My 96 yo father with a very sharp mind is in ALF and the cost based on his current needs is outrageous. He is, for the most part independent, however due to his very low hearing and need for a wheelchair, etc he needs a little bit of daily assistance. We pay for medication management and the dining room/meal service is essential. Otherwise he can do everything on his own. I visit almost every day (10 minutes from my house). Almost everyday he asks if there's another place he could live. He stays in his room most of the time except for meals in the dining room - he doesn't do "activities" - not his style. Due to his low hearing it's hard for other people to communicate with him because it requires a lot of effort - we use a white board a lot of the time. Most of the people at his ALF has some kind of cognitive decline but are not yet in need of memory care so he doesn't think there's a conversational "match" for him there. Our home is from the 1950's and not set up for a wheelchair user so a major renovation would be needed which would probably take a year. The renovation/addition could be justified based on reducing the cost of ALF, but living with him 24/7 would be a big personality challenge, and we don't know at what point he will need additional assistance. We wouldn't mind having a renovated house - we are in a high COL area with extremely high cost of housing so the investment in an addition is easily justified (the pain of going through an addition/renovation is another story). He is very hard of hearing and doesn't use a phone or technology without assistance so he would need an "elder-sitter" to be left home alone for an evening out, or in the least a medical alert system. Siblings will come to stay for planned time away but impromptu time away would be impossible without bringing in a 24/7 "elder-sitter." We don't want to be employers so we would hire via an agency, but at $30+ an hour the cost of hiring an elder sitter for a 3 day weekend would be $2,100! Monthly ALF cost here is $7k. I'd love to hear from others who have grappled with this and found interesting solutions. I think I've already answered my own question - stay with ALF...

When my mother moves out me and my hubby are buying the smallest 1 bedroom we can find. No more live in guests ( except my kids if need be ).

We cared for my dad 5 years in his home (with my daily 6 hour visits), and almost 4 years in our home (until his death by dementia). His only request had been not to be placed anywhere but with family. It was Hard, but worth everything we endured. At the same time, we know what we would have done differently, etc. Now that my MIL has been diagnosed, and is need of care, it was accepted by all that we would be her caregivers. She hadn't seen or even heard from her other children in 2 years, and they were not interested in helping, especially being 1000+ miles away. She only has enough funds to live in assisted living for 4, 5 years max, after which she'd be moved to a medicaid nursing home, (something she's said she never wanted). She's in Good physical health, and her mom lived with this disease for over 10 years, so we are trying to prepare for her potentially long-term care. Our solution was to build a small in law home on our property, care for her every need, investing funds (my husband's experienced), and hire what we cannot provide, eventually. Our plan takes her to her end of life, comfortably. Mom was fine with this, until my husband shared his idea with his siblings. To his face, they both said "go for it", however behind his back, they call mom, accusing my husband of "stealing, taking advantage, wanting to leave her homeless while we raise the value on our home", etc. She's so confused (can no longer figure out finances or cook, etc), and now she's forgotten the fact that we've been here for her for almost 15 years. We'd love to keep her in her home, yet 45 min away, its gotten to the point where she needs care, she won't accept "strangers" in, just wants her son to keep going there to help her log into her computer, etc. She's already fallen prey to scams, giving away thousands, and now has invited a man she met online to come stay with her, and "go over her legal documents with her, helping her" (because she no longer knows she can trust my husband who has been her POA for 12 years). Yet she can't remember not to turn her heat on in 85° weather. My dad was exhausting, however I am thankful MY siblings supported me in his care.

There is so much to take into consideration when changing the footprint of one's home, especially since an in-law suite would need to be on the main level, not multi-level like building a two story addition.

The cost of an addition can be quite expensive depending on where someone lives. In my area, it could be up over $40k. Plus an added yearly cost on one's real estate tax. Higher electric, water, and gas bills.

And later down the road, the re-sale value of a home with an in-law suite, because now that home could become the most expensive in the neighborhood because of the added square footage.

Lot to think about. But worth it if the home can be used generation after generation.