Is it time for a nursing home?

Celia,
I'm so sorry to hear about your dad's sudden decline.
Please keep us posted. My thoughts and prayers are with you and your parents.
Warmly,
Trisha

@trishaanderson, thank you so much! Sadly, my dad passed away the day after my post above. He had a long and rewarding life, but it’s still so sad to say goodbye. I’m still processing everything. We were searching for nursing home placement and suddenly it went to a steep decline and the end stage. I still can barely believe it. I would say that you might want to plan very well for a sudden decline. I had done quite a bit of planning, but would have done more.

My question is a person with vascular dementia better off at home or in an Assisted Living facility? Both considered top shelf environments? Caregiver aside, How will the patient be affected? From what I read they do not like it very much and that can be harmful to them. Are they better off finishing off their lives at home or in a new environment?

I'm so sorry about your Dad - and glad you had help to keep him with your Mom at the end. Those final days, no matter how well-planned or expected, are difficult for all. We had exactly the same sudden decline with both of my parents at the end - nobody prepares you for it!

Now, give yourself grace and time to process before you begin the labor of settling up all the bills and accounts. Will you have help with it?

Sending virtual hugs to you and your Mom.

@trishaanderson . I appreciate your kind words. I have siblings, but I will be the sole person in charge of everything. It just works out that way. But, that's okay. I'll not rush and get it done in due course. I'll have to wait on the death certificates to get things started. My mom's care is now taking center stage. Will address those needs in due time as well. For now, grieving and setttling down after a wild week and half.

The answer, as for many things in life, is "It depends." If cost is not a consideration, it can sometimes still be "It depends."
Here are some factors to consider:
Many people (even without memory issues) strenuously resist the idea of "strangers" in their home, repeatedly refusing home care, firing workers, even being abusive to them or family members because they are there.

Isolation at home - even with caregiver(s) present can make dementia progress faster. Socialization at an appropriate (and changing) level in assisted living can help with physical and emotional well-being.

Stress in the home if the loved one is disruptive to home life can make a very tense atmosphere for all, especially anyone who cannot understand the changes and demands of living with a person with dementia, like a spouse with their own needs or young children. Also, some homes are just too busy to be suitable for keeping a person with dementia on an even keel.

Even with absolutely stellar home health care, living with a person with dementia is extremely stressful to the spouse or other primary caregiver in the home. They always feel responsible for overseeing and augmenting care, which is exhausting.

If the person lives alone, paid health care workers are hard to retain so continuity of care can be very spotty with many different caregivers in the course of a week. The there is the issue of who monitors what is going on day-to-day.

All that said, some people have the personality, patience and time to care for their loved ones at home, sometimes with help from family. But even they face stress, isolation and exhaustion doing it, especially long-term and with family members in the background offering advice but no hands-on assistance.

Are you asking as a someone making this decision about a loved one for whom you are caring?

I am the caregiver along with her daughter who comes morning, afternoon and night. We live in an upscale Life Care Community and have most likely have a five star rating. I understand the stress thing and have managed to learn to deal with the outbursts, etc. In fact, I have an 840 square two rooms reserved that will be brand new and have state-of-the-art electronics to monitor falls, etc. So, put all that aside I am really struggling with what is best for my wife. I'm 87 and can take a lot of stress and am only concerned with this part of my decision making process in what is best for her. Not for me. Not for family. Just her. Better at home (across the street from the Assisted Living Building) or in the building close by.

I think there are 3 parts to your issue - managing the stress (on you and her daughter) will become more difficult over time. What is "best for her" - if you are at hand and your daughter is close by, maybe what is best is to move her calmly and not wait for a crisis, then stay active in her care in the new place. Also, as time passes, she will adapt to whatever you and her family treat as normal.
Would you be able to bring her personal things - easy chair, pictures, dresser, etc? If so, transition will be easier.
Now I am going to play devil's advocate for a moment - you may feel like 87 is no big deal, but what happens to your wife tomorrow if you have a heart attack, a stroke or a serious fall? Life will change in an instant for all of you. Is her daughter willing and able to provide 24/7 care to both of you? Who will help her?
I am asking because my best friends were in the same place back in January, her parents had been resisting the move to assisted living in their community for over two years. Mom was handling things okay with twice a day help from daughters. Suddenly Mom had a fall and was placed in rehab (downstairs), sis got ill, and my friend, her husband & brother took up 24/7 of Dad for 3 months until they could get an apartment. Everyone was exhausted - how much better it would have been if they were already settled, and Dad had the on-site care so they could sleep at home? And Mom could have left rehab sooner if she had the right setting to come home to.
I guess what I am saying is, someone is probably suggesting this move to you. Why? And the best things for your wife are an appropriate setting, no sudden move, and family caregivers who have time and energy for the "extras" - a walk, a card game if she is able, a look at the photo album, even just watching a TV show - because the basics are handled.
Just my two cents worth after caring for parents, grandparents, uncles and neighbors in my lifetime.

Right now, assuming they will say she's qualified and not too disabled, we are putting her in the rooms I've set aside. My age is the big issue of why I want her placed in AL. Instructions I've left now are to immediately put her in the nursing rehab we have here on campus which has a Medicare five star rating. Another advantage of the Assisted Living is they have in Florida something called Extended Congregate Care and because they have this license, they will give additional care beyond what is normal in Assisted Living. I have to furnish the apartment so everything she has in her bedroom goes over plus some of what we have in our other rooms. I'm hoping that and the fact I can walk across the street, have dinner or watch TV with her, will make it much easier. I'm just thinking it through and trying to cover the bases but just thought I'd get some other opinions.

Asking the question, "is it time to...?" IMO, means you are close to reaching a decision, and now you need a plan to act. Over the past 40 years, I have placed my Mother, Father, Mother in Law, Sister, and lastly my husband into assisted living or care of some type. Each situation was very different and never simple. Everyday, ask yourself, what percent of your day is caregiver versus caring for yourself? At some point, is it unsafe for you and your family member to continuing being a primary caregiver? When you place a family member in care, it is not the end of a relationship, it is a new type of relationship. Quality of life for the caregiver directly effects how well you are caring for your family member. Others may say cruel or hurtful things to you, but trust your judgment and live your life to the best of your ability. I don't mean to be blythe by this comment, truly, I know the heart pain that comes with these decisions. As one of my favorite authors, Scott Peck, begins a great book, "life is difficult". It is your life to choose how to live it.