How do you decide when a parent can no longer live safely in their own home?

Possibly you could hire a live-in caregiver, or at least someone that could come in most days. Would one of your parents know how to call for help in an emergency? Alcoholics are more prone to falls, whether they are young or elderly, so that alone is a concern. If you hired a live-in caregiver, your parents would still be able to stay in their home.

Regardless of the alcoholism, your dad is to be commended for having the forethought to obtain LTC insurance. I think it should be mandatory, like car insurance, but that's a whole other topic. :-)

Good for you for taking this situation head on before it becomes a mess and you have to pick up all the pieces. It's never too early to start making some preliminary plans and/or arrangements. As you know, dementia is progressive and you have absolutely no way of knowing when the day is where you'll wake up and your dad will have become unreasonable/combative but that day will come. If you are already concerned about whether they are still able to live in their home they probably aren't, or are very close to being unable.

I know you said your dad has one foot out the door already so I'm assuming he'd be on board with moving to an assisted living facility but what about your mom? And I don't know if LTC insurance covers assisted living but it does cover some in-home help, meaning not all in-home healthcare agencies take LTC insurance. While I cared for my dad in my home for 5 years I'm also in the home healthcare business and I know my company does not take LTC insurance, we're strictly private pay. But like Whitney above me suggested, in-home care may be an option if you're concerned about your parents' safety being home alone. Unfortunately, whether private pay or not, in-home care is a Band-Aid and is not a 100% effective way of keeping parents independent. Eventually in-home care will be inadequate and you'll need to find another solution, maybe under a great deal of stress and chaos. So if you and your parents can discuss a more permanent solution I think it would be wise to do so at this time because ultimately it's going to be YOU who has to do all the work to get your parents out of their home and into a safer environment. It might be easier to do it now or begin to do it now than later.

As for your dad's alcoholism, being a recovering alcoholic myself (sober 16 years) my heart automatically goes out to anyone suffering from alcoholism. And with your dad's recent diagnosis of AZ and your mom's exasperation with him his drinking may increase. When I first got sober I met a bunch of men in their 60's and early 70's who were newly sober like me so I know it's possible but sobering dad up may not be a priority right now, understandably so. But again, like Whitney said, alcoholics are high fall risks, especially in the elderly. The drinking will also exacerbate his AZ so count on him deteriorating faster than someone with AZ who doesn't drink will. He sounds like an accident waiting to happen, Upstream. Most alcoholics are. Throw in his age and his Alzheimer's and it's probably a matter of time before you're faced with having to make some quick decisions not under the best of circumstances and then having to physically move your folks from Point A to Point B.

I don't think it would be premature for you to begin going through the house, throwing stuff away, boxing some stuff up, that kind of thing. You don't want to have to do it in the middle of a crisis. And if your mom is up to assisting you it might be a nice way for you to spend some time with her. Being married to an alcoholic can be very lonely (just ask my ex-husband).

By beginning to think about the implications of everything you wrote about and wondering what you need to do you're off to a great start and I think your parents are very lucky to have you. I will also guarantee that your dad is terrified. Fear is an alcoholic's best friend. We marinate in it. It's why he drinks. And God bless your mom for living with it. You'll make good choices, Upstream. I can tell.

Eyerish: Thank you so much for your thoughtful insight, on so many levels! You have given me a lot to think about, and most of those things have been circling around in my head for a few months. I have been manic about keeping up my home and my business (I run a small business), so that I am ahead-of-the-game with my own life when theirs really starts to fall apart. I hate living each day waiting for that emergency phone call, but it seems that's where life is at these days. I am just a couple of years older than you. I did not think I would be facing this stuff for another 10 years or so, my parents were once very healthy, even competitive marathon runners. It's shocking how rapidly things have deteriorated. Thanks again. I see your posts on here often, and I always read them, you seem so wise and thoughtful.