Can an Alzheimer's patient decide they are ready to die?

See how he is doing over the next few weeks but don't make any rash decisions about taking him home.
You can try for a W/E if he is mobile enough and you can get him to go back, or before that try taking him out for meals or a drive.

My husband has been in a nursing home for 2 years with alz disease. He has reached a point where he rarely speaks, recognizes no one, is unable to get himself in/out of bed (needing a machine to do this for him) but he is still eating very well. Is there any way to predict his death?

skanea, I don't think so. The NH staff may have some thoughts on the subject, based on frequent and repeated experience. Hospice probably has the most experience along these lines of any group, but they are often wrong in their predictions, too.

As Shakespeare put it, “Death, a necessary end, will come when it will come.”

It is so sad, and feels very hard, to be in this situation. My heart goes out to you. Do you have supportive people helping you cope? Those could be a real help.
It can be very heart-wrenching to be in that Med.Directive/Advocate position of making end-of-life choices for someone who no longer can.
It can Feel like it goes against everything we ever learned...and certainly, against inner survival instincts, to have to be the one to stop life support activities [food, water, meds, etc. treatments].
Often, people "rally" before they go. It sounds like maybe yours did that.
The pattern usually always is followed by relapsing into their illnesses and/or dementias...science has nothing to prevent or improve that.
It has been my experience, during patient care of elders and in hospice, that even those with severe dementias, including Alzheimer's, can often show some evidence that they do have some thoughts left, which they might wish to act on...and will try to do so. Stopping eating and drinking, is often that.
Whether that is intentional, or related to them "forgetting" to sustain themselves, is a moot point...they are too sick and science has Nothing to help it with.
They might, or not, be able to express them clearly to others.
To those not paying attention, the evidence that they have any cogent thoughts, can also resemble behaviors of a dementia'd mind...unless one knows that person, or has watched their behaviors closely for some time.
Things people might be ask themselves, might include:
---- Would your elder want to exist long-term, in a facility with no way to communicate and _no quality of life_?
Many, with minds intact, express strong feelings about NEVER wanting to end up in vegetative circumstances, much less prolonged using advanced life-saving techniques.
Most just say they wish to "be kept comfortable"...which can differ, per person, but bottom line, they don't wish to have their lives artificially extended, at the very least, not beyond reason.
---Inside yourself, is it OK to allow loved ones to naturally dwindle and die due to their illnesses/conditions, faced with only worsening of that?
You are her Advocate...make sure the facility honors her wishes in the most humane ways possible.
Search yourself; see what your beliefs are, and how those might help support allowing someone in her circumstances to die more naturally, with as much Grace as possible.
----If there is an Advanced Directive on file there, to prevent anyone from using advanced lifesaving, artificially prolong life, are there some staff who might be struggling against that? Some do. Even some dealing with writing orders for hospice patients.
We cannot prevent death; nobody gets out of life, alive. We miss those who go before us, terribly. We want to keep each piece of our hearts with us.
But we cannot, no matter what, prevent anyone dying.
We only have a certain amount of control over some of it, for a certain amount of time.
Sooner or later, we must allow them to die, with as much _Grace_ as we can muster, holding tightly to the good memories.
Imho, they are still there in our hearts...we can still talk with them...only their bodies are gone.
Keep talking with her. It is said that the last sense to go, is hearing [unless it was already gone].
In those precious, brief moments during the dying process [minutes, hours, days or weeks..sometimes months], one might experience that sense of Grace, sort of like attending a birthing for them into another level of existence.
Kinda like witnessing and feelings at a birth into this life. Just at opposite ends of the lifespan.