Hi, Karen,   Thainks for asking these important questions. My mom had Alzheimer's and I faced some similar situations. So here are my thoughts:   - I agree with Nina that your family should be "advocates" to the nursing home. I always went by the motto, "They won't respect what you don't inspect." Therefore, I was very visible and very known to all the staff members at the nursing home, from the director and the nursing surpervisor to the nursing aides and the aid who drove the van to Mom's appointments. If there was an issue, I'd make sure they knew about it. And if they did a good job, I'd praise them.   - I also found that in Mom's case, she could be really with it one day and completely out of it the next. And she'd definitely be "on" if she had an audience, whether it was a family member or a friend. In these cases, friends would be sure that she should not be in a nursing home. They wouldn't see her the next day when she was incapacitated from this mental effort. So I'd suggest that you really get an honest assessment of your father's capabilities if you don't spend time with him on a daily basis.This includes participation in activities. In Mom's case, she no longer had the concentration to participate in the most basic events.   - If I were you, I'd also really explore the VA option. But realize that you really don't want to make a lot of moves with your father, especially as his illnesses progress; additional moves can be very deterimental. My mom had two moves within the nursing home and went downhill both times. Fortunately, she came back up, but some people with dementia died soon after the moves.   - My mom also wanted to leave the nursing home. However, I was not able to provide a level of care at home, especially since she had advanced Chronic Obstructive Pulmonary Disease as well. Although ideally I would have had her at home, I had to be realistic about the skilled nursing that she needed and that I wasn't equipped to provide her. When she told me she wanted to leave, I told her the decision was made by the doctor, which was true. If she pressed the issue, I'd have a compassionate discussion about her health issues, including her memory. She'd always agree with me, but we'd end up having that same conversation regularly. Therefore, know that this conversation is probably going to be a consistent part of your interactions with your dad.   - I think you need to make the primary decision about your dad's care. You can offer him some input but I think his choice is going to be to live at home. You need to really assess whether you really, truly can do this. (I also was working part-time when Mom's issues happened, and even juggling that level of employment with advocating for Mom at the nursing home was really stressful and actually affected my health.) So you need to take into account what this decision is going to do, again being realistic about the consequences.   Take care and keep us posted! Dorian