I've done both -- at-home hospice for my dad and a nursing home for my mother-in-law. Ultimately, each was the best choice in the circumstance. My dad was easi

I've done both -- at-home hospice for my dad and a nursing home for my mother-in-law. Ultimately, each was the best choice in the circumstance. My dad was easily scared and cognitive decline was, for a while, outpacing the physical decline. Having him at home, with my mom nearby and in familiar surroundings, was a comfort to him and -- despite my mom constantly being scared of having medical strangers in the house -- I'd like to believe she preferred it as well. And it's hard to argue with the cost; my parents didn't have much money and think 18 months (three six-month cycles -- dad held on longer than anyone thought) of at-home hospice resulted in <$1,500 out of pocket. At the end, he died with three generations of people he loved literally standing over him and holding his hand. My mother-in-law? She was always proud of her health and, to be fair, it was well earned. So after her second hip fracture, a planned rehab stay turned into permanent nursing-home residence as it became clear she needed 24-hour care. Could she have gotten that at home? Yeah -- but she once said, years ago, that death was very private and she decided to stay in a facility. It ran about $8k/mo for moderately-OK care and she passed in her sleep about a year later. I don't know there's any wisdom to be found in any of this other than the obvious: Have clarity about what you want before you're too old and too incapacitated to make a nuanced choice. Write it down. Communicate it with your kids and loved ones. Anything else is just creating needless pain.