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How to choose between assisted living or nursing home

Carol Bradley Bursack, Forum columnist

Dear Carol: Your column has been incredibly helpful for my family as we care for my sweet mother-in-law who is in late stages of frontal temporal dementia. As we've struggled to find the right care setting while she progresses through this disease we've been confused by care options. From assisted living to skilled nursing, there appear to be many choices, but it's not always clear what each provides.

Recently, we learned from a nurse in Mom's current nursing home that some memory care assisted living facilities (ALFs) care for dementia residents through the end of life. We haven't been looking at assisted living options as she needs far more care for other health problems, but now it looks like we should reconsider since her current nursing home doesn't specialize in dementia. Can you please clarify for us and other families how these care options are named and what they provide? AG

Dear AG: Thank you for your kind words. It's always wonderful to hear from people who feel that the columns have helped them.

Your confusion about ALFs is understandable because they vary greatly in the services provided. Many are set up to offer basic services and then, if your loved one needs more assistance, they provide that assistance but charge accordingly. An added variance might be how long into some health issues they will allow someone to stay.

In most states, ALFs have fewer regulations than nursing homes which partially explains why they can be so different from one another. When looking into an ALF, people need to ask about what is offered in the basic package, what other services can be added as needed, and — this is vital — at what point the facility can no longer handle certain health issues. It doesn't hurt to have an expert or an attorney look over the contract so that you aren't surprised by extra charges. You want to fully understand what is offered and what you are paying for.

Assisted Living Facilities with memory units are gaining popularity for people who have dementia but don't have a significant number of other health problems. These units have trained staff that should be able to care for people with Alzheimer's, though they may or may not be trained in other types of dementia. Again, that would depend on the facility.

In your case, I am wondering about your mother-in-law's other health issues. An ALF memory unit may not be able to take care of all of her needs. These units are not the same as nursing homes. Since she has already been living in a nursing home, it seems to me that you may need to find another nursing home that also offers a memory unit so that all of her health needs are covered.

What you want is the best care for your mother-in-law. You also need to be satisfied that she likely won't be asked to move again because she's become too ill from something other than her dementia.

Carol Bradley Bursack is an established columnist, blogger, and the author of a support book on caregiving. She hosts a website supporting caregivers and elders at Carol can be reached at