In my own quest in the SF East Bay, right before COVID stole the scene, I ended with choosing a board and care for my parents that is owned and administrated by a retired nurse with a Filipino background. It is a family-run affair rather than some corporate warehouse. It is a converted small motel, with about 15 rooms, not the typical converted single-family home. This means they are just large enough to have an overnight staff shift and multiple daytime staff roles, instead of one person struggling to handle everything.

It's by no means one of these places that puts on a facade of being a retirement resort. A first impression might be that it is dingy. But, for the combination of dementia and other care needs we have had on our plate, they have provided just about the best care I could hope for.

Along the way, I've had to disregard superficial judgements from some extended family or family friends, who seem to harbor a fantasy image of elder care as an elevated experience with the trappings of a luxury hotel stay and experiences fit for aristocrats. In a dream, I too wish my mom could have stimulation and education in her final years like immersion in an artist colony combined with a Parisian salon from a novel.

I settled for a place that consistently keeps her safe, gives her communal meals, manages her hygiene, manages her medications, monitors her health, and communicates reasonably well with me on these topics. I also visit weekly and take her to all her medical appointments etc., so I think I have an accurate view of how things really go there.

My biggest lesson from this, applicable to future generations, is to find your enriching experiences and setup your end of life plans while you are young. By the time you or your family realize you are in decline, you likely have lost the cognitive and/or emotional flexibility and/or agency to really adopt the most enjoyable lifestyle or life setting. Your more basic care needs will start to dominate all decision-making.

> taking care of the elderly is a fundamental tenet of Judaism

As it's done in most of Europe, Latin America, Asia, Africa. US/Canada were turned against family and tradition thanks to decades of brainwashing by movies, TV, and ads. To be cool you had to go to a college in another state. Then move to a big city. Pick career over family and having children. Take antidepressants.

This started in the 70s and is well documented.