What's the difference between assisted living & nursing home care? How do you decide what suits your loved one best?

First of all, you have already honored the spirit of your promise to "never put her in a nursing home." You've done all you can, so don't feel guilty.

Your mom likely thinks of nursing homes as they were decades ago. Most have changed quite a bit, many have changed dramatically. They aren't the warehouses they once were (in most parts of the country).

As to what she needs - I'd say a nursing home. Assisted living is generally for a basically healthy elder who needs some help and increased safety. When a person can only be alone for a couple of hours and has COPD and other physical issues, plus dementia, she should qualify for a nursing home. Since she's already on Medicaid, a nursing home would be paid for, while assisted living may not.
You may have to put her name on a waiting list for a Medicaid bed, so I wouldn't put it off.
Good luck,
Carol

In my town, here is the difference between Assisted Living and Nursing Home. In AL, you have your own apartment/room (some with a little kitchenette and some without) but you have to provide all your own furniture and essentials (i.e. toilet paper, toothpaste, toothbrush, towels, soap, etc.), usually 3 meals a day are provided to them in a cafeteria type setting, their medicine is controlled by the staff, and the rent is set by how much "help" you need. In a NH, you usually have to share a room with someone, all essentials are provided, their medicine is controlled by the staff and there is usually one set rent-rate due to you usually requiring more help be provided. A NH is usually higher than AL. Check with your Adult Services and see what Medicaid pays for. If she can get in one of these facilities, I would suggest it. She would be around people her age, but she doesn't have to be very social either. It's up to her. She can watch TV in her room or whereever and would have 24/7 care while you and your husband are at work. With Dementia, it will relieve a LOT of self-induced stress so you're not so worried about her (or your house) when you're not home. If you find one you like, maybe you could take a tour of the facility with your mother so she can see what it would be like. Just tell her you're just checking things out in case she becomes worse where she wouldn't be able to stay with you - that you'd like her input on it. But only you know when it is time to do something like this with your mom. Just do some research ahead of time so you know what Medicaid will pay for. Hope this helps. ((HUGS))