I anticipate moving into a home type of residence. What are your opinions?

At my moms former facility, the memory care unit was in the same building as assisted living. The memory care area is locked down of course and requires a code to get in. There were couples that had one spouse in assisted living and the other in memory care and it was an easy walk to visit the one in memory care. They could dine with one another or just visit for a while. I'm sure the cost is substantial, but a very convenient arrangement for a couple requiring different levels of care.

In many places IF you are able to monitor your spouse so that he does not wander off the two of you could reside together in AL. If there is any possibility that he would wonder off then Memory Care would be the best option.
As you tour places look for ones that have "continuing care" that will go from Independent Living (if you do not think you need Assisted Living now) to Assisted Living and Memory Care.
I also suggest that you and your husband talk to an Elder Care Attorney and make sure that you have all the paperwork done that you may need, Will, Trusts (if needed) POA for Health and Finances (Do not be each other's POA find someone that you trust that would be willing to take this on. Or at least do not let your husband be your POA if he has cognition problems now.)

In our facility, couples share apartments although they may require different levels of care. Some people remain even if they require skilled nursing care, but then costs increase immensely (although not sure any more than in a nursing home). Some partners have one person that requires a caretaker, depending on the extent of time and care involved, they may hire an outside agency. I don't think a person with memory problems, who wanders, would be safe here. I chose it because my husband was quite sick at the time and some places required assistant living candidates to live in a separate area. We did not want that. Shop around. In fact, I tell everyone even thinking of getting old to start familiarizing themselves with the tons of different facilities in the area they plan to use. Sometimes, the need is unexpected and sudden, no time to start looking if one can avoid it.

My Mom is in a MC floor. The entire building is Assisted Living with one floor of Memory Care. Some rooms are studio and other rooms are 2 person shared suites. The entire building shares nursing, caregiving, program, and dining staff.

Two of the people in Memory Care, husband and wife have a room together on the floor. I'm not sure if she is memory impaired, since I never see her talking to the caregivers or the nurses or to any of the visitors. The husband is full time in a wheel chair and I have never seen him talk, even to his wife. He wears a urine bag full time. She and He eat together with the other MC residents.

Another resident has a room of his own, and his wife lives upstairs in one of the Assisted Living rooms. She uses a cane and is able to carry on a conversation. She visits with him in the mornings. She does not eat meals with him. Occasionally, he can get very pushy and beligerant (he doesn't use words, only noises). One time, he was being belligerent while his wife was there. The caregivers were handling the situation and she quietly exited.

My sister's in-laws have an independent living apartment. You could buy a meal plan. Laundry, medication management, housekeeping, grocery store delivery are additional costs. Mom should be in memory care, however, she doesn't wander and is not violent (she is belligerent.) They have turned off electricity to the stove and bring food to her. She would rather starve than walk to the dining room. Dad is no longer alive so she lives alone with a few hours of caregiving daily to help her with baths, etc. The point here is that she is still in an Independent Living apartment.

Here where I live, there is a place that you can purchase, through a realtor, where the condos are independent living. However, the building has the infrastructure to care for you all the way to the end, including memory. They have a rehab area and even rent it out to outsiders.

So ignoring costs, I think whatever combination you would like, is possible.

MetroUrban: Perhaps you can locate a facility that serves both you and your husband's needs on the same campus.

I am 88 caring for my 89 year old wife, who has Alzheimers. Love is my strength and motivator. Familiarity is important. I intend to stay in our home. I say, “Move only if you must.”

Metro, I would look into board and care homes. They are typically 10 or less residents with 2 caregivers. They are in houses and have a less institutionalized atmosphere.

You and your husband could share a room if you wanted or not. The downside is that they do not have activities like the larger facilities but, only you can know what would enrich your life and ensure proper care for your husband and what services you would utilize.

Best of luck finding the best place for both of you.

Oh, Google senior placement specialists for your area and they can help you find the facilities that you can afford, that can meet your needs and ones that take Medicaid if required.

Some retirement communities offer apartments that are licensed for personal care in the home. The couple can stay together. But that means the able spouse will function as the 24/7 caretaker with additional paid support. Most continuing care communities will require the separation of the couple in order for the person in the need of more care to move into the appropriate facility. The separation, although difficult, allows 24/7 care for the spouse that needs it as well as respite for the spouse that is more able. Tough call either way. My thoughts are to go with preserving the mental and physical health of the more able spouse so that they might navigate the difficult journey.

I've visited quite a few places that have 'continuum of care' models.

Bigger facilities may be set up for this & include 1-2 bed apartments (for independant living), bedroom with ensuites that include intermittent staff assistance (assisted living) & rooms for higher needs, also rooms more securely monitored for memory/behaviour support.

I've visited many places over the years & volunteered at a lovely smaller residence too. It was mosly AL but a small MC area. Quite a few couples resided there. One had separate rooms. I believe they had trialled sharing together but it didn't work well. Wife could be agressive + tricky behaviour issues. Didn't want staff ('the girls') with her Husband, wanted to boss him all day. Lacked insight. Was preventing him getting his own care needs met. Separate AL rooms worked better for them. Husband could visit her for a limited time but then was free to join the men's groups, enjoy his own hobbies etc, also get a decent night's sleep.

A few couples shared rooms & seemed happy with this. One man said his mind was good but legs bad. Said his wife was the opposite.

There are many factors to consider for or against sharing a room: mobility, memory & behaviour concerns being big ones (but money & avaibility too of course).

I've met people who just need the 'heavy' work of showering or transfering their spouse into a wheelchair done by staff - they can be mostly independant during the day otherwise. An AL suite could suit them.

Yet others are worn down by their spouse's constant anxiety, shadowing behaviour, need for reassurance, redirection, prompting & supervision. A duo of MC & ind rooms may be needed.

42 hrs a week care may be needed, but how this would be supplied is key. My impressions are MC has more supervised time eg a day room & arranged activities. AL residents are freer to hang out in their rooms (unsupervised) as they wish. This could mean you stay your Husband's main carer for much of the day.

You know him best, what he needs. You also know what you need.

Best of luck with your next steps.

Some facilities offer multiple levels of care in different areas of the same campus or building, that can be a good solution for couples with differing needs.

Hi Metro,

I'm actually kind of doing that right now for my dad and his wife (remarried 40+ years). Both have dementia, although different kinds. My dad has had two strokes in six months and as a result, has vascular dementia, speech dysphasia (scrambled words come out), significant right-side weakness affecting his mobility and history of refusing to take his medications. That was the reason for both strokes. He would lie about it when asked... we really did our best, but he refused to even consider a senior living community and would get quite angry if we even brought it up. His wife is in decent shape physically, and can walk around fine although she's a bit unsteady, but my dad is now using a wheelchair to scoot around because he gets tired very fast with the walker. So, his needs are now more than hers.

I live in WA state and found a great alternative to traditional Assisted Living/ Senior Communities, but it may vary by state. It is Adult Care Homes which are converted houses and generally only have 4-6 residents. It is less expensive, and has a much higher ratio of caregiver to resident by a long shot. It's much more personal, feels like a small family, and caters better to the individual. They also take Medicaid down the road if needed. Best of all, they are very highly regulated by the state (at least in WA), have to meet stringent guidelines, frequently inspected and every resident file is reviewed when inspected, not just a random small sample like is the case with big corporate run senior living and assisted living places. The only downside is you don't have a full apartment to yourself, you have a bedroom with perhaps an attached bath. You share the common areas like the living room/kitchen etc with the other residents... but there are only a small handful of other people, so you get to know them really well, like a little family. They cooking is really great, provide healthy meals catered to your dietary needs (my dad is diabetic). I'm not at all against the big corporate places at all... they are great too, offer wonderful activities and services, have a great community feel, but are more expensive. My husband's parents chose that option and are very happy with it! They need less care at this point, and really enjoy all the activities. I think it's about finding what is the best fit for your personality, lifestyle preferences and budget. I didn't even know about the AFH (Adult Fam Home) option so I thought I'd pass it along.
We went on three AFH tours and liked two of them, but didn't click with one at all. One of them my dad, his wife and everyone liked a whole bunch, and that's what we chose! Haven't moved in yet, my dad is still in rehab facility getting physical & speech therapy, but happy to update you later on our experience if it's helpful. :o)