He has vascular dementia and a zero cognitive test score. Walking is slow around the house and he is hanging on to walls and objects to balance. I help him dress and shower, use the bathroom. Should I start with AL then later transfer to MC or just skip the AL?
If he has no nursing care needs currently, and he can still assist with standing up, then MC would be best.
If you can find one with in-house PT/OT that's great. Even better if they have a skilled nursing area, and the best would also offer a rehab unit (in case he falls and breaks something).
Most MC's can keep their patients through hospice if they're weight-bearing, unless a nursing care need crops up before that point (like a large pressure sore that requires daily wound care), but you'd want to know what would specifically require them to move your husband out of MC for skilled nursing.
Hopefully you could visit a few facilities with MC to best determine which one you prefer and can have a comparison.
This is a big move and adjustment. The less stressful it is would be best I believe for both of you. I hope you find the right choice.