My husband is constantly pointing out my faults.

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As I am the one who has the issues, but my mother in law's dementia is increasing. Mother in law is 89, had numerous TIA's over the years, a stroke last spring, a minor heart attack in November which brought her from 30% heart functionality, to now 20% heart functionality. She lives with us, my husband is in the Navy and travels a lot. My sister in laws are not local and are not in a position to care for her. No one wants my mother in law in a home. We watched my father in law in one of those places and it was devastating.

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We put my father in law in a nursing home. It was very difficult for us all to have him there. We all made extraordinary efforts to see him regularly as he was in LA and we are in SD. My mother in law took a cab there every single day. Yes, they keep the place clean and the staff were nice and good to him, but she's no where near that. She just has confusion and memory issues at this time. It's vascular dementia which, is due to her 20% ejection rate. She has a valve that is hard as nut. She is far to weak to have surgery of any kind. Yes, she is at risk of a fatal heart attack. We are all very much aware of that. She's tough though, she has had Pneumonia twice, a stroke and a heart attack last year, and keeps coming back, not to mention the issues she's had over the years. However, this last few months the memory issues have been more and more evident and the confusion too. Everyone is starting to get on the same page. I've done some research, went to a class and came back with the answers I needed. Now my nurse sister in law is the only one calling her memory loss from old age. She was an oncology nurse and frankly hasn't worked in the field over 20 years. You are right, it is denial. But if I were a betting person, I think she's declining rapidly now, her eating habits have changed, she's gaunt, gray and so thin. I doubt she'll get to the point where she will not be able to get her own lunch, put her own clothes on an take as shower. I think it is only a matter of time before her heart just gives up. We have a DNR. Last week was so frustrating. Thank you for chiming in.
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Sandwich, thanks for sharing your insights. I got a kick out of the concert violinist comments! I have heard of yuppie mothers putting yuppie children in high end care centers and just feel really sorry for the kids who are growing up without much real parental involvement except decision making.

All the facilities of which I wrote were SNFs for rehab after falls, or for my sister (who chose her own facility) after respiratory failure due to metastasized breast CA.

The nicest facility was a Heartland facility near a medical mecca just east of mid-Michigan. There were 4 pianos, including one in the dementia unit.

I chose the baby grand, which was out of tune and asked the staff if I could pay to have it tuned. My playing was bad enough without using an out of tune piano, and my father really needed the musical support.

The staff instead had all 4 pianos tuned, at their cost! I was so impressed with that facility.
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Garden Artist - you are right, there is always room for improvement. I find all facilities depressing on some level. I wouldn't want to be in one myself, right now. But I think it's OK to find the place that is good enough. I'm a pragmatist at heart.

I didn't even tour the places out of her price range because that would be pointless. There are some spectacularly posh places to be had. There are 47 senior facilities in a 10 mile radius of our house and you can pay as much as possible. In our price range, I think mom's getting really good care. Could it be better? Maybe. Probably, but it it meets her needs today and it's a mile from my house. She doesn't want for anything. I checked it out with the state DHS agency to see what their ratings were and any complaints that had been filed in the past year. Nothing provoked a red flag and they had one of the top 5 ratings in their category.

Every floor has a dining area, so she doesn't have to go but down the hall and she is taken there for meal times. There are multiple activity & visiting rooms and a schedule of activities. She gets changed every 2 hours unless she rings for assistance. Her bath day is Friday. She is always in clean clothes when I pop in. Mom opts out of just about every activity because "she'd rather watch grass grow", so they just put her in the activity room anyway. I'm sure she could be in a facility where there is nearly a one to one patient/care aid ratio, lots of ammenities, and professionally decorated rooms with brand new furniture, but I don't know that it would make her less BPD, less angry, or slow her dementia. They got her off her diabetes meds recently, so something is working.

For what the price is, I am satisfied with the quality of care she gets. It's just like finding daycare. I never could afford the place that had professional symphony orchestra violinists come in and play Mozart for the infants at nap time. The sales brochures made it sound like any parent who didn't put baby there didn't love their child. But, at the middle-of-the-road facility, the Montessori place, and at a home care over the course of the pre-K years, I feel like my kids had decent care because of the people who worked there. It wasn't sterling silver/white glove level care, but it was good enough. They are teenagers now and no worse for the wear.

Finding the right place is a complicated equation of what you can afford plus what's important. Plush ammenities & decor might be a lot more important to some than me. And that's OK. Looking at the resolution or findings of complaint reports to the state was important to me. I saw proactive reporting by the facility on incidents and nothing an inspector had found for violations. The food isn't gourmet or prepared by a chef with Michelin stars, but it is tasty and dietetically appropriate for mom. Good variety too. I talked to people who had elders there and got their stories on what the place was like.

There is no one size fits all solution to our very individual care needs and priorities. I am very, very lucky to live in an area with so much competition in the market.
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Sandwich, I would like to comment on a few of your observations.

Odors are NOT always going to be present in facilities. We checked out facilities before placing parents there and if there was an odor we just left.

None of the facilities we selected had unpleasant odors at all. In fact some are immaculately clean.

In addition, I too have seen the folks who appear to be catatonic, but they weren't in debilitated conditions as a result of their conditions. They were lined up waiting for therapy, sitting in the hallways watching visitors come by, but not to see them. It's an undignified but more efficient way for the staff to administer therapy.

There are ways to deal with this though. Patients left in the privacy of their rooms could at least watch tv or nap until therapy time. Or they could be lined up in a room with music, even just a CD playing in the background. Or, as in one AL facility we visited, the resident pets could be brought in to comfort them while they waited.

One of the problems of institutional placement is the warehousing of people without adequate mental or emotional stimulation.

I used to take sheet music with me when I visited my parents, and took them to the room where the piano was. Initially it was just Mom and me, with the catatonic folks just sitting in the hallway staring out into space. Once I started playing, they began wheeling themselves into the room and stayed until I finished. And I'm a terrible musician.

It takes a lot of effort and planning, but institutions can be a lot better than some of them are. A lot of research and on-site inspection is required.

The Eden Alternative sounded like an excellent premise, but I've only seen one Eden facility and it was abysmally depressing. But it was also County run.

I'm not challenging your statements, just offering a different perspective.
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Chicago1954 gets an Amen from me. There is not enough money in this world, past, present, and future, for me to take care of my Alz mom at my house.

I think people get scared in NH because they don't understand what they are seeing. They see people who may be tied to the wheel chair to keep them from slipping out onto the floor, and it's not something you or I would want to have happen at this moment in our lives. The see people who are catatonic, or who can only make shrieks and screams because they have lost the verbal part of their brain. Or people who are coiled up in a tight fetal position on their beds. This is not the NH's negligence or doing. This is what dementias do to people and it is very ugly and uncomfortable to look at. It doesn't smell too good either. It's just the raw facts of it.

It's just like looking for childcare. Tour the place. Is it clean? Are employees friendly? Ask about their training. Ask how they like working there. Do residents appear clean? There is just going to be a smell, no matter how diligent staff are about changing the disposable underwear, so just be prepared. Ask about the activity calendar and try to arrange a time where you can come during activities.

OR people remember visiting some great aunt in a hospital ages ago, when people who were "senile" were treated like mental patients. They were tied up, medicated, and it looks so totally barbaric compared to today. If they saw that as a child, it would be as scary as seeing a horror movie, and be a lasting emotional memory.

Watch this Teepa Snow video on Youtube, and it will hopefully help you get a plan together. It's part 6 in a series on "Making visits valuable" for Senior Helpers in Naples FL. I am on part 11, and have found the entire thing terrifically valuable so far. youtube/watch?v=dmPQLf9IUNI
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Tell hubby that if he thinks you have so many faults, let him take over care of his mother.

He's probably blaming you because he's not prepared to deal with the reality of his mother's illness. But that's not your fault.

If by heart functionality you mean ejection fraction, at 20% she's at high risk of a fatal cardiac event.

Military men like to think that they can control situations even if they can't, and with a 20% ejection fraction rate, there's not a whole lot he can do. Does she have a pacemaker and has it been discussed?

Perhaps you could print out some information on her cardiac condition and give it to him. He needs to "see the light" and realize how unstable she is, NOW, or he may blame you if/when something happens.
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Your stress can kill you. Then, what will your husband's family do? Not all NHs are awful. They are only the ones that you hear about. But, don't put someone in a NH thinking that it is a hospital. It is not and people do deteriorate, but that isn't the nursing home's fault.
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Thank you for your support. I do agree with all of it. I'm particularly going nuts over the fact that even with documentation showing what vascular dementia is, they keep calling it Old Age. I finally started to realize I lost an uncle over a 6 year period because he had a stroke at 45. That's not old age. He came out of it wight a complete personality change. He was a devout Catholic and never cussed. Now he'd lost use of his legs and cussed like an angry old man. This is not old age, it was vascular dementia based on the fact that a port of his brain was blocked from oxygen. I did tell him that today. The denial they had when his father ended up in a home was ludicrous. His sisters said awful things that his dad just gave up. I shook my head an said over and over again, "A guy doesn't just give up and never get out of bed." "He couldn't get out of bed and go to the bathroom." He wasn't a man that would just do that, he might be a pity party type, but not someone that would be happy spending the rest of his days in a nursing home. So... on the whole it is the denial I'm dealing with. He uses my faults as a diversion in a conversation, "I'm looking for stuff, or I'm always looking for stuff". It is denial. I have my MIL going to her doctor who plans to do a test on her and check what her level of dementia is. After we get a prognosis, I'm going to schedule a group to come in and speak to me and my husband. Jim's dad was in the Royal Navy. I'm not sure he qualifies for American VA benefits. His dad was in WWII.
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Hubby needs a reality check. Blaming you or finding faults with you does not cancel out that his mother is going thru the same thing as his father. He cannot make it seem like it's You who is messing up and not his mother. He's in denial and blaming it all on you. You need to remind him that this is His Mother and he should show more appreciation for all that you're doing for her. I know that the military drills the wives/husbands of those who are active how important you spouses be Supportive of your military spouse. Sometimes, like this, is the time when you need to figure out what it is You want with your marriage and with your relationship with MIL. When you figure it out, write it down, think about it every night until you truly believe that this is what you want.

Then, do what Pam suggested. Start calling around and get options. Not all nursing homes or Assisted Livings are the same. Some are bad, some are okay and some are excellent. That's where you do your research. You have also the option of putting MIL in an adult day care (but don't call it that to her or hubby.) Find out the cost, etc.... Get your game plan in place.

Then when you have all that down, practice in front of the mirror what you want to say to hubby. You know that you did good when you can look at yourself in the eyes (via the mirror), smile or show seriousness and still talk about what You want to discuss with regards to your marriage and MIL. I did the mirror thingy when I was attending college and had to do a speech in front of the class. When it was time to do my speech, I thought I was going to have a heart attack. I was ale to do my speech, look at my classmates in the eyes, smile, and had them laughing. I was very introverted - walked looking down, and rarely looked at people in the eyes. This was my speech class. It was mandatory that I look at the audiences eyes (or their ears or shoulders). Once you get it down, you do what Jeanne recommended - to tell him to knock off the criticism and be supportive.
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Dementia progresses. It is what it does. That means it gets worse and gets harder to care for. You need your husband's whole-hearted support at this time, and, as Pam says, you also need and deserve some help in caring for MIL. It is time for a frank heart-to-heart talk with Hubby. If he wants to keep his mother out of a care center, he needs to knock off the criticism and at the very least be emotionally supportive.
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