Many people often wonder when is the good time to send the dementia elders to the nursing home and how long should the elders be kept at a private home. There are many articles that talk about it.  There are many good ideas in the website eldercarelink. For families, this is a tough question and every elder is different. There is no standard answer. Having a stroke does not mean a nursing home right away. At times, it is not obvious and it is even confusing.

My father-in-law, who has late Alzheimer's, had had in-home care since late 2005. The hours at first was one or two hours. By the time of late 2007, it has become 24 hours. It got more expensive with more caregivers in May, 2009. On the surface, it seems it is the money issue. But in retrospect, I found that it is not easy and sometimes it is just an educated guess.

The in-home care agency wants the job and would not let go. So it is not an objective evaulation by the agent. In fact, their idea was to wait until my FIL got into a very bad shape like being idle and all that. So it was up to us to figure it out.

The key is the quality at home. Is there enough activity for him? Is there a group for him? Is he too confused at home? Does he get lost? Does he go upstairs without us watching and thus would fall? Does he get confused in the big house? Does he think the neighbors are his "caregivers"? Does he bother the neighbors?  The neighbor issue is tricky because sometimes you would think they are friends and can help the elders. But there is a limit for the neighbor and beyond that, the neighbor would just call a social worker and give us trouble. Is the house too old to be repaired to fit his need in the near future? So many factors. In fact, the home was no longer a best option for my father-in-law.

He got quite sick in April this year. It is the urine problem, not dementia issue. However, it is a complicated situation about eating well, drinking well and feeling well. He was acting like he was in the end stage of Alzheimer's: no eating or drinking properly and he was depressed. What do we do? If he was really dying, why bother to go to the nursing home? Maybe hospice or other alternative or home hospice.... Maybe in a year.... However, we took the guess to sign up for a nursing home in Nov. last year before he got sick. The waiting list was still not up to us yet. So we waited. I checked with the nursing home, a residential care facility for mid-stage to late Alzheimer's, and they say they can take care of him.

My FIL got better in late June/July. Then we were told we got the space in July!! Wonderful news! We were glad because he no longer had the issue of catheter in July. But we thought he didn't want to eat so he is in late stage. So I warned the nursing home.

Well, to everyone's surprise, he loves the food there. He eats and drinks a lot and he is a good eater according to the caregiver there. We thought he was not sociable, well, he loves the ladies there. The ladies love him too. The caregivers like him because he is well-mannered. He is not dying at all. No need for hospice at all (no doctors mentioned it anyway.)