Is it wise to move 94 year old parents to assisted living, or just get more and more home health care as they need it at home?

The palliative care dr. who saw my 92 yr. old mother during the latest of this year's five hospitalizations (each time followed by a stretch in rehab) said that people always wish to die suddenly at home while sleeping in bed, but it rarely works out that way. (The doc also told my mother, very firmly, that she should NOT return home after this latest hospitalization/rehab stint.)

I have been dealing with home health care for almost 9 years for my mother. For the first few years, she could get by with a CNA 3X/week in 5 hr shifts. As her health has steadily declined, it's needed to be increased to 5 hr shifts every day, and beginning last week, we've had to add an additional 3 hour evening shift every day. We've also had to periodically up it to 24/7 following hospitalizations which is really hard to do. And you can't predict when the crisis will happen.

My mother adamantly refuses to move to assisted living. The SW during this last round of rehab said that discussing it with her was like trying to fight city hall. My mother has CHF,(afib), advanced kidney disease, a bleeding disorder (but also on blood thinners) and extremely severe osteoarthritis in her hips (worsened after a fracture 3 years ago). Her edema is so severe she can no longer wear even slip-on shoes. She's in a wheelchair when the aide is there, and in bed sleeping the rest of the time. The pain reliever she is on has many side effects, and she is barely eating. However, no one dares mention hospice.

The aides (CNAs) are amazing: competent and caring. This agency is top-notch and also operates (non-profit) a IL/AL/NH facility which is where my mother goes for her many rehab stays. The problem with in-home care is that there isn't sufficient back-up when life happens: right now the agency is dealing with a number of other patients who have just returned home after rehab for fractures & need increased care; several patients have become sicker, needing increased care; there is a virus going around & some staff are ill. And there's the holidays to navigate around. Unfortunately, no agency that I'm aware of (and this is our 3rd) has a bench of extra aides ready to fill in when needed.

The cost of all of this is horrific. Some people think that you can save money by keeping your parent at home: this is only true if unpaid family members are providing the care. My mother's 56 hours of care weekly cost much more than the extremely nice assisted living (or nursing) facility she could go to. That's also not including all of the expenses of living in a condo, and the work that it takes to keep it up. Cleaning, laundry, maintenance. My mother has to be transported to her many medical appointments instead of having in-facility care. And this living situation is much harder on the family members (me).

Someone on this forum told me a while back that my mother wants to live her life on her terms, and I should accept that. I do accept that she has a right to make her own choices, but she's also chosen for me. Did I mention it's been almost nine years of this?? My advice is if you can get your parents to go to assisted living, by all means - sooner rather than later.

The situation isn't sustainable for a long term. Their condition will worsen, perhaps suddenly. You need to have a plan in place before that happens. Sister is right, and you'll probably need more than assisted living, since mom has dementia and may be better off in memory care. Dad can be in an assisted living unit at the same facility, if mom is in the memory care section. And transportation will be available there, so they can go out or be taken to appointments without dad's having to drive. or your having to be at their beck and call.

Yes, it would be an emotional upheaval, but they'd still be together. If you want to talk about emotional upheaval, consider what it would be like if you added home services at their present home with all the people coming in and out, someone having to shop and cook for them, order medical equipment, take them to appointments, and cleaning and maintaining their home. I did it for my parents. It was extremely difficult to manage care at home, and I don't recommend it for anyone.

Your parents' lives aren't going to ever be the same whatever your choice. So you might as well make it easy on parents and yourself by finding them a nice place to live where they have professional care 24/7, a nurse on the premises, 3 meals a day, entertainment and field trips. You can visit them a lot. Their present home would likely be sold to pay for their new place. And you won't have to take care of it.

Good luck as you navigate the joys of eldercare for your parents. It's not fun.

At 94?
My vote without details is "ALF" for sure.

This is entirely dependent on how much help your parents currently need, how able they are to live with minimal assistance, and how mentally stable and capable they are.
We can't know ANY of those details, as you can imagine.
Living at home if help is needed daily is VERY expensive. While an ALF may cost about 5,000 a month per person meals included, the cost of help at home will far exceed that.
So much here depends on how much the parents can afford in in-home help. You quite honestly have to be at the very least a Millionaire to even begin to afford in home care of any good amount weekly.

So you now are left to assess as of this as a family.
1. What do you parents need?
2. How many hours of care do they need per week?
3. How much would this care cost in your area?
4. Who will oversee all this care, appointments, medications?
5. How long can that go on and would it deplete all funds.
6. How mentally fit are your parents, how capable of managing things in their own household.

I think that those suggesting it is time for ALF likely know what they are talking about.
It's time to sit together with parents and discuss all needs and options.
And it is time to try not to enable them by picking up more as a family in care than you can continue to do.
Certainly wish you good luck. It is a BIG SUBJECT worthy of a LONG BOOK for every family considering it.
Hope you will update us as you go.

The sibling is right. Get them into AL. Their health is not going to improve as they get older.

Who, if anyone, has their POA? How many siblings are participating in the decision-making?

I suggest that you start exploring Assisted Living and Memory Care facilities near them so that if it comes to a point that home care is inadequate (whether that is next week or next year), you already have the information you will need to make a good decision for them.

Be gracious with your sibling(s) as you go through this process, and keep an open mind. Don't dig in your heels and hopefully they won't either, so you can reach a consensus together and not be feuding over who is "right."

It depends on if/when Mom’s dementia is too difficult for Dad to handle . At 94 , that is likely to happen . Living with someone with dementia can become exhausting , too stressful , impossible .

At some point it is likely 24/7 care would be needed , which is often more expensive at home than in assisted living . For now an increase of homecare can be attempted .

Keep them where they are . people with Dementia Like routines and Familiarity .