What happens when my Dad spends down his assets and can no longer afford his caregiver? Can he access a nursing home asap?

If he chooses the route of Medicaid, they will require that he provides at least 5 years of all his income and what was done with it. So, spending $150,000 a year under the table for care is a big No-No. Unless he had done it legally, based on the current wages, reported it to the IRS, etc... Which he's not doing. So, they will view this as a Gift. I don't really pay attention to this on AC since I have no plans of doing that with my father.

If you do a search on the top right, you will find more on the topic. I typed "spending down and medicaid"

Below are some threads/discussions you might find useful.

https://www.agingcare.com/Answers/what-is-5-year-look-back-medicaid-154959.htm

https://www.agingcare.com/questions/the-legal-way-to-spend-down-assets-before-medicaid-qualification-135066.htm

https://www.agingcare.com/questions/spend-down-and-gifted-money-162425.htm

Book has covered the difficulties Dad will encounter. There may even be some legal ie fraud problems ahead. He is perfectly free to enter a nursing home at this time which would probably be a great deal less than the $150,000 he is currently paying for car. That is an exhorbitant amount to pay as salary for that level of care.
Of course he loves this caregiver (I won't be offensive here) Dig a bit deeper my friends. As a nurse wouldn't you like an annual salary that high?

For reference, we are paying $15,000 per month in suburban Connecticut for my mother's NH care.

Costs vasry a lot. in my area of Upsate NY it is about $8,000 a month for a single and much less for double

Care is $11,000 per month in Tucson, for full time care in your own home, but the taxes must be paid.. Perhaps you could revise his tax report.

And the caregiver is going to be I big trouble also. My bet is she did not report the income. Any money paid to her will be considered a gift and subject to penalty by Medicaid if he needs it. And $150,000.00 a year? In my area it would be about that much for two people requiring 24\7 care.

If you mean by "under the table" that no employment taxes have been paid and social security withheld, etc. then Dad is going to be in tax trouble when this is revealed. It will be revealed when he applies for Medicaid. Or there will be a substantial penalty before he is eligible for Medicaid. (The caregiver will also have tax troubles if she has not been paying income tax and self-employment tax on her income.)

In short, your Dad needs a lawyer to straighten this mess out. I suspect that paying penalties and taxes will deplete his assets even faster.

When Medicaid is applicable, there is a waiver program that will pay for in-home services. It certainly won't be at the rate the current caregiver is getting paid, and it won't be for 24 hour care, because at that point a care center is more cost-effective.

soo ... unless Dad is on hospice and not expected to live much longer, I'd say a lawyer is the best bet.