Question: I am a healthy 76-year-old. My wife of 51 years suffered a stroke a month ago. She was in the hospital for ten days before being transferred to a rehabilitation facility. Now she is in a nursing home, where her therapy continues. While she has made progress, she is still mostly paralyzed on the left side, needs help getting from her bed to the wheelchair, bathing, dressing, etc. Her speech is getting better.

Here’s the rub: My daughter keeps reminding me that I promised my wife that I would never let her die in a nursing home. My son, on the other hand, thinks his mother and I will be better off if she stays in the nursing home, where she can get the best care possible. This has led to a feud between our children, and I am in the middle. I believe that I can take my wife home and care for her if I get some help, but I am torn. I know there is no clear answer here, but the added pressure from my children is difficult to take along with everything else that is going on.

Answer: While commendable, promises made to spouses while both are healthy concerning what will be done in the event of a future health-care meltdown can’t always be carried out because of economic, health, and other considerations.

That said, before making this important decision, we believe you should take an objective and practical approach to assessing the factors that should enter this equation: 1) your ability to bear up under care responsibilities 24/7 without jeopardizing your own health; 2) a professional assessment as to whether your wife will be able to receive the care she needs at home; 3) the physical and financial ability to fix up your residence as may be necessary to provide for her care; 4) your ability to find quality aides; 5) your ability to pay for the cost of care at home and still ensure your own future financial stability.

If factors 1 through 4 seem to make caring for your wife at home feasible, you must take a hard, objective look at #5 before jumping too quickly. Based on our experience, few families today can afford for long the $4,000 per month-plus that it takes to fund nursing home care, much less the greater cost of providing care at home. All other factors being equal, we believe that those families who have had the foresight to purchase adequate long-term care insurance stand the best chance of instituting the home-care option.

Taking the NextStep: Secure an independent assessment from an experienced geriatric care manager caremanager.org of your wife’s ability to function adequately at home. This professional can also give you ideas of what care you would need at home, the cost, and where to get it. You should then make an objective determination of whether you can afford to provide this care without bankrupting yourself. A certified public accountant and an experienced elder law attorney naela.org can help.

After you take a methodical and objective look at all of the facts, make your decision using your head, not your heart. Only you know what you can do and what you can afford. Guilt should not enter the picture. Sometimes it’s more productive to spend the day with a loved one at a facility and then be able to go home and get a good night’s rest. While children should be informed about the health of parents, so long as you have the capacity to make decisions and surround yourself with professionals to help you make these tough choices, the final determination is yours, not theirs.