What do you do when home care isn't available and they can't be left alone? Put them in a home?

I am so sorry.. that is such a difficult situation. My mom went through that after my dad had a major stroke. He was completely disabled, bed ridden and lost his speech so he could not be left alone but we tried putting him in what we thought was a nice nursing home after all the research we did but it became a nightmare.
My mom ended up quitting her job and became his full-time caregiver. I don't know how she did it but for 12 long years she took care of him and if she ever needed to go out for something, she had family and neighbors who would sit with him. Once in a while she would hire professional help just for a few hours or for a day here and there.
I wish you luck in whatever you decide to do because I know that is not an easy situation to be in and definitely is a difficult decision to make.

If you aren't referring to your own situation, and they each have their right minds then no one can force them into a facility. If you are concerned about this couple and they don't have family to contact about their situation AND they don't have the finances to hire in-home care and their living situation is deteriorating, then I would contact social services for their county at the Dept of Human Services and report them as vulnerable adults. APS will come out for a wellness check and they will be on the the county's radar. If necessary, the county will arrange guardianship of each of them and they will find a facility for them where they will be cared for and protected. It might take a while, but this is what will eventually happen if no family is able to step in.

Why would home care not be available, as it's available all over the country? Or is more of a money thing? But if for some reason it's not and there is no one to care for them at home, then I guess you would have no choice but to place them in the appropriate facility. And they can always apply for Medicaid if necessary. Best wishes.