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In most cases, AL is private pay. In my State, Medicaid will pay after the resident has paid at least 2 yrs privately. Other members have mentioned Medicaid waivers in special instances. Be aware though, Assisted Living is just that, they assist. We have two where I live. One allows you to keep you PCP the other you use the doctor's associated with the AL. There is no skilled nursing. Depending on the size of the AL, there is only one RN and maybe an LPN. Care is mostly done by aides. Where I live there are Medtechs that can distribute meds.

From your wifes health discription, she may be better in a nice Long term Care facility. Depending on your finances, you could become the Community Spouse staying in the home. Your assets will be split making you able to pay your bills. Her split will need to be spent down and then you apply for Medicaid. I am just giving you the basics here. Every State is different. An Elder lawyer well versed in Medicaid could help you figure this out.
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Call your Area Agency on Aging to see what services might be available for you and your wife. Your situation sounds very difficult. They can help you assess what level of care is needed and may have suggestions for you.
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