don't think they qualify — get an assessment. The Aid and Attendance benefit is substantially underutilized because families don't know it exists.
Cost: VSO services are free. Never pay someone to file a VA benefits claim.
How to find one: Your county's veterans services office. Most counties have one. Also: the National Association of County Veterans Service Officers (nacvso.org).
What they do: Handle the practical financial tasks a senior can no longer manage alone — paying bills, organizing records, sorting mail, reconciling accounts. They work directly with the senior or the POA holder.
When to call one: When bills are going unpaid. When the senior is confused about finances. When there's concern about financial exploitation or disorganization that the family can't manage directly.
Important distinction: A daily money manager is not a financial advisor. They handle administrative financial tasks — not investment advice.
How to find one: The American Association of Daily Money Managers (aadmm.com) maintains a national directory.
Every state runs its own Medicaid program, estate-recovery rules, and probate process. The following states have rules distinctive enough to flag specifically. For all others, see the catch-all at the bottom.
Texas has specific rules worth knowing here — the Medicaid income-cap rule (and the Qualified Income/Miller Trust it requires), Lady Bird Deeds, and a community-property step-up in basis that can dramatically reduce capital gains for a surviving spouse. Look for an attorney with a specifically Texas elder law and Medicaid practice, and a CPA who understands the community-property step-up.
California is a community-property state, so a surviving spouse may receive a full step-up in basis on the home — a major capital-gains advantage worth asking a CPA about. California also has high home values that frequently exceed the federal capital-gains exclusion, and Proposition 19 changed the rules for transferring a parent's property-tax basis to children. Look for an elder law attorney and CPA who handle California property-tax and Medi-Cal (California's Medicaid) planning specifically.
Florida has no state income or estate tax, but it has the strongest homestead protections in the country — which affect who must sign to sell, how the home passes at death, and creditor protection. Florida's enhanced life estate deed is widely used for probate and Medicaid planning. Look for an elder law attorney with a Florida homestead and Medicaid practice.
New York has its own estate tax with a notorious "cliff" — estates slightly over the threshold can be taxed on the entire amount, not just the excess. New York also runs a distinctive Medicaid program with broader home-care eligibility than most states and its own look-back rules. Look for an elder law attorney who handles New York estate tax and Medicaid planning specifically.
Pennsylvania levies an inheritance tax on transfers to most heirs — which makes how assets pass genuinely consequential. Pennsylvania is also one of the states with an actively-used filial-responsibility law that can hold adult children liable for a parent's care costs. Look for an elder law attorney who handles Pennsylvania inheritance tax and Medicaid planning.
Illinois has its own estate tax with a threshold well below the federal level, so estates that owe nothing federally may still owe Illinois estate tax. Illinois Medicaid planning has its own rules and timelines. Look for an elder law attorney and CPA familiar with Illinois estate tax and Medicaid.
Ohio has no estate or inheritance tax, but its Medicaid estate-recovery program is comparatively aggressive. Ohio uses the transfer-on-death designation affidavit for real estate to keep the home out of probate and out of estate recovery. Look for an elder law attorney with an Ohio Medicaid and estate-recovery practice.
Massachusetts has its own estate tax with a low threshold and a "cliff" structure, and its MassHealth (Medicaid) program has distinctive rules and a robust estate-recovery program. Irrevocable trusts are commonly used in Massachusetts Medicaid planning. Look for an elder law attorney who handles MassHealth planning and Massachusetts estate tax.
New Jersey has an inheritance tax on transfers to certain heirs and historically aggressive Medicaid look-back enforcement. Look for an elder law attorney who handles New Jersey inheritance tax and Medicaid planning specifically.
Washington is a community-property state, so a surviving spouse may receive a full step-up in basis on the home. Washington has its own estate tax with one of the lower thresholds in the country and a relatively new long-term-care payroll program (WA Cares). Look for an elder law attorney and CPA familiar with Washington estate tax and Medicaid.
Oklahoma has no estate or inheritance tax. It uses a transfer-on-death deed for keeping the home out of probate, and like Texas is an income-cap Medicaid state — meaning a Qualified Income (Miller) Trust may be required to qualify for long-term-care Medicaid. Look for an elder law attorney with an Oklahoma Medicaid practice.
Louisiana is unique — its law derives from the French civil-law tradition rather than English common law, which affects nearly everything: "forced heirship" can require that a portion of an estate pass to certain children regardless of the will, property is community by default, and the terminology (usufruct, naked ownership) differs entirely from other states. Louisiana families especially should not rely on general guidance. Look for a Louisiana succession and elder law attorney — out-of-state advice frequently does not apply.
Every state runs its own Medicaid program, estate-recovery rules, and probate process, and some have their own estate or inheritance taxes. The federal rules in this guide apply everywhere, but your state's specifics may change the picture significantly. Ask any attorney you consult whether they practice elder law and Medicaid planning in your state specifically — not just estate planning generally.
Start with the workbook. Note what's missing. Then use the companion guide's professional table to route each gap to the right call.
Hospital Social Worker / Discharge Planner
What they do: Facilitate hospital discharge planning — identifying appropriate next-level care, connecting families to community resources, and coordinating the logistics of a safe discharge. They do this every day and know the local landscape well.
When to call one: The moment a parent is admitted to a hospital. Don't wait until discharge day. Ask for the social worker or discharge planner on day one.
What most families don't know: They can provide a list of skilled nursing and rehab facilities that accept your parent's insurance, often within hours. In a crisis, they are your most underutilized resource.
See also: The Crisis Path Guide for the full 72-hour discharge playbook.