Get help.
However that looks to you. Hired or otherwise. Live in a one story home. Stay with them as much as possible and go to the gym, a regular night with a group of friends, or a support group. Live in a state with assisted suicide. Not because you want them to, because every day has to be a choice to go on. Find things that make you both laugh, and do it every day..
I don't like facilities. But if it was unavoidable, I would relent, and demand 24hr access.

Do what you have to do in order to keep your sanity. Being a 24-7 caretaker is an emotional rollercoaster. I've been there. Be good to yourself, if you are unhappy so is the one you are caring for....

I would if I had too

Only if I am not physically able to take care of her in a decent manner. That's what you promised when you married her.

I would hope that we had discussed this stuff a few times before it ever came to pass, so that I would know what she wanted, she would know what I wanted, and when it came to that decision, we would have already covered it.

I, _tymtravler___, take you, _xxx___, for my lawful wife, to have and to hold from this day forward, for better, for worse, for richer, for poorer, in sickness and health, until death do us part.​
"​"" in sickness and health"...... Do whatever you think will honor your vow.

No. I took care of my partner of 10 years at home until he passed.

Only if I am unable to care for her.

To be more specific, my wife had lung cancer 12 years ago and it was followed by 6 metastatic tumors to the brain. She had targeted radiation to the brain followed by whole brain radition. That was 10 years ago. I retired early 5 years ago due to her many falls and severe COPD. Her cognitive abilities are really getting worse and she has great difficulty with conversation. By no means am I putting her in a home until I just can't keep up with her needs.
She spent 3 months at a skilled nursing facility and I was able to see how poor the care was. I visited her every day for hours and more often than not I had to resolve some mistake or lack of care that was provided.

My ex husband and I were divorced 20 years ago. He is an NRA and Trump supporrter now and we barely speak. He had a tumor removed from his spine and can no longer walk. He also has cancer, diabetes and lymphadema. He was in a nursing home with nowhere to go. He became my tenant and I have a nurse and nursing aide for him. Unusual situation but my daughter moved back and I keep my distance. You have a hard decision to make.

When my husband started to get sick, I gladly took care of him. He had taken care of me throughout the years as well. It was a team effort. I was completely committed to him till he passed. He was my true love. I would never have thought to leave him in a home, no way. His place was with me. I enjoyed taken care of my husband, it was my pleasure. He was my responsibility to take care of him out of love. I was not about to quit. My husband was the most important person to me.

YOU ARE HER CAREGIVER! What is there to discuss?

I strongly suggest that you and your wife go to counciling. It will help you and your wife move forward making concious descisions. You have a painful and complicated situation you both need support.

I would also add that no matter how passionately you love someone, the realities of either choice make it impossible to know how you would feel or what you would do in that situation until you are actually in it. What's "best" is very likely not at all what you would consider until you are faced with these circumstances.

If her family is unable for whatever reason to give her adequate care at home and a good, nearby nursing facility is financially feasible for her family, then a nursing facility is the better option. If it's feasible for her family to address all her needs in her own home and she is happier and more comfortable there, then home is the better option. It's important not to be guilted or pressured into choosing either option. No matter which you choose, someone will offer a second-guess or outright criticism of your choice. It's your choice to make, as you alone know all the circumstances and logistics involved. And neither choice will be easier than the other. If she is placed in a nursing facility, you will probably struggle to monitor the care she receives, no matter how "luxurious" the facility looks on its surface. You may also find it challenging to juggle work and other responsibilities with visits to see her. No matter where you are, you'll feel like you should be someplace else taking care of another issue. My best advice is that when you are with her, be with her and think only of that; when you are at work, think only of work, etc. If you don't compartmentalize, you'll be overwhelmed. Best of luck to you and your family. Hope this helped at least a little.

What does your spouse want?
It is not any easy question but if at all possible I would stay home as long as you can.

only if it got to the point where I could no longer give her the care she needed. And even then, I'd visit daily.

No, I don't think so: but I would consider regular respite so that we both get some time out.