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My fiancee takes care of his mom at home. Up until recently she has been able to be on her own while he works but now she can't remember how to go to the bathroom, if she has eaten, or if she has taken medication. The safeguards that were in place no longer work because she can't understand them anymore. What do we do next? It's not safe at home for her and she refuses outside caregivers or adult day care.

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If she can't understand things anymore, then she needs to see a geriatric doctor to evaluate her for primary physicians usually can't do that very well. Sorry to have to say this, but she sounds beyond assisted living. See what the doctor says and go from there.
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Focus on the fact that you are needing to do what you would hope someone would do for you, given reverse situation. Many assisted living facilities allow for trial periods of 30 days or less; find one that has a good reputation, check it out and have her give it a try. It will help if there is anyone there she already knows as a peer or friend.
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I would have her evaluated by her doctor and listen to the options he/she provides. Sometimes the point is reached where it isn't a matter of what your loved one wants; but rather what is best for their safety and wellbeing.

This is the really hard part of caregiving, becoming the adult and making the tough decisions because it is the right thing to do for your loved one.

Best of luck!
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