If money were no object (which of course it always is) I'm looking for pros and cons of placing mom w dementia in Assisted Living vs. keeping her in her home with aides as long as possible. There is an AL that can take her until she needs a two person assist (so far she is still walking, but does sometimes "forget" how to get up from a seated position); there is an AL with enhanced care, that can help for longer, though I don't know their criteria for placing in a NH. At home, she needs 24 hr supervision, and goes to a day program during the week. My concern is that placing her in AL will be confusing, and lead to quicker progression, and would like to preserve as much funds as possible, figuring nursing home will be inevitable at some point. Downsides to keeping her at home is that I am managing the aides and upkeep of her house, which will also need updating assuming she becomes unable to walk up the stairs. Keeping her at my house isn't an option right now, I've been straddling work and caregiving for a couple of years, and can't keep doing it. Thoughts?

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frequflyer - victorian hotel with nice sunrooms - sounds perfect. I will keep checking out the options here.
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Beethere, I went through this with my very elderly Dad. He was happy with his around the clock caregivers at his home but the monthly cost was $20k. Being he and my late Mom were very fugal their whole life, such an extreme expense was always on his mind.

One day out of the blue my Dad said he was ready to move to a senior living facility. I found him an excellent one that had a 2 bedroom apartment which had a full kitchen, large living room, and lots of sunlight. He was ready to sign on the dotted lines. This cut his cost in half, as now he didn't need around the clock caregivers, but he did keep his morning caregiver.

Dad was so glad to get away from the house that he and my late Mom had owned. Too many stairs, too many memories. Now no more worry about property taxes, utilities, lawn maintenance, trying to shovel snow, and his list of repairs he wanted to do. So I sold the house "as is" and it worked out great.

Eventually as Dad's dementia was showing up more and more, the facility said it was time for him to move into their Assisted Living/Memory Care. I didn't know if Dad would like downsizing yet again and this time to a studio apartment.

I did a "therapeutic fib" telling Dad that this studio apartment was cheaper, as Dad was getting worried about the cost of his other apartment. He was more than happy to move into his "college dorm" sized room. Plus he also brought along his morning caregiver which was good as he got to see the same smiling happy face every morning for over a year.   Dad main concern about the move was would he still have the same chef for his meals.  Dad's face lit up when I said "yes". 

Yes, there are pros and cons. A lot depends on choices of facilities. I live in an area where there are a ton of choices, and more being built. My Dad liked the design of the place he moved into, it was like a Victorian hotel, nice sunrooms, numerous front porches, tucked away behind a lot of trees from the main road.
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jeangibbs - good advice on the changes being confusing no matter what. I can't say for sure if she enjoys the day program or just tolerates it. One of the reasons why I'm not sure about paying more for an assisted living - paying more for her to not be engaged (she can be particular about what she likes to do). I may try respite at one of the centers, and see how that is.
cwillie - yes, I've heard that about moving sooner rather than later, also private pay for a time. I think we will try to keep her at home (or move to another home already adapted for one floor) w aide before nursing home, so that when the time comes, there really is some money to get into one she likes.
all good answers and helps me think through options
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If the choice is between moving to AL or NH sooner vs later then I would opt for sooner. My reasoning is that the further along she is the less adaptable she will become, the less able to form connections with staff and other residents or to benefit from any activities available in her new home. (If the choice is now or never I may have a totally different answer).
As for the financial considerations, others on the site have mentioned that those who can afford to private pay for a few years may be able to select a better facility than those who wait until their assets are totally depleted. Just be sure to check that any home you choose will be able to accommodate her as her health declines and are willing to accept medicaid in the future.
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Going to a different environment will be confusing to her. But I don't think there is any evidence one way or the other that that leads to quicker progression. For my mother the structured routine and the opportunity for social interaction seemed to be a real benefit when she went from living at my sister's home to a nursing home. I'd say she blossomed there ... after a kind of tough adjustment period.

Dementia progresses. It is really hard to guess whether a certain course of action will have an impact on how quickly that occurs.

If Mom's house will need to be updated as her dementia progresses then that represents a change to her environment that might be confusing to her, too.

How well does she do in the daycare program? Does she seem to like it, or just tolerate it?

Would selling her house and eliminating all the upkeep costs help stretch her funds?

I guess I wouldn't worry so much about her confusion with change. Changes are inevitable no matter how hard we try to keep things stable, and we really don't know the impact of that short-term confusion.

Rather I'd concentrate on things like social interaction, financial considerations, the impact of various options on you as the primary caregiver, safety considerations, and her happiness (hard to predict). It is a hard decision -- there are a lot of factors to consider. I wish you a successful outcome!
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