Father is 89 and does EVERYTHING in house and for step-mother; step-mother with debilitating RA, almost to point of not being ambulatory.
Light housecleaning and personal hygiene help for step-mother would be ideal.
My siblings and I live hours away.
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Consulting an certified Eldercare attorney would be money well spent. Just because they are over the "Medicaid income limit" on the face of things doesn't mean that there isn't a way that they can't qualify.
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Your only other option, if they don’t actually need home medical care, would be self-pay. Care.com might be the way to go. Failing that, itmight be time to consider a facility. This situation sounds like a whole lot for your elderly dad to handle with no hope close-by.