Options include: both partners moving to a community that offers independent and assisted living levels, allowing them to live near each other; the healthier spouse remaining at home with support while the other receives care in a nearby facility; or both moving to assisted living even if one does not strictly need it (for companionship and because independent living at home alone is no longer desirable). The right answer depends on the couple’s preferences and the healthier spouse’s needs.

Many assisted living communities permit couples to share a room in standard assisted living even when one has early to moderate dementia. Memory care units may be more restrictive depending on the facility. Factors include the non-dementia spouse’s ability to cope with the behavioral symptoms in a shared space, whether the dementia-affected spouse’s needs can be safely met in the room type available, and the facility’s policy on mixed-level couples.

Some communities are structured to accommodate this — a campus with both standard assisted living and a memory care wing, where couples can be close to each other and visit freely even if they live in different sections. This is worth specifically seeking when one spouse has dementia and the other does not. Ask placement agents to identify communities with this configuration in your geographic area.

A CCRC (also called a Life Plan Community) offers a full continuum — independent living, assisted living, memory care, and skilled nursing — on one campus. Couples can enter together at whatever level they currently need and have the assurance that both can remain on campus as care needs change. Entry typically requires a significant one-time entrance fee plus monthly fees. They are one of the best structural solutions for couples with different or changing care needs.

Key financial issues: the cost of care (assisted living or memory care) plus the cost of the at-home spouse’s ongoing living expenses can create significant strain. Medicaid planning is complex when one spouse needs nursing home care — the community spouse has specific asset and income protections under federal Medicaid rules. Long-term care insurance policies for one spouse only cover that spouse’s care. An elder law attorney is invaluable for couples navigating these issues.

Federal Medicaid spousal impoverishment rules protect the community spouse (the one remaining at home). The community spouse can retain the primary home, one vehicle, household goods, and a Community Spouse Resource Allowance (approximately $154,140 in 2026). The community spouse also receives a Minimum Monthly Maintenance Needs Allowance from the nursing home spouse’s income to maintain their own living expenses. An elder law attorney helps maximize these protections.

This depends heavily on the geographic location of the facility relative to the at-home spouse’s home and ability to drive or access transportation. Choosing a facility within close proximity to the couple’s home is important for maintaining frequent visitation. Many families also consider whether the at-home spouse’s own mobility and transportation will remain reliable over time — if driving becomes difficult, a nearby facility becomes even more essential.

Spousal caregiving is very common and often very effective in the short term. However, spousal caregivers are at high risk of burnout and health decline — particularly when the spouse has dementia. Monitoring the at-home caregiver’s health and stress level is essential. Regular respite, support groups, and proactive planning for the point when home caregiving is no longer sustainable are all important components of a sustainable spousal caregiving arrangement.

When both partners need care but at different levels, a community with graduated care levels on one campus is ideal. Both can receive the appropriate level of care while remaining close. If both need memory care but at different stages, look for a community that manages the full continuum of dementia care rather than transferring residents out at the late stage. Staying together as long as possible is typically a strong priority for couples.

Adult children sometimes disagree with each other or with their parents about the right care approach for a parent couple. The key is to keep the couple’s own expressed preferences (to the extent capacity allows) at the center of the decision. Respect the healthier spouse’s authority as healthcare decision-maker for the other when appropriate. An elder law attorney, geriatric care manager, or mediator can facilitate decision-making when family dynamics are complicated.

The death of one partner in a couple who moved to care together often triggers a reassessment of the surviving partner’s needs. Grief is profound, and the adjustment to solo residence requires support. The facility’s social work staff should be involved in supporting the bereaved resident. Some surviving partners may want to return home; others prefer to remain in the community they know. Reviewing care needs and the financial plan at this transition point is important.

A placement agent understands the specific complexity of couples placement — the different care level needs, the campus configuration requirements, the geographic proximity constraints, and the financial planning considerations. They can identify the communities in Texas that are best equipped to accommodate both partners across their likely care trajectories, and can facilitate the conversation with communities about room sharing, visitation access, and dual enrollment.