Pressure sores while in an ALF. Did they drop the ball?

I cared for my husband here at home until I could no longer lift him to change his diapers or transfer him from bed to wheelchair (Jazzy). I was fanatical about making sure he never developed pressure sores. He has been at an ALF and how has a #2-3 pressure sore on his bottom. Home health care RN is coming out twice a week to cove it with a large patch but he is incontinent and has severe dementia. The RN that came was awful, apparently had never worked with a dementia patient before and got him so upset it was a nightmare. She gave him all these instructions to do to keep the pressure off the sore and he, being totally unable to comprehend time in order to do what she was telling him to do every 2 hours, just went off on her and at me (of course). My question is am I wrong to believe the ALF really dropped the ball when it came to changing his diapers and checking for any redness? I fear this sore is going to get worse and he will have to go to a nursing home for treatment and then the ALF will not hold his room. I am also freaking out if we are supposed to pay for the ALF and the nursing home at the same time? I can talk care taking at home b/c I have done it and lived it but the world of an ALF is new to me.