JD, This is going to sound cold, but part of my consideration is money. In the USA it will cost from $6,000 to $10,000 per month for special care for my mother out of pocket. The family wealth will be gone quickly and so I'm thinking of options. Bringing my mother to a nice home/house with a full time nurse in the DR may be much more affordable option. Since she is nearly in the state where she is staring at the wall or TV almost blankly, I don't think her location will matter much to her. She already thinks the care facility that she is currently at is her home... I mean the house she used to live in. I want her to be comfortable and happy, but there is less and less of her that is responding and being in a large institution in the States doesn't really improve the quality of her life. Anyways, I don't know whats right, wrong, best or horrible any more... If a good affordable facilty might exist in the DR I would be tempted. If its home care in the DR, then as things get worse I can help the nurse turn her over and clean her and such... just rambling with thoughts now... Thanks for your help and contribution...much appreciated.