Is there NO bathroom on the first floor…or just no bathing facilities?
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No bathing facilities downstairs. She is open to the idea of adding an accessible shower stall to the downstairs powder room (there is room to bump out to an adjacent closet). I had wanted them to do this is 2021 when they renovated the bathroom, but they saw no need 
AL is not even a discussion point, as we are so far passed that stage. She does not want to have him in a nursing home.
I think a good avenue to explore might be to first have him discharged to a subacute facility…medicare will pay for 20 days there, which will buy her a little more time to work things out and also give him 20 days to continue (
) to improve.
I think she really just needs to come to terms with the idea of spending down their assets on a 24/7 aide.
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@DeeCee36 if they have a bathroom downstairs, that is what is important. Caregivers are excellent at doing very thorough sponge baths. And this will give some time to get that new shower installed (with grab bars and a seat).
The bigger question is…what room will turn into his bedroom? Is there a small room that can be used for this?
If my MIL did not live on a one floor house (she absolutely should not be going up and down stairs), she would have needed to move to a place with single floor living.
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Probably the dining room. It has a set of doors so he wouldn’t just be out on display like in the other communal areas. My mother could put the furniture in storage…or just get rid of it, as she has accepted that her days of entertaining/hosting meals are behind her.
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Note there are agencies that specifically do live in help which is significantly cheaper than paying for 24/7 care by the hour. Of course then you need a bedroom for the aide. I don’t know how time off /vacations work, but I assume it is all worked out ahead of time. If they want to go hourly and they don’t have long term care insurance going private rather than through an agency is also cheaper - just make sure you get a recommendation from someone you know/trust! Good luck!
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Any idea of price range for live in help? (I do realize it would vary by geography and supply/demand.). Interesting that it can be coordinated through an agency. That would address my concern about a less official live in aid claiming “tenant rights” (stopping the work but not vacating).
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When you use an agency, usually they take the responsibilities for paying, taxes, FICA, and whatever other benefits they provide. If you hire someone yourself, YOU need to remember that you will need to deal with all of this.
Plus, if you work through an agency, you will have coverage even IF your caregivers get sick or otherwise need time off.
If you have live in help, you still need to provide them with time off, and time to do things like sleep.
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Make sure the workers have worker’s comp coverage, whether thru agency or if you hire directly. People get hurt and you don’t want to be in hook for injuries. It can be VERY costly!
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I don’t remember but it was a lot less. A lot. My mom is in assisted living now so I didn’t follow up. The rehab gave me the brochures - these were not the same agencies as provide hourly aides. To address some of the other concerns people have raised: don’t assume the agency will provide back up care if your usual hourly person isn’t available especially if you live in a rural area or anywhere else where there are workforce shortages. When we needed more help with my dad they just gave us the phone numbers of other agencies. I have a friend whose parent lived in an even more rural area and they couldn’t get anyone at all, even as he was actively dying. Admittedly those were both closer to COVID times (though after the worst of it) but assuming the agencies have plenty of good people just waiting for your call is inaccurate in many places (especially with immigration actions, as that is often a job newer immigrants take). We used a private person for my grandmother/great aunt for years and she was a wonderful person (had to be to put up with the two of them). When she was unavailable she usually sent another family member to cover. Not everyone can afford agency rates and while you are correct that all the legal stuff is better with an agency sometimes you do what you have to do.
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Agree that agencies can have gaps in coverage. They’d sometimes let us know at the last minute there was no one, so we’d have to scramble amongst the family and one of us would cover for the missing shift(s). Many of the people in our state that do caregiving are immigrants and some may be nervous about recent news and that may be increasing shortages.
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This confuses me. What can they think he needs at least 12 hours a day of home health assistance for? If he needs that much rehab, how can they possibly say that he should go home at that point? What would someone be doing there for 12 hours?
I could understand them saying he needs 24 hr/day help or that he needs to be at a nursing home, but 12 hours?
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It sounds like your mom wants to remain in this home - and so having him go to care before coming home is important time to really assess if he is going to be truly able to be home. Gives time to clear the dining room at least for having a plan for where he will be downstairs.
Does your mom want to remodel the home for downstairs shower? Reasonably it seems sponge baths will be short term; never going upstairs is already spelled out.
Reality is smacking her but she is understandably in a bit of a fog – it is all a crisis/shock (even though she has not accepted or remembered the situation and display of your dad’s care needs and his mental state not being 100% there and lack of positive/loving feedback to your mom) before his time now in acute rehab.
For him to come home, she HAS to agree for some kind of caregiver schedule. Will he use a bedside commode, or can she help him get to the bathroom? Is he going to have the mood swings, anger, to where it will negatively affect her (as it did when he was home before this acute care/rehab?) Can she manage the household running - keep up the bills, is the outdoor landscaping being managed?
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My father had live in help (as you know, near where your father lives). In 2021 and 2022 it cost approx. $18,000/month. I would not be surprised if it is now $22,000-$25,000/month. The agency absolutely provided replacement help when the main caregiver was on a break. The agency had just been bought by another group when my Dad passed away, so no idea if it is still good etc.
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They are how old? I would be planning for she never comes to terms and never agrees. I think you need to be absolutely clear to the discharge folks that you have zero confidence in her plan to care for him herself.
I think if you haven’t experienced an elder with magical thinking, it’s hard to explain how intractable they can be. There’s no reasoning, there’s no persuading, there’s no reality check. There’s you, choosing to make them furious and create a permanent rift…or there’s you, watching people who matter to you careen towards disaster (and they either make you the safety valve against your better judgement, or you just despair about the situation’s stupidity)
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So…is the wife also planning to sleep in the converted to a bedroom dining room? If not, what happens in the middle of the night when this person wakes up (and they do) and needs assistance getting to the bathroom, or even just adjusting the covers on the bed? This is a fall risk waiting to happen.
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A baby monitor can help in that situation but then you have two sleep deprived elderly people.
I pray @DeeCee36’s mom will come to the realization that this is too much for her prior to D/C so they can get dad into a safe situation. 
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In the suburbs of Chicago, the agency charged $10,500 per month. Two aides who splitted the week (3 and 4). They brought their own meals. The aid was in the same bedroom as dad because dad was unpredictable. Dad was in a hospital bed. Mom was in a different bedroom. Mom hated it first, because she and I couldn’t do it alone by then.
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I can’t remember if Hosparus has been called in for your father? If you make them part of the caregiving plan, they provide a lot of assistance. A hospital bed sounds like a good choice if he is going to get set up in the dining room and Hosparus can get one there that same day (in my experience). They also supply adult diapers, which I assume he will need, and someone to shower/bathe him 2x a week.
@SOSConcern’s points are excellent.
My mom did not want 24 hour aides but I told her I won’t help anymore after 3 years of daily help, if we had to do it alone. At this point hospice was involved too. This choice was right for my parents, their home was already remodeled prior to his big decline - master bathroom remodeled with walk-in shower with grab bars and bench, toilet seat with arms, chair lift for the stairs, grabs bars in hallways, etc. Even after various hospital stays, dad was able to walk with a walker. Not being mobile makes it very very hard to care at home.
@DeeCee36 Your mom probably has mixed feelings about everything - sadness, guilt, anger…. She can’t make this decision alone and I think she doesn’t want to be the bad guy either. Your dad’s dominant personality and bullying over the years probably does not allow her to make a decision that is best for him and her.
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Per showers, has anybody investigated washlet toilets (or seats)? Seems like paired with upper body sponge bath it could be a way to need with fewer showers (paid help) when mobility declines. Not sure it is practical at parents house, but it is something we are considering ourselves to make us more ready to “shelter in place” in our house as we age.