Why does home health and home care not include necessary care for paraplegics?

You are speaking about specialized services and nursing care which is mighty expensive to pay their salaries. Nurses would need to be scheduled and any caregiver of this nature will not be available on the spur of the moment. With the major shortage for competent nurses to work in health care with benefits might be too daunting. This is why a SNF becomes necessary unless you have a few million of dollars somewhere. Catheterization by a hired nurse might be required to have a doctor's prescription including for supplies by insurance.
I have worked with a 3 quads when they were hospitalized and who lived for 2 or 3 decades. They were rich in their youth by inheretance, but their personal complaints was how to find services on the spur of the moment when there were callouts. Also they all said that they had to hide the valuables.

Have you talked to your doctor about writing up an order for "in home services" with Medicare paying? If you have a Medicare advantage plan, have you talked to them? Office of Aging and Disabilities?