What do you do when your mother, who turned your life upside down, says to you when the dementia is not bad, "I want to go home!"

I'm not sure I have this right -- let me check. Your mother is in a good ALF now. You think that is the best situation for her. However, you are in the process of arranging for her to return home because that is what she wants. Is that correct? Is the ALF near you? Is her home near you? I'm not sure where the "long distance" caregiving comes in.

How old is your mother? How long will her money last in the ALF? How long in her home? Is this a factor in the decision?

Most people prefer the comfort of their own home. That doesn't mean it is always best for them or even always possible. If you can arrange for her to be safe and well-cared for in her home that might be a great option. But keep in mind that it may not be possible for the rest of her life. Dementia is progressive. The time may come when it won't be possible for a single hired person (in shifts) to meet her care needs. Also don't be surprised if she continues or resumes saying "I want to go home. Please take me home." This is not uncommon in dementia patients no matter where they are. (My husband did that. He thought our house was a railway station or a motel or a high school or a hospital. He wanted to go home.)

If Mom lives at home for a couple of years with a reverse mortgage and then needs more care than can be provided there, what will her financial situation be? (I don't know how reverse mortgages work if the recipient moved out.) Medicaid might need to be in the picture, so be sure what you are doing now won't interfere with applying for that.

Long-distance caregiving is difficult. Mother now needs an active advocate. Which option is closer to you geographically? Seeing a loved one frequently can be very important to the well being of an elder.

What kind of dementia does she have? How long has she had it? What is her health like generally?

There are lots of factors to consider. There is no one-size-fits-all answer. Good luck to you and to Mom.

I agree that you should really understand how Medicaid works and make sure that within a 5 year range you have everything planned out except that with dementia it is hard to tell when the disease will progress and a different decision must be made. I'm not very familiar with reverse mortgage but that could be a problem betwn. Medicaid and the Lender b/c if I understand the Lender has a greater stake in the property and once you balance out (equity is gone) the house must be sold b/c if you keep the reverse mortgage then I believe the Lender takes the home back. Well my concern would be - what would Medicaid want. Please check thoroughly into that part of it...ask many many questions using the worst case scenario with a 5-yr plan. Also if she is safe why not keep her there and just sell the property.

Jeanegibbs was right-on the button!
Further, Please do be wary of reverse mortgages.
There is generally stipulation that "you can live in the home until you die, and until your spouse dies", but there might be verbiage that turns the home over to the mortgage holder if the person[s] must stay in an extended care facility for longer than a [usually] specified amount of time--could be 6 months or a year or so.
The elders MUST inhabit the home most of the time.
In cases where the elder must get long-term care outside the home, the lender gets a terrific prize, since the elder has left the building sooner than later.

Once dementia starts, it generally progresses, and that progression is shorter time than if the person was healthy and able to maintain themselves.
Even having a staff of caregivers in the home with her in shifts, she will not use anything near the full advantage of the homes value, using a general reverse mortgage..
...lender still wins big.
The reverse mortgage will not likely pay for caregivers costs, un less there are very special arrangements.
My understanding is that Reverse Mortgages are best used by healthy elders, not sick ones.
Medicaid and medical providers demand payment for services, which are not covered by most Reverse Mortgages, in my understanding to date.
If a person gets welfare /medicaid, the State goes after Estate Recovery after-the-fact.
They expect assets will be liquidated to repay the State [or the Docs, or the hospitals], and they feel entitled to whatever was owned in the [5?] years previous to a client needing their help; they will want data proving assets were not sold or signed away to prevent Welfare from getting them, or to prematurely qualify a client for welfare. [fraud prevention].
So you might have more than a few difficulties by using a Reverse Mortgage.

The ONLY time I ever heard of the borrower "winning" in a reverse mortgage deal, was the French lawyer [ in the 1980's or early 1990's?] who contracted with a sweet little 80+y.o. woman he figured was gonna die soon.
He wanted her Paris apartment, she needed income; he had a young family to provide for. But the old lady FAR outlived him, indeed, to an extraordinary old age of something like 120 y.o.; which meant the lawyer's estate ended up paying her monthly stipend far longer [he failed to write adequate protective clauses, since people simply do not live that long, right?], his kids were adults, his wife, ailing.
But that is the exception, not the rule!
Your Mom has dementia, therefore likley a shortened life span related to that.
IF the Reverse Mortgage is written in such a way as to provide large enough monthly stipend for that predicted shorter time span, then good.
OR, even better, using the home as collateral for a Line of Credit. That way, bills can be paid as they come up, instead of budgeting payments each month on a fixed monthly sum. That also needs an executor to manage the estate...that could be you. That would enable paying for round the clock care, and other bills, which would it seem to address your Mom's needs.
IF you can arrange either of those, it provides data that proves you were providing for her care by using her assets wisely instead of prematurely forfeiting assets to a lender, gets your Mom her home care and ability to have needs met, on her time clock, instead of the lender, and gives firm data for later application to welfare.
If you arrange a line of credit, she might still move to a facility if needed, without losing all remaining assets to lender.
But perhaps the lender has that in mind, and perhaps that is getting written into teh Reverse Mortgage document?
Also,
Her home will need greatly pared down, to make it easier for in-home workers and your Mom to manage the environment indoors, perhaps to allow for medical equipment, easier cleaning, etc.; and to ensure family heirlooms, for instance stayed in the family.
Homes of elders are easier to manage, keep clean, and navigate within, by having less furniture and belongings in them, even though it seems so hard to remove them, as it can feel like the home is no longer really their character. But it is preventative of a number of problems, to just "greatly simplify the contents of the home".
Good luck! Keep us posted here, as these are really good discussions for so many!

I understand your wanting your mother to go home when she asks to go home. But remember, even though the dementia may show signs of improvement, there is no cure and she will eventually deteriorate. It is much harder emotionally on both you and your loved one to move her back and forth between an assisted living home and her own home. I am speaking from the experience I have had with my husband. God bless you.