Have you ever been denied services (exact words were "we are not a good fit for your mom") by a caregiver agency that provides 24/7 care?

Yes, slp, as lealonnie said, the agencies have a "right" not to take on your case or they can cancel your contract at any time, for any reason.

I was a visiting nurse (different from the in-home 8 hour shift care you need). I had a few occasions when I would not return to a patient's home.....severe verbal abuse from patient or family, physical abuse from patient, abject filth and dangerous working conditions in the patients home.

Nurses or caregivers working for these agencies make much less pay than in a hospital. Many work on a per diem basis-not getting any benefits but they get to dictate the hours and days they work. The company you contract with is at the nurses mercy for when the nurses or caregivers want to work and for whom.

You probably will go through a few agencies until you get one that will "fit". If your mom has a bad attitude, you will have a hard time retaining caregivers. They can choose not to be with her and move on to a more cooperative patient. Sad, but true.

If the situation is severe, you may have to place your mom in a facility. I'm sorry.

Your post reminded me of a situation where I was told by a facility that they “felt they would fail to meet my expectations”.

My inlaws had been evacuated due to a hurricane.
They both wound up in an ALF and then a hospital. About six weeks later they were to be transferred back to their home town. I had things arranged for them both to go to a NH for rehab. I had covered with the admissions folks all they had been through and stressed that I didn’t want FIL left in a wheelchair all day, that he was a fall risk etc. All the papers had been faxed and approved.

I get a call at 5 pm, letting me know the facility would not take them after all. They were coming by ambulance 7 hours away. It had taken a lot of work with FEMA to get this arranged. They were to leave the next morning.

I called another home that had actually been my first choice. I had asked a family member to check for availability for me and was told that it was full. I decided to call them anyway. They agreed to take the inlaws. Another flurry of paperwork. I was so thankful.

The next morning I received a call from the hospital letting me know FIL had passed that morning. I was stunned.
MIL was brought by ambulance alone. I had to get FIL transported by a hearse.
MIL died one month and one day later.

But the NH was great for the time she was there. I turned her over to SIL who I heard later was upset at my choice of rehabs. I was so tired, I didn’t even let it faze me.

I was traumatized by the whole ordeal. I lived two hours from their home and 6 from where they were in the hospital. I had spent everyday on the phone with the medical team trying to handle surgeries, a fall, rehab, MRSA, crazy relatives. I could write a book.

I will never forget that NH employee telling me she “ felt they would fail to meet my expectations,”. As hard as it was to hear those words at that time, I’m sure they were right.

I was like you, foolishly thinking that as the customer they would want my inlaws business. I look back on that (10 yrs ago) and realize how lucky I was to have people cooperating with me at all. I was so frantic with the enoromity (to me) of what I was trying to accomplish.

I felt so bad for the inlaws. They too were difficult to deal with in previous years. Their children were easily intimidated by the father.
The SIL had not shared the obvious diagnosis of dementia of FIL. He had been calling the shots. She was protecting his dignity. Sigh
We had just learned MIL had cancer.
All that resistance went away when the natural disaster struck. They were not pushing back at this point. All the fight was gone from them and the dementia had really escalated. They were frail old people ready to go. Lost in unfamiliar territory. What a shock it is to enter the care taking world for the elders and the family. Yes. Reality is tough.

Oh wow...does this all sound familiar. My mom is 84, diagnosed with Alz after a hip break in 2016; she had mild cognitive impairment prior to the break, but anesthesia sent her into the stratosphere. 2+ years later, my sister and I let her live on her own for two years (she never drove on her own, never cooked, so wasn't at danger of much and in fact, did okay). She now has a debilitating knee injury which she says will "get better with rest." But she's as stubborn and outspoken as you say your mother is. Refuses to believe anything is wrong, hates Western medicine, hates doctors (well, people in general, really), germaphobic, hates people touching her. Just hate on a grand scale for anyone and everything.

On Friday, my sister and I met with an "elder advocate" who has agreed to be the "bad guy" in telling Mom she can no longer make decisions for herself. This advocate told us that if a State Protective Services agent found her in the state she's in, with the wreck her house is, that she would be found to be self-negligent and would become a ward of the state (Fla.). We are paying this advocate about $1,500 from Mom's estate to walk us through the process of a visit to the doc this coming Friday, which will result in a declaration of incompetence, hospitalization for a min of 3 days which will trigger Medicare-paid rehab, and eventually a move to a memory care facility. Through the advocate, we are working with a senior housing specialist who has been in our local market for 30+ years doing this job. We have complete faith they will walk us through this horrifying process. We are lucky in that Mom's estate can afford to pay the higher fee it will take to get someone to accept her - as difficult as she is. Though oddly Mom thinks the govt should pay for "old people" when they have to go to nursing homes.

Our situations sound so much alike. And I understand the facility's saying there wasn't a "good fit." Workers at these places shouldn't have to put up with brutal treatment from residents. The indignation the needful residents experience is understandable, unfortunate, but unchangeable. They don't suddenly turn around one day and say "Oh, honey, you were right. I'm so happy here." People who think that are naive. This is a tooth-and-nail battle in which no one wins. I wish for you luck and peace. And eventually, happiness again.

I can appreciate the situation you are in. As an owner of a Home Care company, we see this quite frequently. There is no way to force someone to have care, or accept care. If they are under a court order or you have guardianship then you have some say in the matter. Sounds like your mom is not accepting of care and as another response says, it is difficult, actually impossible to keep staff going there. An agency does not want to take on a client, work hard to get it staffed 24x7 and then have caregivers refuse to go back. We cannot force a CG to go, and so now you are stuck and the agency is stuck without carers for your mom.
No one has said anything about her being a vulnerable adult. If the hospital or rehab declares she needs 24x7 cares, and you cannot find an agency, then she should be placed in a Skilled Nursing Facility. Her going home without that level of care puts her in imminent risk and danger. You should be able to get emergency guardianship by going down that path and work with a probate attorney and the county to get it in place in just a few days.
There are many memory care facilities that can accept the more challenging clients but you have to ask.
You may also have the opportunity to work with your mom to say it is either home care and you have to be “nice” to them or we will have to move into a facility. As another writer stated, verbal abuse is hard on the CG despite alll their training, I believe she said she lasted longer than anyone prior.
Good luck and try the route of emergency guardianship as it sounds like you need to have some level of say and control.

I know of two ladies who were "fired" by a number of agencies. Agencies who are also reputable employers have a duty of care towards their employees and will not keep them working in an environment where they are at risk of abuse or open to unfounded accusations - knowing both of the ladies quite well, I had only sympathy for the agencies who terminated their contracts.

One lady eventually moved under protest into an excellent continuing care facility whose experienced and highly trained staff were made bullet-proof by first rate management. She was thus able to slander her caregivers and family members in safety and comfort and to her heart's content until the day she died.

The other lady, happily still with us, is in the care of a reputable agency - about the fourth the family has tried - who have looked on her as a challenge. Over the last three years or so they have put together a team and are extremely selective about who they assign to her; two or three individuals rotate shifts and live in from Sunday evenings to Saturday mornings. Over weekends, the lady goes to one of her children's homes to visit. I quail to think what the service costs, but it will not be less than $1200 per week and is probably nearer $1500. Note: this lady does not need any form of personal care and is in good physical health. And on a personal note, I don't happen to agree that she's demented, either. Just... a bit of a handful, you might say.

So I sympathise with all concerned in your situation. With the agencies, whose job is not easy. With you, of course, because you must be frantic. And with your mother, because when I look through her eyes I can feel her resentment of interference and intrusion, and I know I wouldn't like it any more than she does.

So where next? You say: "My mom doesn't think she requires 24/7 care but I do for her own safety and health."

Okay. You have a diagnosis of Alzheimer's Disease from, what, 2017? - plus a range of other major issues. Until that diagnosis develops into a formal assessment that your mother lacks legal competence because of her mental incapacity, though, your mother outvotes you. So what you need is allies. Who else agrees that your mother needs 24/7 care? Who is on your side of the page?

I don't understand why you think AL would be a huge and negative step for your mother. From what you have indicated I think she may not be eligible for it. Chronic falling is not a condition that determines one should live alone. You list such a host of other serious ailments. I don't like to be negative but I think you need to think clearly and determine how you feel she can be cared for. My mother has been in 2 AL. I don't think your mother would have qualified for the ones I am familiar with. There have been 2 because we moved to a different state. As others have stated an agency is not likely to provide care for an individual that is overtly hostile. You may need to find a NH for her. These decisions are never easy but there may come a time that there is no other choice if survival is desired. I hope you are able to find some solution for this situation.

I got my dad to accept the young man I hired to care for him by telling him initially that he was coming to work for him in his shop. He accepted that very easily and as time went on and dad needed more help he was there to help him. Perhaps your mother would accept a “housekeeper” who will be there to say “oh let me help you with your hair, clothes, etc.” Most caregivers also do light housekeeping so this shouldn’t be an issue, just make sure that they are in on the mild deception also.

Will rehab discharge her home alone ?

having the police show up because mom was in the street screaming for the neighbors to help as someone’s in the house is just one of many moments I’d rather not have experienced

even now, immobile and needing to be hand fed most of the time, mom suggested the other day that her least favorite caregiver leave as she wasn’t needed

have you thought about assisted living for her?

I believe "Not a good fit" is agency code for your mother fired them. My mother's home health nurse told me "there's nothing more I can do" which meant the same thing. I didn't realize how non-compliant my mother was til after she died.

If she won't accept 24/7 care, can she survive with 12 hrs a day? Maybe family can step in for one day a week?

You could be describing our mother when you said:

"She is a very stubborn woman and it's either her way or the highway. However, she does not know the care services are private pay, had to tell her the government was paying for it (it was the only way she would accept caregivers)."

and

"My mom thinks she can do for herself, but in reality she can't and hasn't really accepted any of her limitations or aging."

Her mantra was "I'm independent." "I can cook." "I can take care of myself." We hired staff to come in once/day for an hour only, mainly to ensure she took her meds from a timed dispenser and otherwise just check on her, as she was able to do most things (cooking? no way. at this point it was frozen dinners and boxed snacks.) We also told her that someone (MediCare or VA) was paying for this. Eventually when she asked about how the facility we moved her to was paid, we just said the VA covers it. No need to tell her otherwise!

However, our mother did not have all the issues you have listed. Mainly mom developed dementia, which impaired her short-term memory, and led to problems following through (cooking/finances) correctly and kind of self-isolating. Are you talking in-home care? If she refuses to let them in, there isn't much you or they can do. Our plan was to increase help as needed, but after a few months she refused to let them in. They even brought in their "expert" at getting clients to understand - that woman was lucky mom would not have been able to toss her out the door!! Your mom certainly sounds like she needs 24/7 care and if she won't let anyone in, you will have to consider a facility,

That said, being stubborn and "independent", mom also would not consider moving to AL of any kind. In the end we had to "trick" her. She developed cellulitis just before the planned move, and one brother typed up a letter from "elder services" at the hospital where she was treated (ER/outpatient only) saying she goes to the place we selected or they will place her. Mad as a wet hen, but she reluctantly let the brothers move her. For 9+ months after she hounded that brother to take her back to her condo - never asked me thankfully. Then she stepped back in time a bit (!!) and became focused on the house they lived in previously (about 24 years ago.)

For your mom, this decision can be taken out of her and your hands. The rehab should be doing an assessment and if they feel she cannot be discharged to her home without 24/7 services, and those services are not available, they can deny discharge.

I would seriously consider finding a safe place for her and have her moved directly from rehab to the facility (assumption is you would not be taking her in, which sounds like it would be a disaster even if you wanted to do this!) Once you find a place and set it up, you can use some kind of transport system to transfer her from rehab to the facility (it'll cost, but again, then the onus is not on YOU!)