I was beginning to realize that being David’s caregiver would mean becoming his healthcare refuser.  Instead of going to the ER, we called the doctor on Monday morning, and David started another round of physical therapy.  Instead of starting the ER-hospital-rehab-release cycle, we went to see a nearby assisted-living apartment.

The apartments were beautifully designed – and expensive.  Our friend Mickey had taken David for a tour months before, and he had proposed the idea of moving there both to me and to his financial planner.  Mindful of the high care costs facing him, both of us voiced concern about the rent.  But David loved the layout and setting and finishings, and he brought up that proposal again and again. 

The expense still gave me pause.  On the other hand, those apartments were five minutes from my house and a few blocks from David’s gym. The building had elevators, a café, a restaurant, an art room, a library, and an exercise room.  And while the rent was higher than David’s monthly mortgage payment, we could offset the extra monthly cost by reducing his travel budget.  We had flown to New York City to see our daughter twice since David’s diagnosis, and it was clear to me that the most recent trip had been the last unless we traveled with a second caregiver. 

I was unprepared for that trip. I’d spent hours of every day with David, so I thought my assessment of his condition was fairly accurate.  Besides, we had made the same trip the previous year, and as far as I could tell, David’s condition hadn’t worsened much.  This time, though, I was traveling with a David I could barely recognize.  He was hallucinating constantly, insisting that I was going the wrong way, that our daughter was standing on the corner waving us in her direction.  On a train, I turned to find that he was holding onto a pole that wasn’t there.  Throughout the trip, he was too agitated and disoriented to sleep; he trembled with fear and fatigue.  I was too scared to sleep because I was afraid he would leave the room and get lost.  Back at home, David slept for days, and his agitation and hallucinations eased back to the baseline.  I was shaken. 

So shifting the travel budget to rent made sense.  A beautiful building with areas for meeting other people promised to bring pleasure and social interaction every day in a life of loneliness and mounting losses.  David wouldn’t have to navigate stairs, and he wouldn’t have to spend his days trapped at home, alone.  We could shift the bus service to the new location.  David wanted to walk the short distance to the gym; I suggested that we think about that again after the winter.  I secretly hoped that he would be willing to give up the gym and work out in the exercise room.  Gym aside, a move to that assisted living apartment would make his days so much richer: he could go for coffee, go to movies, take art classes, and join a game night without leaving the building.

Moreover, the assisted living building was affiliated with our local medical clinic and was part of a “continuum of care” cluster of facilities.  For an hourly fee, the housing manager told us, we could arrange basic medical assistance at the apartment.  As David’s LBD progressed, he would have priority for placement in the memory care unit of a nursing home in the cluster.  He was already on waiting lists, but he didn’t have priority status on those lists, and it was anyone’s guess whether his need would align with an opening. 

David was ready to sell his house and move to the apartment.  The weekend of pain and restricted mobility had underscored the problems with the floor plan: the shower was upstairs and the kitchen was downstairs, so there was no simple way to live on one level.  He’d recovered, but something similar would happen again, or again and again.  And even though we lived in townhomes, ongoing maintenance for both houses stretched my capabilities.

We consulted with the financial planner, met with a realtor, and put down a deposit on the only open apartment.  Moving from a house to a one-bedroom apartment meant parting with furniture and books now rather than later, but given the likelihood of eventual placement in long-term care, it seemed best to make the decisions together while that was possible.  We learned of a service that specializes in moving people to assisted living and nursing homes, and we got to work.