So mother-in-law has an apartment but it’s not in an assisted living facility? Why on earth is the sister-in-law so against assisted living facilities? They are rather awesome actually. They are more expensive, but they have levels of care from very little (basically a meal plan) to medium level (meals, laundry, housekeeping) to higher level (all the previous plus assistance with dressing, medications, etc.). Plan cost differ by need. Perhaps your sister-in-law needs to actually tour some places with your mother-in-law to get a better idea of what is available.

My dad was in assisted living for several years (thank goodness by his own insistence). Started with very basic care (basically meals). He ended up eventually at very high care with additional hospice care until we moved him into a care home the last year of his life.

ETA: Some people just don’t really have an understanding of the various levels of care available to seniors. My cousin really fought placing his mother in hospice, I think because in his mind that was end-of-life care. But he finally understood that hospice care can go on for years (with renewal of eligibility), is covered well by Medicare, and qualified her for a care home facility which is much smaller and more personal than a nursing home facility. It took really talking to him and educating him about the options for him to realize there were better options for care.

Senior care options are complex. Boy, has it been an education these last few years!