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Here finances are tight and she really doesn't have the money to upgrade care. I'm not able to provide the additional money. I'm looking at group homes to see if they're more economical but I have concerns of course. I'm 1000 miles away in TX and she's a resident of AZ. Would Altcs help in this situtation? We have Americare going by once a day to help manage meds but it's an additional of pocket expense. Shouldn't medicare or Medicaid pay for this service if she's not able to manage meds on her own?

When a senior cannot manage "on their own" and have no family nearby who can assume care and management of medications, placement help, assistance with insurance calls and choices, then they may need a Fiduciary if that's affordable, or may need management of the state court system under guardianship.

You won't be surprised to hear that medication management is one of the first reasons mentioned with going into assisted living. Because no, the government won't send in someone to fill prescriptions, pillboxes and to give medications for any appreciable length of time. Often that's done only after a severe illness.

It's honestly going to be impossible for you to manage your mother's choices and care from this distance away.
With limited funds you are looking at ALF on self-pay while able, and a movement then to applications for Medicaid and a nursing home when she can no longer pay. Do not use your own funds, which you will need MUCH sooner than you can begin to imagine for your own care.

I would discuss next moves options by phone or zoom appointment with management of the Facility your mother is at currently. Some few of them do accept Medicaid if the resident spends down their assets living in their OWN ALF. Most do not. But you can discuss finances, if you know you mom's assets, and future moves.

We as a Forum of strangers can only give you advice. And it is very difficult researching all this from miles away, and gathering options and assets. If you are unable to serve as her POA I would seek a Fiduciary for her while one can be afforded and allow the state to take over finally.
There are so few options in all this, and I am so very sorry. You aren't alone and I hope others who recently or are currently dealing with such a question have good advice. I will wish you the best.
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Also I should add that I could not ‘choose’ AL for my father. The community had a questionare his doctor needed to fill out to say what he could and could not do for himself and then it was up to the AL to say whether it was with in their capacity to handle and to give a price.

I entered my dad there as IL. Included with IL was housekeeping, laundry, linen changing, all meals and snacks. That was about all the assistance he required until he fell. For a month after he came back, he needed AL level care for showering and an escort to the dining room. They added the AL fee for that month and then removed it when he recovered.
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I used A Place for Mom to find a facility in AZ where my father lives. I live in CA. His doctor suggested finding a community with different levels of care since he would get worse not better and moving each time would be traumatic. He is 91 with dementia and very frail. He was on a very tight budget, just over 2k per month but they found a beautiful place with independent living, AL and MC.
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I would go with ALF. Not likely to be a whole lot more for her one small room than Independent, especially given her meals are a part of it. Also, if she has a home, sell it and invest those funds in her care until she is out of funds. Then apply for Medicaid for her. You should not use your own funds. It takes a lifetime to save for your own old age.
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It might be time to look into the possibility that she may need to apply for Medicaid soon. (If she qualifies now begin the process now)
The question now is .... is she currently in a facility that has Assisted Living and do they accept Medicaid? Many facilities that accept Medicaid want the resident to be Private Pay for 2 years before Medicaid.
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