Can I go first? I'll try not to take up all your time.
Yes, I agree that we must have institutions and that they must be good and they must be humane. We have to have institutions for, essentially, two kinds of people: the people who can no longer make rational choice, who are predominantly the people with dementia, and the people who genuinely choose to give up their independence. There is that group of people, and I don't want to take that choice away from them.
We need to support the choice not to be institutionalized. In most situations, in the situation you talked about, there is no choice. It's not “Shall I go to the institution or shall I stay home?” It's “Shall I go to the institution or stay home without anything?”
We have the idea that you're either independent or you're institutionalized. What I'm saying is that there's a bridge, and the bridge is community support.