A. Dealing with a parent who has lost their mind:
If a person’s father or mother has lost their mind, the child needs to try to treat them and act with them in accordance with their mental capability, until [G-d] has mercy on them [and returns them to sanity]. If, however, it is not possible for the child to deal with his parent being that the parent has become unbearably insane, then he may go and leave them be and instruct others to properly deal with them. [Hence, if one’s parent has lost their mind or becomes unbearable to care for in their old age, then one may enter the parent into an old age home or other facility that can care for them. Furthermore, he’s even encouraged to have other people deal with his parents then to deal with them himself in a dishonorable manner. Furthermore, even if there is no one who is able to take care of them due to their state of insanity, the son may absolve himself from responsibility of dealing with them. However, the above allowance to institutionalize a parent only applies if one is truly not able to deal with his parents because of their mental deterioration, if however one can deal with them but is simply worried that he may not honor them as much as is required, then it is disputed amongst the Poskim as to whether he may place them in an institution. Practically, in all cases that the care for the parent would be better if they were in the institution, then one may place the parent in the institution even if the son can also care for his parent but to a lesser degree. Likewise, in all cases that the son would need to fight with his parent in order for them to follow with the care that is required, then it is better that they be placed in an institution and have this done by others.]
Is a child obligated to listen to the instructions of a parent who is insane?
No, with the exception to matters relating to their general health and well-being.
B. May one place his elderly parents in an old age home:
This follows the same law as above, and hence if the children cannot care for the parent due to the overburdening demands, or if they will simply receive better care in the old-age home, or due to them entering into too many arguments with the parent, then the parent may be placed in an old age home.
What is to be done if there is a dispute in the family as to which institution or old age home to send the parent to?
If the parents have not made their opinion known, or are too incapacitated to do so, then if one of the children have been appointed by the parent as their medical proxy, then his decision is the final decision in this matter. If no medical proxy was appointed, then the matter is to be given to the local Beis Din and they are to appoint a medical proxy on behalf of the parents for the decision to be made.
C. Hiring another person to care for one’s parents in one’s place?
Based on the above, it is understood that it is permitted for a child to hire another person to care for his parents in his stead. One may even hire a Gentile for this purpose. Nonetheless, as is the general rule, is a greater mitzvah for one to personally serve and honor his parents then to do so through a hired emissary. This applies even if the son is a Torah scholar. If, however, the son lives a distance from the parent, or simply does not get along well with them, then he may hire someone to provide them their needs rather than do so himself. In such a case, it is proper for one to pay the emissary for his troubles, even if the emissary is willing to do so for free. Nonetheless, if the parent desires that specifically his son care for him, then he cannot delegate the duty to another person to do so, and is even to live next to his parents for this purpose.
 Michaber 240:10; Tur 240; Rambam Mamarim 6:10; Kiddushin 31b regarding mother of Rav Assi “Rav Assi had an elderly mother and would do whatever she asked. If she asked for jewelry, he would give her jewelry. When she asked for a husband, he replied that he would search for one on her behalf. When however, she asked for a husband like him, he realized that she lost her mind, and he therefore left her for Israel.”; Ran and Nimukei Yosef Kiddushin 13a; Ralbag Parshas Yisro; Pesakim Uteshuvos 240:36; Encyclopedia Talmudit Erech Kibud Av Vaeim Vol. 26 p. 416
Other opinions: Some Poskim question this ruling and state that it is not correct to follow it. [Raavad Mamrim 6:10] The Poskim however negate this opinion being that it is based on an explicit teaching in the Talmud. [Ran ibid; Beis Yosef 240] However, in truth the intent of the dissenting opinion is not to say that a child does not have the right to leave his parent if he is unable to deal with them due to their state of insanity, which is explicitly written in the Talmud. Rather, he is dissenting over the added words of the Rambam which instructs the child to appoint someone else to guard over his parent. Now, if the parent is able to be guarded by someone else then why can’t the son himself do it, and if the child himself can’t do it then how will someone else be successful in doing so. [Taz 240:14; Derisha 240:2; Bach 240; Rashal in Yam Shel Shlomo Kiddushin 1:64] According to this opinion, not only may the child absolve himself from dealing with his parents if they are too unbearably insane, but he may even do so if there’s no one else who can deal with them.
 Ralbag Parshas Yisro
 See Taz 240:14; Derisha 240:2; Previous footnote
 Some Poskim imply that a child may choose to delegate the care of his parent to another person even if he is able to do so himself. [Setimas Michaber ibid; Rambam ibid; Ran and Nimukei Yosef Kiddushin 13a] However, from other Poskim it is evident that any time the child himself can care for the parent, he may not delegate the care to someone else. [Raavad Mamrim 6:10, as explained in Taz 240:14; Derisha 240:2, Bach 240; Rashal in Yam Shel Shlomo Kiddushin 1:64]
 Shevet Halevi 2:111-7 based on Radbaz and Migdal Oz on Rambam Mamarim 6:10
 Aruch Hashulchan 240:32; Tzitz Eliezer 12:59
 Bach 240
 See Michaber C.M. 290; Pesakim Uteshuvos 240:36 footnote 323
 Pesakim Uteshuvos 240:37
 Shemen Hamur Chelek Haderushim p. 111; Zera Emes 2:148; Kneses Yechezkal Mareches Chaf; Implication of Kiddushin 31b; See however Machaneh Chaim 2 C.M. 29 who implies that a son cannot delegate the mitzvah to another
 Article of Rav Sheprun in Koveitz Hayashar Vehatov 13:7
 Kiddushin 41a; Sdei Chemed 4:239; See Admur 249
 Shemen Hamur ibid; Michtam Ledavid Y.D. 32; Or Hayashar Pesachim 104b; Har Tzvi Y.D. 97
 Yismach Moshe Parshas Eikev; Mur Veahalos 31; Sdei Chemed 9 Divrei Chachamim 44; Darkei Teshuvah 28:61; Doveiv Meisharim 1:47-2; See however P”M 432 A”A 5
 Shemen Hamur ibid