How do you deal with the stress/mental effects of making the right decision regarding their care?

I always like to suggest we reexamine our interpretation of the word GUILT because words themselves do matter.
To be honest, guilt belongs to felons. It is reserved for someone who understands that they have done GREAT HARM by their own FREE WILL and have taken GREAT JOY in doing harm. I doubt that is a category you can squeeze into.
The word you want is GRIEF. It is another word entirely. Grief acknowledges that you are a human being, not a saint, and that you are attempting to do the best you can while still reserving some deserved life for you yourself, and for your primary family.
You are extraordinarily lucky. Your father, like my brother, recognizes that his going to ALF will greatly relieve you. That is the TRUTH. That is the truth that many families have to explain to the best of their ability to an unwilling LO. Your father is like my brother who told me "It isn't what I would have chosen for the end of my life, but the people are wonderful and treat me well and I am adjusting (he DID) and I look upon it much like my being a young man who had to join the army. I didn't much like it, but I made the best of it.
How much of life is just RECOGNITION of the facts of the case, and adapting to the best of our ability.
I wish you so much luck and I exhort you to watch your labeling of yourself. You are trying hard. You see here on forum over and over again the dire results of not recognizing the facts, of labeling ourselves wanting when we are honestly trying. Please be gentle with yourself.
There is no path in life that we have a guarantee of it being "the right path". I wish you luck.

jkl, let me start by saying I am an only child too, and my mother is 94 with severe neuropathy in her legs/feet which has been an ongoing issue for as long as I can remember.

She lives in Assisted Living since 2014 and now in Memory Care since 2019. She was walking with a wheeled walker beginning in 2015 and the falls started then; she took 40 of them while in AL! FORTY. She developed severe vertigo due to the neuropathy advancing and having poor hearing, poor vision and no feeling in her feet, giving her no idea of where she was in space. That's what led to all those falls. She also has very bad balance issues and 'falls backwards'......IDK if your dad does that too? It contributes greatly to the falls.

She never went to the hospital for ANY of the falls, believe it or not, but wound up with broken sternum bones and ribs as a result of them. When she was hospitalized in 2019 with pneumonia, a CT scan was done & the doc noticed those broken bones in different stages of healing and brought it up to me. That's when I knew she DID hurt herself with some of the falls, and that's why she was asking for Icy Hot patches 24/7 from the staff!

Anyway, back to 2019 & the hospital. The doctor spoke some wise words at that stay. He said at some point, with neuropathy, the patient MUST go into a wheelchair for their own safety. That's when my mother, at 92, went into a wheelchair full time and the walker was retired for good. That's when AL refused to take her back & she went into their Memory Care building. Since June of 2019, and while in a wheelchair, she's taken an additional 32 falls.

I truly do not understand why you are feeling depressed & guilty about helping your dad get settled into Assisted Living. Especially since HE is the one who brought it up. The truth of the matter is that nobody is going to be able to prevent him from falling, not you, God or anyone else. Neuropathy is a terrible thing and IT will cause him to continue to fall, thanks to balance issues, nerve damage and loss of feeling in his feet/legs. He is best off in AL where help is available 24/7 and teams of people can pick him up if/when he does fall and he can be examined by a nurse to determine if he needs to go to the ER or not. That is a BETTER situation for a man with a chronic condition than living alone with an absentee WIFE and a daughter who's overwhelmed and unqualified to help him 24/7. Your only goal here should be your father's best quality of care and his safety, leaving emotion OUT of the equation. You can go visit him every day at the AL if you want to and assume the role of his daughter again instead of his stressed out and scared to death caregiver, you know?

From one daughter to another, I get it. I know how you feel and what you are going thru. And I can tell you the BEST thing I've EVER done was to place my parents in Assisted Living back in 2014. Dad had neuropathy too but it was actually a brain tumor exacerbating it, unbeknownst to us, and the staff at AL treated him like gold. Cared for him right to the end of his life beautifully, just as they are for my mother now. Don't attach a stigma to AL; realize it's dad's best bet for 24/7 care available to him and help with showers and getting dressed as his condition continues to deteriorate.

Wishing you the best of luck and NO GUILT on your part!

Again look at his willingness to move into AL as a gift to you. He's allowing you to live out your life as it should be lived. You won't be abandoning him.

I, too, am an only child with parents who were still living in their own home until 2 months ago. My dad has moderate dementia and my mom was doing well physically and they both were pretty mobile. I was trying to care for them 250 miles away by going every 2-3 weeks for several days, cooking and freezing meals for them, taking them to appointments, being there for hospital stays, etc. It was wearing me out traveling back and forth, always being on call to drop everything if something went wrong and constantly worrying about them. We also have 4 grown children of our own with families and of course we’re wanting to be available to them also.
I could tell taking care of my dad was taking a toll on my mom but they would not move out of state with or near us as my dad was adamant about staying there. In January, my mom had to have a pacemaker put in and after that, her mental state rapidly started declining. It was obvious they both needed more help and care than I could give them since both had had falls in recent months. They became open to AL so my husband and I with the help of an agency found a great AL. They agreed it was time so we packed them up for the move to an AL which was pretty near their hometown so friends and other family could see them often. It was the hardest decision I’ve ever had to make and I felt guilty about not being the one to care for them but after 5 weeks of staying with them 24/7, my husband and I knew they needed more than we had to give them. That’s why nurses have shifts we decided because no one can do full time care for 2 people who have many needs and who don’t sleep at night, btw. It was hard and I still feel guilty at times but I know it was the right decision. They are slowly adjusting after 2 months and really have no complaints about where they are in a 2 BR, 2BA apartment. It’s just not home. And then with dementia, you never know what might be off one day and better the next.
I wish you well on your decision but try and not feel guilty. Some have said, I need to take care of them because they took
care of me growing up. But I been reminded that adults are not infants or children and their needs are far different. I AM taking care of them by finding a great place for them that is safe and they are well taken care of 24/7. And I can sleep at night knowing that if something happens, someone who is a professional will be there immediately.

Your feelings are normal but, as Alva pointed out, you have no reason to feel guilty. Focus on your grief. You are grieving for the man who was once upon a time your strong father. Find him the best assisted living within his means and place him there as soon as possible. You will still be his advocate and his loving, caring daughter just not his caregiver. His needs are only going to increase.

If your father is willing to move to AL go for it. Do it together and include your Finance in shopping for a good fit for your father. Do not feel guilt which is self imposed. I doubt very many of us feel we adequately take care of our LOs. There is nothing wrong with your father making it easier on you, he's allowing you to live your life. My parents decided to to move into Independent living, progressed to AL because of dad's fall and dad moved into SNF shortly before his death. I will be eternally grateful to them for the decision they made. Mom is still in AL, they neither one wanted my brother or I to take care of them day to day - they wanted us to lead our own lives.

You will still be your father's caregiver by advocating for him and making sure his care needs are met. Look at it this way, your father will have others to associate with and daily with activities available. He will have staff round the clock available to him. His meals will be prepared, housekeeping, laundry. And (if like my father) when he falls, someone will be there - they will take efforts to cut the risk of falls, but they can't promise he won't fall. With him in AL you will have less to worry about.

I don't know if any of us at times know if we're making the right decisions. You research, list pros and cons and make the best decision you can. You don't have to do this alone, your father has evidently express his willingness to go; be inclusive with your father and his wife (if she's interest), and your fiance.

Er.

You'll have to excuse me, but can I just point out that from the sound of your excellent father and sensible stepmother, these are not your decisions. They are making choices they are happy with, and God bless them practical choices too.

Less tearing around like a blue-arsed fly. More respect for your father's ability to decide for himself. That's my advice.

I guess I am looking at this a different way. Caring for your Dad is his wife's responsibility. For better or worse, sickness or health. Not saying you can't help but she should be there. So you have no reason to feel guilty. She does.

Allow your Dad to go to an AL if he can afford it. Then you can just enjoy visits and getting him things he needs. He will have socialization. He is giving you a gift, except it. He will continue to get worse and the caregiving harder. Enjoy the time u have together.

WOW...dad is agreeing to transition to AL.
That is a major step!
Yes it will make it easier on you but it will also be easier for him. AND when SM visits she may realize that he really has a pretty good deal going on she may also decide that AL is not such a bad thing.
As long as he is willing then there is no reason for you to feel guilty.
He will have more help, he will have more activities, more people to communicate with.
Do make sure that you have all the paperwork you need.
Have you talked to an Elder Care Attorney?
The fact that he is married IF something were to happen legally his wife is "next of kin" and she is the one that would have to make decisions and if she is away it might be difficult. (this is more important if he can not communicate his wishes at the time, not so much if he is able to make his own decisions)

Your dad is a wonderful man for bringing up the subject first, because he UNDERSTANDS the burden his care places on you. You should be absolved of guilt right then and there, because he's made that decision.

I certainly hope your dad and stepmother kept their finances separate, because clearly your stepmother has no intention of honoring her marriage vows. If her health precludes her from helping, that's one thing, but if she simply would rather go off to her house when your dad needs her the most, then she might just as well stay gone.

Focus on Dad and getting him into a good assisted living situation. In the end, both of you will be happier, because he'll have good care and a way to socialize with others who won't take off as soon as times get tough.