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I will not be able to renew a drivers license when this expires. For financial, medical, general needs will it be necessary to get a state ID. Problem is they want him to come to the DMV for a picture which may be a problem. They will be lucky to get a picture if he can cooperate. I will need to get a friend to help me take him in. I just applied for a handicap tag.

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I'm going to assume with his level of dementia you have his financial and legal affairs in order, POA etc. If so, I don't think its that important that he have a state DMV ID. If ID is ever needed you could use his soc sec card or other form of ID. Many people still use the expired dr lic for a picture ID. Hang onto it.
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If your state does a forever ID, I'd go ahead and get one done. Yeah it can be a total butt rash to get them there but something is going to come up and having it to show will make it easier. For us, I had to deal with TX-Dot & their offices are usually overcrowded & slow, like glacial slow. I went the day before to get the forms with moms (lewy body dementia) old about to expire DL & told them the situation. The manager arranged for us if we got there early to bypass the wait & get ID done. Mom & I were able to sit in a cubby adjacent to the state trooper away from the general waiting area which is a bull pen of noise, got photo done & the trooper helped her stand & steady and we were done within 15 minutes.

Did I ever use it? Well it came in handy if I ever used a drive through banking or utilities as the teller could see mom and allow for whatever to happen. But the most surprising use of it was when mom died, I was not there when she died (in a NH and on hospice) and the FH asked for a current photo or valid ID to verify the body & process it & and I was able to use it for this. Now I was dealing with my mom and not a spouse, so you may find no need for ID but if you can do this with a bit of help I'd go ahead and then you have this to use forever.
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Does your state have driver license renewal online? NC just recently started this. I'd check and see. If so, renew online. If not, I'd call and ask about the ID card. See if they have any options for people in your situation. I think it's important to have one. I know that I have had my cousin's to present when we went for doctor appointments. Even with insurance they want it, however, they have excepted an expired one before. I have her current one, but accidentally, picked up her old one and they were fine with it. I wouldn't rely on that though. I'd make sure it's current if at all possible.
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