C.; I am a physical therapist and work in a hospital setting. Here are some things to consider: 1) are they mentally intact enough to be left alone safely? For example; maybe they forget names or the date or what they had for breakfast, but what is important is that they remember important things like turning off the stove, taking a shower regularly, remembering to eat, take medications in appropriate dosages. 2) Do they have the ability to move around their home safely? i.e. are they falling or do they look so unsteady when they walk they have to hold onto furniture, are they having to use a lot of stairs around the home and appear unsafe? 3) Are they able to take care of their basic daily needs at home? i.e. are they bathing themselves, dressing themselves, eating nutritious meals, do they look well kempt, are they incontinent and unaware or aware of it, is their home relatively clean.
Keeping these things in mind, there are many adaptations or services available to keep them at home- of course you have to figures out what insurance will pay for, what's private pay etc. For example: if they just have difficulty going up and down the stairs, can their living space be rearranged to keep them on 1 floor? if they are having a difficult time keeping up with housework- can housekeeping services be brought in every other week? if they are having difficulty keeping up with meals- is meals on wheels available in your area? if they are having difficulty remembering to get their medications taken- can a home health nurse come in a couple times a week to help? If they have difficulty bathing- can a home health agency provide bathing services or do they just need some extra grab rails in the tub or a bath chair? are you just worried that they won't be able to get help in an emergency- can they get lifeline set up? There are many services available to keep people at home as long as possible. If they are having difficulty walking or dressing, maybe they just need some physical or occupational therapy to help come up with some adaptations or activities to get them back on the right track again.
Now- if you think they need more than that, they don't necessarily have to go right to a nursing home. Maybe they need adult day care during the day and family or friends to check on they in the morning or evening. If that's not enough, maybe an elderly community where they still live independently, but there is someone on the premises that keeps an eye out for everyone or they can contact in an emergency. If that's not enough, maybe assisted living where again, they live independently but they can also go to a common dining area if they don't feel like cooking and there is a nurse on the premises 24hrs/day. There are some assisted living centers that provide levels of care; for example, maybe your parents can be independent but just need help getting dressed in the morning and getting ready for bed at night- the assisted living center could send someone in to help with that everyday. Or maybe they just need occaisional help getting on or off the toilet. Some assisted living centers provide levels of care based on time; for example, they'd have 4 levels- 1) the resident is independent 2) the resident needs 1 hour of care a day 3) the resident needs 2 hours of care a day 4) the resident needs 3 hours of care a day. And what care is provided in those 1 to 3 hours can vary from needing help getting medications set up to bathing to walking down to the dining area for meals etc.
If that is not enough care, then you might need to look into a nursing facility. And yes, there are bad nursing facilities and good nursing facilities just like there are bad hotels and good hotels. In my experience, you get what you pay for- and this can be difficult because they are all expensive relative to living at home. You'd have to see what kind of insurance or plans your parents have for long term care and go from there.
I think it is great that you are trying to look out for them. I guess my point is that at some point a nursing home might be appropriate, but many people aren't aware of the various services available to help the elderly.
Hope this helps.
L.