Dad is one of those "I want to die in my home" elderly. He is mid stage dementia at 84. He is at home. I need advice for future living.

Good advice has been given to you. Knowing his options and proper planning will make it go easier. I suggest meeting with a Medicaid Planner so you can know for sure how and when he would qualify. Also, there are ways to mishandle his finances that would give Medicaid the appearance of "gifting" money or managing assets -- which would delay or disqualify him. You need to know what these are because they are innocent mistakes people make. As others have suggested you should also see an estate planner, and an elder law attorney to make sure all his financial and legal ducks are in a row. Even though you are an only child (like me), there are ways to make distributing his assets after death go much quicker (and reduce probate).

As far as future care for him, research good, reputable facilities in your area that also accept Medicaid (many do). Find one that has a continuum of care so that he will be on the same campus for AL, MC and LTC. Also, existing residents get priority for Medicaid beds over non-residents. My MIL is in LTC in a great facility on Medicaid and even has a private room. Wishing you all the best as you help your dad on this journey!

Lea's post just about says it all.

If you are up for it, I would opt for more help at home. Don't wait too late to line up more help as it is soooo easy to get burned out.

I like the idea of home with more help or do the MC ALF while he can afford it. When it gets close to the time he is running out of $, move him to a medicaid accepting nursing home. At the point you need to do this, he will be needing much more assistance than you can provide at home and hopefully he won't understand too much about where he is, etc. Many people ask to go home even when they are home so you need to do what is safe for him. And for you!

I think that, in a perfect world, most if not all elders say they'd prefer to die at home. But when dementia sets in, safety and 24/7 care becomes the first priority as you're beginning to see now. While it's best to keep the moves to a minimum when dementia is involved, why not give dad a year in a nice Memory Care ALF and then move him to a Skilled Nursing Facility with Medicaid if he's still alive after that year passes by? That's how I look at things. My mother lives in a Memory Care ALF herself and will be running out of money shortly too; if she's still alive when that happens, I will have no other choice but to get her into a SNF with a roommate, which isn't ideal, but at least she'll have had the time in the Memory Care ALF with her own beautiful room, etc.

The other thing to consider, however, is that you're better off paying out of pocket for a Skilled Nursing Facility for a few months before you apply for Medicaid; that will ensure dad's spot in the SNF b/c they always prefer self-pay over Medicaid. So if $$$ is an issue, you may have to go that route vs. moving him into the Memory Care AL first. Does that make sense?

You may want to meet up with an Elder Care atty for a free consultation to get some advice about the Medicaid approval process in general. That's what I did and I'm happy I went that route.

Wishing you the best of luck moving forward.