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My wife has vascular dementia and extreme difficulty walking even with the aid of a rollater and risk of falling after 30 feet or more as her legs give out.
The doctor and psychiatrist at the VA advised she needs to go to an assisted living facility but after looking at the difference between the two and the costs involved and the fact she is not able to take care of herself at all, it seems the nursing home would be the best option. Her memory is less than one minute and she is also incontinent and needs my help taking care of her.
What is your opinion?

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As a Vet, there are nursing homes she could go into. I would question why an AL was even mentioned. Like said, an AL is just that, for people who need assistance. Aides are limited because the residents don't need fulltime nursing care. I think ur wife is passed this. I would ask if there is a VA home nearby that you can visit. (Ours was a 45 min drive traveling on back roads so I chose another home nearby)

If you choose a NH, if your income is low you can get Medicaid. You will become the Community spouse. Now this is just a short version, but your income will be looked at and split in a way that you will not be made impoverished. Her half will be spent down and then put on Medicaid.

Aid and Attendance is only for those who served during wartime. This can be used for her care. With her also being a Vet, she could get as much as $1700 a month. This can't be used with Medicaid.

You may want to sit down with a Social Worker at the VA hospital and see what options you have.
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She needs more care than any assisted living facility I am aware of. The name says it all. Assisted living means you need assistance, on any of four or more levels with costs, esp when memory care is needed, of up to approx. 10,000 a month. Your wife unfortunately needs a lot of staff to help care for her. I am so sorry you are going through this. I think a nursing home may be the answer, unless you are made of money.
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I have found the VA to be very helpful in helping individuals stay in their home. There's home health so many hours a week. Have you checked about aid-in-attendence? Check to see if you can be paid to care for her. You would have to be CPR certified, etc. My dad received a grant to install an electric lift from the bedroom to the bathroom. It's called a HISA grant.

If you decide to go the nursing home route, you will need to check on her often, such as every day.
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Dementia is a progressive disease and your wife will need more and more assistance as she declines.  I advise looking into a nursing facility.  If you want to be close to her, there are facilities that offer both assisted living and nursing care on the same premises (should you want to leave your home as well). Bless you - this is a very difficult decision and I hope you find the help you need.
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