By Austin Senior Advisor Care Team · November 9, 2026
More than a third of Llano County is over 65, the highest share anywhere in the Capital Area, and the systems that serve Austin families reach the Highland Lakes unevenly. Here is which ones do.
The oldest stretch of the Capital Area is not in the metro
Llano County is older than almost anywhere in Texas. The Census Bureau puts 37.3 percent of its residents at 65 or over, against 13.9 percent statewide, in a county of about 23,350 people as of the July 2025 estimate. Next door, Burnet County runs 25.2 percent over 65 across roughly 57,000 people. No county in the Austin core comes close to either figure.
That matters for a practical reason. Demand for senior care in the Highland Lakes is concentrated exactly where the licensed supply is thinnest, and where the specialists are an hour away. Families in Marble Falls, Burnet, Kingsland, Granite Shoals and Horseshoe Bay are not shopping in the Austin market even though Austin is where half the decisions get made, usually in a hospital hallway.
Our own directory reflects the metro, not the lakes: it covers Travis, Williamson and Hays County communities. For Burnet and Llano, the state's own license database is the honest starting point rather than any directory, ours included. We explain how to read it in how to verify a license.
What follows is not a list of communities. It is the set of systems that do and do not reach the Highland Lakes, because that is the part families get wrong.
Two hospitals, doing two different jobs
Baylor Scott & White Medical Center – Marble Falls, at 810 W State Hwy 71, is the larger of the two. It lists emergency care, critical and intensive care, surgical services, imaging, a heart and vascular institute, orthopedics, and cancer care with 21 private chemotherapy bays. Its main number is 830-201-8000.
Ascension Seton Highland Lakes in Burnet describes itself as a full-service hospital with 24/7 emergency care and a Level IV trauma center with an intensive care unit. That trauma designation is the detail worth understanding before you need it.
Texas trauma designation rules define a Level IV facility as one that provides resuscitation and stabilization and arranges for appropriate transfer of trauma patients. The rule requires written transfer agreements and processes to expedite moving major, severe or critical trauma patients out. A Level I facility, by contrast, meets the American College of Surgeons criteria for comprehensive trauma care. In this region, that is Dell Seton Medical Center at The University of Texas, 1500 Red River St. in downtown Austin.
Translated into a Tuesday afternoon: a serious fall or a stroke in Burnet may begin at Ascension Seton Highland Lakes and finish in Austin. Which means the discharge conversation — the one that decides where your parent lives next — often happens 50 miles from your parent's house, with a case manager whose referral list is an Austin list.
Say the geography out loud at the first care conference. Ask the case manager directly whether the options being handed to you are in Burnet and Llano counties or in Austin, and ask what the plan is for getting your parent's records back to their Marble Falls or Burnet primary care doctor. Nobody does this unprompted. Our walkthrough of what to ask at each Austin hospital system during discharge applies here, with the drive added.
The ombudsman you call is in Austin, and it is not the Belton office
Every nursing facility and assisted living resident in Texas has a long-term care ombudsman. For the Highland Lakes, that ombudsman works out of Austin. The Capital Area Area Agency on Aging covers Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis and Williamson counties. Its managing local ombudsman is Tracey Cummings, at 512-916-6054 or 888-622-9111 option 3, located at 6800 Burleson Rd., Bldg. 310, Ste. 165, Austin, TX 78744.
Here is the mistake that costs families a week. The Area Agency on Aging of Central Texas, in Belton, is a different agency covering Bell, Coryell, Hamilton, Lampasas, Milam, Mills and San Saba counties. It is geographically closer to parts of Burnet County than Austin is. It does not cover Burnet County. A family in Bertram or Burnet calling the nearer office is calling the wrong one.
What an ombudsman actually does: advocate for residents on care quality, residents' rights, improper transfer or discharge, restraint use, and abuse or neglect. The Office of the State Long-Term Care Ombudsman is structurally independent of the Texas HHS system. The service is free and confidential, and an ombudsman acts only with the consent of the resident or their representative — so an adult child cannot set one loose on a facility over a parent's objection.
What an ombudsman does not do is issue citations or fines. That is the regulator's job, and it is a different phone number. The practical use of an ombudsman is earlier than most families think: call before signing a contract, and call when a disagreement is still a disagreement. More in the Texas ombudsman program.
Which number to call when something is actually wrong
The jurisdiction split is the thing to memorize, because calling the wrong hotline loses days.
Inside a licensed facility — assisted living, nursing facility, home health agency — complaints go to HHSC Complaint and Incident Intake at 1-800-458-9858, staffed Monday through Friday, 7 a.m. to 7 p.m. Central. HHSC also calls its online portal the most direct route: the TULIP complaint form runs 24/7 and gives you an intake number the moment you submit. Email, mail and fax are accepted; in-person complaints are not.
In the community — your parent's own home, your home, a relative's house — it is Adult Protective Services at 1-800-252-5400, answered 24 hours. Non-urgent reports can go through txabusehotline.org, which requires an account. If someone faces immediate risk of death or serious harm, that is 911.
HHSC says it keeps your name and the resident's name confidential unless law requires release. You can stay anonymous, but HHSC then cannot give you the results of the investigation, which is usually the wrong trade for a family member.
On pace: HHSC's FY 2025 regulatory report sets entry timeframes by priority — immediate jeopardy gets an on-site entrance no later than 24 hours, high priority on or before 18 calendar days, medium on or before 45 days, and low priority is tracked and trended rather than investigated. We will flag honestly that the report's own appendix is internally inconsistent here, carrying a 14-day heading alongside the 18-day text. Treat these as the agency's targets, not a promise, and keep your intake number so you can ask where the complaint actually stands.
Scale explains the queue. That same report counts 3,097 assisted living complaints and 11,913 nursing facility complaints statewide in FY 2025. Dates, times, names of witnesses and a specific described outcome are what separate a complaint that moves from one that waits.
Complaining without consequences, in the actual rule text
Families in a small market worry about this more than families in Austin do, and for a reasonable cause: when there are three plausible communities instead of thirty, nobody wants to be the difficult daughter. The rules anticipated that.
Texas assisted living rules at 26 TAC 553.267 give a resident the right to complain about the resident's care or treatment, and state that the complaint may be made anonymously or communicated by a person designated by the resident. The same provision says the provider must not discriminate or take other punitive action against a resident who makes a complaint. Residents also have the right of access to the State Ombudsman and a certified ombudsman.
The facility owes your parent the rights statement in writing: a copy of the Residents' Bill of Rights to each resident, and the statement posted in a prominent place in the primary language of each resident. If you cannot find it on a wall during a tour, that is information.
Separately, Texas Health and Safety Code Chapter 260A covers reports of abuse, neglect and exploitation of facility residents. Any person with cause to believe a resident's health or welfare has been harmed must report immediately on learning of it, and the facility must then submit its own provider investigation report not later than the fifth day after the initial report. Section 260A.004 addresses anonymous reports, and Section 260A.015 is titled retaliation against volunteers, residents, or family members or guardians of residents. See also Texas resident rights and reporting abuse and neglect.
The rides problem is usually the whole problem
CapMetro does not serve Burnet or Llano County. The rural alternative is CARTS, the Capital Area Rural Transportation System, and its district covers Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Travis and Williamson counties, offering fixed-route service and non-emergency medical transportation that connects to CapMetro.
Read that county list again: Llano is not on it. A non-driving parent in Kingsland, Sunrise Beach Village or parts of Horseshoe Bay can be outside the city transit system and outside the rural transit district at the same time. That is a small sentence with a large consequence.
Count the rides before you decide anything. Three medical appointments a week, two of them in Austin, is roughly 300 miles of driving a week for whoever is doing it. Families who skip this arithmetic end up moving a parent twice: once to stay home, once a few months later when the driving collapses. Our note on managing care from out of state runs into the same wall from further away.
The call that sorts this out is the Aging and Disability Resource Center of the Capital Area at 855-937-2372, Monday through Friday, 8 a.m. to 5 p.m. The Capital Area agency funds congregate and home-delivered meals, benefits counseling, care coordination, caregiver support and legal assistance across all ten of its counties, Burnet and Llano included. Walk-ins are accepted; appointments are strongly suggested.
What it costs, and the number nobody publishes
The 2025 CareScout Cost of Care Survey, released March 2, 2026 from rates collected July through November 2025, gives Texas statewide medians: $5,666 a month for assisted living in a private one-bedroom, $5,627 a month for a semi-private nursing home room, $7,604 for a private nursing room, about $30 an hour for a non-medical in-home caregiver, and roughly $90 a day for adult day health care.
Those are state figures. CareScout does not publish an Austin table, and nobody publishes a Marble Falls, Burnet or Horseshoe Bay table. There is no published median price for memory care in Texas either. Anyone quoting you a precise local memory care average invented it. We would rather say that plainly than make one up.
One caveat on the nursing figure: Texas's semi-private median is the lowest in the nation and is heavily weighted by Medicaid rates, so it is a poor predictor of what a private payer is quoted at the front desk. Full detail in what senior care costs in the Austin area.
Thin markets cut both ways. Labor costs less outside Travis County, and there is also less competition to discipline pricing. The only figure that means anything is a written all-in monthly quote at your parent's assessed care level, plus the community's rate-increase history for the last three years. Ask for both in writing, and ask what triggers a move to a higher care level.
If Medicaid is anywhere in your parent's five-year future, get on the STAR+PLUS interest list now rather than when the money is gone. The list does not move faster because your situation became urgent.
What to do first, in order
Pull the license. Use the state's TULIP provider search for every community you are considering in Burnet or Llano County, and read the inspection and enforcement history, not just the license status. Our guide to reading an HHSC inspection report covers what is normal and what is not.
Ask the license type before you tour. Texas licenses assisted living as Type A or Type B based on evacuation capability, and it is the cheapest filter available for avoiding a community your parent will have to leave within a year.
Call 512-916-6054 before you sign anything. An ombudsman who covers Burnet and Llano has heard about these specific buildings, and the call is free and confidential.
Call 855-937-2372 and ask for benefits counseling, meals, caregiver support and the STAR+PLUS interest list in one conversation.
Write down the transfer question and ask it at every tour: when a resident here needs a hospital, where does EMS take them, and who calls the family. In the Highland Lakes, the answer may be 50 miles from the building, and knowing that in advance is worth more than any brochure.
