Anonymous wrote:80 years old with high blood pressure, failed kidneys (dialysis 4x a week), hyper-limited diet due to kidney failure, depression and many other issues. Her medicine regime is at least 10-14 different pills per day. She fell recently and injured her leg to the point of not being able to use it and is now in a wheelchair, but she cannot get in or out of the chair without being lifted basically. The recovery from the leg injury is going very very slowly. She needs help to change clothes, go to the bathroom, bathe. Even when she could walk it was very slow, stuttering steps. She cannot cook. She does not speak English as is currently living with my sister-in-law who is having difficulty dealing with her.
OP, the step between family care and a nursing home is in-home care (a certified nursing assistant, also called "unskilled care"). The truly rich often pile on the in-home care and skip the nursing home route altogether. In-home care serves a dual purpose: it helps the elderly person and it gives the family caregiver a break from what is otherwise grueling, emotionally and physically depleting work. The caregiver claws back some of his/her life and also becomes renewed enough to do a better job caregiving.
When planning or talking with people caring for elderly family members (your SIL for example), I would suggest you not skip ahead to what might be 2-3 steps ahead of the present, as you're doing. Even in families from cultures who are more open to nursing homes, the caregiver is so caught up in the day-to-day work that s/he can't see ahead one day or week, let alone a month or a year. Plus the caregiver has a better idea of the obstacles than you do. Even in-home care comes with a price beyond the financial cost; it's a contractor to manage, it's an invasion in privacy.
Has any doctor in contact with your MIL expressed a professional opinion about your MIL's current quality/level of care? You told us your observations, assessment and conclusion. What are your wife's?