My elderly parents are refusing home care. What do I do?

I would be blunt with your dad. You don't feel like you can really help enough to keep them safe by themselves. If they have money for aides or can get help through VA or other programs that's the only way to prolong things.

Not getting help means you'll have to move them out to get them help.

Your poor dad really needs to put his own health first at this point in time. While he has surgery and recovers there are only 2 options for your mom that I can think of - a 24/7 caregiver in her apartment while he's gone or she needs to go into a nursing home for respite care. Talk to your dad about this ASAP. He needs to help her make a decision and get her into somewhere. He needs to get on the schedule for surgery and get the respite care lined up. Have it come from him, not you. He has to say that you caring for her while he's away is not an option. "No, she can't do that. You are going to stay somewhere else where they'll take good care of you while I get my pacemaker. I have to get it done." It is possible that he could have rehab at the same place that she goes for respite. Hmm, not sure if that's a good or bad idea but it might be a possibility.

Not sure what you were asking about insurance in your last sentence, but I do not think insurance will cover any care for your mother.

Good luck!

Help dad get to an appointment for his pacemaker without discussing it with mom anymore. Talk with dad about their need for help, being realistic about their aging and increasing needs, and protecting himself. If he agrees to have help come in, make arrangements to hire someone. Mom doesn’t have to accept help but if dad will stop trying to do it all, she’ll have no choice. You doing it all isn’t an option, make that clear.
Geaton has good advice about POA and your mom’s treatment for the agitation. Your parents need help, but mom has to be calmer for it to work. My dad was hugely opposed to outside help, but when he saw there wasn’t a choice if he wanted to remain in his home, he got used to it. After a few months, an excellent helper we hired became a person he treasured

Is anyone your mother's PoA? This would be extremely helpful info because it will change what guidance is given to you. Basically, if no one is her PoA then no one can force her to do anything -- except the county when they eventually need to acquire guardianship if she remains uncooperative but needs to be removed for her own good. You are her landlord, and technically you can evict her and she can be escorted off your property by police if she doesn't respect the eviction. I know this seems like a horrifying prospect, if no one has PoA and your dad can influence her... you have very limited options. Your profile says she became violent after radiation for her brain tumor. Is she under the care of a neurologist for this? Is she being treated for her agitation? If she's violent you cannot in good conscience ask any caregiver to put themselves at risk until she's under control with medications (if that's an option that has yet to be tried). And again, with no PoA she can fire them and kick them out of her legal residence -- your in-law apartment. Does your father at least have an assigned PoA? He should before he goes in for his procedure. Your answers will be very helpful.