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Most (not all, but most) AL centers don't give nursing care, so the need for skilled nursing is the clue for a change. If your elder has health problems that need consistent monitoring, or has mediations that are vital and he or she can't be counted on to take the medications on schedule, you may want to consider a nursing home. In other words, if the services offered by the AL aren't enough - it's time for a move.
Take care - it's hard to move, but when it's necessary, then you should seriously consider this.
Carol
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Everyone has their own opinion on this but I say when you cant possibly do it at home any longer. The nursing home (skilled or not) will not put up with anger, etc either and will medicate them, so why not medicate them and keep them in a loving environment. Daycare and then homecare is a great break , or home care to give you a break. Its so routine for me now to go from work to pick up my Mom. Sometimes she doesnt know me or is moody, sometimes she is euphoric that I came to get her!! Whatever the case, we sing to music on the way home and she has a family life with my husband and I, wether she remembers or not, she is spoiled and so loved at home. As you can see, I prefer home care and I do it alone using daycare, she was always there for me and now I am there for her. Its up to you, but know that the skilled nursing homes will NOT be as good as you will be.
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If the patient needs consistent monitoring and cannot be left alone, then assisted living facility may be your best option. You have to weigh the cost of home care and the cost of ALF. There are so many factors to consider, such as cost, mental and physical health of the patient, support of family, physician recommendations, etc.

You will need to consider the pros and cons of a home health care agency vs. a ALF: 1) You need to consider whether you want to bring a stranger from a home health care agency into your home. The home health care agency would care for the patient at their home, which is a benefit for some patients. ALF offers three meals a day, monitoring, medication management, etc.
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I read the other answers, and these are my thoughts. Having been through a lot, and having a lot of caregiving experience, I think the answer lies with you. If you are the primary caregiver? Are YOU the power of attorney for health care? If so, then the questions and answers lie within you. Ask yourself: Am I able to continue giving my loved on the care he or she needs and deserves? Am I functioning in the best interest of my loved one? If so, and placement is your next move, then ask the facility director or administrator, exactly what kind of care they provide? Will they give oxygen, or breathing treatments if COPD or asthma is a factor? If not - then move on to the next place. There comes a time in all caregivers lives when placement for our loved ones becomes a reality. Can he or she get the best care at home? Or would the best care be elswhere? You should consider your lifestyle and how it is impacted by your caregiving duties.
are you still able to assist with all the ADL's? Are you getting adequate sleep? Are you attending regular support group meetings? Are you able to take care of yourself?
If your goal is to function in the best interest of your loved one, then you can't possibly make a wrong decision. Pray about it. The answer will come.
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I personally believe that if you have the room, the money, the time and the skills needed to host your disabled relative, you should do it for the psychological, emotional and spiritual benefits of using your parent's last months to heal and forgive one another for being imperfect when you were both younger. I've been there with my mother-in-law, and watched the healing for a decade before she died in our family room. It's hard. You will have to grow into the process and learn truckloads. But it's worth it. If you don't have the room/time/skills, etc., then pay someone else to do it. Good luck.
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Bottom line: no facility will be like living in a home environment. By their very nature ALFs and NHs have too many people to take care of and your parent will not get the one-on-one attention he or she would get in your care.
Right now, we are doing a combination of caring for Mom ourselves and using some in-home help. So, far it has worked well.
However, the time to consider a facility is when the parent's ailments are so severe that it surpasses your ability to care for their medical needs.
If it is just a matter of comfort and being a little inconvenienced, I would choose keeping my Mother in a home environment for as long as possible. The golden rule still applies...think about what you would want if you were in their shoes.
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Wow, thats horrible. I am a total advocate for home care like 100% BUT being so young as you are, wiht a family, you dont want this at your age. How is your Mom, can she afford a caretaker fulltime or go to daycare? Assisted living maybe? Your poor thing. I feel SO bad for you. I see elderly men bringing their frail elderly women to daycare and they refuse to place them in a home, its such true love and devotion it brings tears to my eyes. We children need to help but in cases like yours, bless you, I think your family is more important. Will your Mom understand?
What an lesson of love you have shown to your husband and children . Myself, I have Adult children now and they too are very proud of me so please know that your children see what you do even if young and you are an inspiration. But, if you cat get fulltime help with your Moms funds, you are too young with a family and shouldnt put your life on hold. Best of Luck
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I think you need to look at the situation and assess whether or not you are willing or able to give the care needed by the person you look after. What would be best for them and you is the guideline really, ask experts and their PCP as well if you are unsure just what the cut off may be for going from OK at home to out of my hands... Good Luck.
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K-Like many other diseases that affect motor skills, they can be different in severity~The National Parkinson Foundation - may be another place to contact. - If Home care skills that are offered in your community do not work-then the next step may be to find a facility for your Mom that can meet her medial needs. You might also speak with a physician or a social worker as to what is available for your Mom. There are resources available, such as this forum, but you have to seek them out...
Best,
Hap
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I now volunteer at three ASL facilities here in town. Although I only have permission to offer magazines and books, I also carry a tray of Hershey bars, Snickers, Kit Kats, etc. The residents love it., especially Architectural Digest and Popular Science/Mechanics. This little effort could be done in NH's and other places where the people can't get out and help themselves to "treats" like these. The little bell rings at night about 7:30 p.m. and they know I'm on the floor. Most of them look forward to my visit.
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