Dear Carol: My wife's in a wheelchair because of an accident that she had 10 years ago. I've gladly taken care of her, but now she needs an increasing amount of care that I can no longer provide. We found her a place in a large, once-private house that has been converted into a group home, but she's terribly unhappy. All of the other residents have advanced cognitive ailments. We both understand the challenges that these good people face, but my wife isn't there to be a caregiver. She loves to play cards, read, talk about news and do puzzles, but all she does now is hide in her room and read. We need to find another kind of care for her, but we've read about how horrible some nursing homes are. What are our choices? - SG.

Dear SG: Having to move your wife after all of these years together has got to be terribly hard for you both. I'm sorry that it's been made extra hard by already needing another change.

I can understand the allure of a smaller private care home and, for some people, these homes work beautifully. In your case, it isn't a good fit because your wife needs a different level of care than the other residents and a wider variety of individuals with whom she can communicate.

My advice would be to re-evaluate your view of nursing homes. Sadly, nursing homes vary greatly in different states. Additionally, a reality of our times is that even the best nursing homes can be so understaffed that it's worrisome. Still, you could start visiting every nursing home that has potential. Ideally, you will find one that is fairly close to your home so that you can visit regularly and be a strong advocate.

I've addressed the issue of what to look for in nursing homes in past columns that are still available online, and you'll find more comprehensive articles on my blog at www.mindingoureldersblogs.com.

Briefly, however, visiting the homes is the first step. Talk with the administration about your wife's needs, but also visit at odd times so that you see all aspects of their care. Watch to see how the staff interacts with residents and ask if you can look in on activities when people are participating so that you can see their level of engagement and enjoyment. Ask, as well, about their medication routine and tell them upfront that you intend to be involved.

Everyone needs some type of socialization, so most nursing homes will include people with dementia. Many of them are still able to converse and will enjoy her company, but your wife has specific needs that are just as important. A larger facility may be able to offer her the physical care she requires while also providing a cross-section of people who enjoy some of the activities that she enjoys. It's unlikely that you'll find a perfect solution, but we can hope that you'll find something acceptable.