How can I document everything for Medicaid when I have a million other things to take care of?

She has dementia. She cannot properly process things. Give her tasks to do that won’t matter whether or not she does it right. Maybe a basket of small towels to fold or arrange small things that really don’t matter. You don’t need more work for yourself after the fact and she just can’t do it properly. I did this with my MIL. She was happy to be “helping” and it didn’t cause any stress for either of us. You may also need to hire someone to come in a few hours a week so that you can keep up the paperwork. Do you have respite care available to you? That helps as well.

Being blunt - you sound as though you have not planned, and continue to not plan. You micromanage, and make work for yourself.
Sit down, make a list of what you can do and hours that it takes, Then a list of additional needs and hours needed and who can be paid to deal with those issues.
Stop trying to do everything, and thinking everything must be done your way, and apply your accounting organisational skills to the care for your mother.

This is from one of the OP's previous posts:

" I live in Missouri and am the sole caregiver for my mother. A contract was arranged through Elder Law that pays me $17/hour, but not more than $2500/month. That is what they advised."

So, guess the question is how much documentation does Medicaid require to show that this was paid for caregiving and not "gifting".

I would make up a time sheet with hourly blocks. Each meal is one hour. Dressing and toileting at least one hour each AM. Getting ready for bed, at least one hour. That's 5 hours of each of 30 days each month.

Are you being paid to care for your Mom? Is there a contract in place? If you are paying yourself out of Moms money with no contract in place, that may cause a problem. And at this point Mom can't agree to one. It needs to have been put in her POA. If its just a flat amount like $200 a week you don't need to list every little thing.

Medicaid looks at bank statements so do everything for Mom thru her bank account. They look for an inconsistencies and large amounts of money. If I paid with my credit card or out of pocket I kept the receipts and once a month wrote myself a check from Moms account, put the receipts in an envelope and put the check # on the envelope. Medicaid never questioned these checks but they were never much more than $100.

Medicaid will give you a list of items they want to see. One of the basic items are bank statements. If you have access to the online account you can probably download a few years of statements. Otherwise you will have to
pay the bank to get them.

You have a lot on your plate - can you outsource something?

What role do you enjoy more? Being an adult daycare organiser or being an accountant?

Is it possible to either engage an in-home aide for some daycare relief? Or engage an accountant? (you just hand over the shoebox...) Or maybe a mixture of both?

When my kids were young, I choose to use daycare for 2 days a week. It was a good compromise, although we were not in a world pandemic & mixing with others was a safe thing to do. I am a bit of a 'one thing at a time' person. I could get my housework done with littlies crawling around (but drove me slightly mad), but I was so much more efficient when they were out. I then enjoyed my time with them so much better when they got home too.

I too wonder what documentation Medicare would require.   I documented doctor trips, mileage and any other out of pocket expenditures, even though I rarely could deduct them from taxes b/c they didn't reach the 7.5% minimum.   

You wrote:

"I feel like I have to entertain and/or manage her activities all day.    If I give her a task, I have to monitor to be sure it is done correctly, or sneak in after the fact and re-do it, creating even more work. "

This raised a potential red flag for me.    What kind of tasks are you giving here that have to be done "correctly"?   Perhaps tasks that don't require that standard would be more appropriate.  This isn't intended to be a criticism, so please don't take it as such, but I think you're seeing her more as an employee than a mother.

I also question the effect of redoing and correcting her work.    Is she aware of your feelings on this?  If so, I think that would really undercut her confidence, and perhaps that's why she's become so reliant on you for directions.

Think about that issue and consider other tasks or not requiring them to be to your level of satisfaction.   That's not an intentional criticism, but rather an observation.   She needs to have a morale boost; can you think of tasks that provide that?

Would your mother adapt to some days of adult day care and be eased by the presence of other people, at a Day Care facility or does it have to be YOU?

Even two days a week would give you some breathing room.

I think you may be thinking of what you will need for mediCAID, not medicare???
What do you mean by "documenting for medicare?" I did all my brother's POA and Trustee of Trust, bill paying and record keeping. I had a separate folder for everything. I kept all medicare payment notices in one folder, all supplemental insurance payments in another, phone in another, and kept a running monthly documentation of all assets he had, increases in and payments out. Once established it was easy to keep up.
Might your mother's funds go now to hire a beneficiary to help with bill paying and document keeping (only about 90.00 an hour, and not much time needed monthly after monthly routine is established. Your mother's funds go to pay this.
I am wondering if you are speaking of something other, such as applying for mediCAID. If so, that is burdensome, as Igloo suggested, some one hundred pages in her case. Your monthly expense in and out will really help you here, as you have ALREADY thereby documented her assets, her income, her expenses. You will also keep her account, which I assume you are the POA of. You will keep all receipts in individual folders.
If you are financial POA for your mother you have to do this ANYWAY. You also keep a folder with all her bank statements, one with last 7 years of taxes and so on.
Originally I had one wine box for my brother's "file" folders. I branched into a nice black file box eventually. But once all this was established, with all his mail and bills coming to me and with POA handed in to all entities it was a somewhat smooth flow.
And no, if you are doing in home care you will never receive financial recompense to be certain.
And yes, if you are meaning entering a nursing home, going on MEDICAID, all of this will be audited. ALL of it. And if anything looks like gifting it won't be good news, so I am thrilled to hear you have your elder law attorney. Do allow your Mom's funds now to hire a fiduciary if that is needed. If Mom's funds stretch to do so she can pay both you, the attorney, and the fiduciary for the care she needs. And you will have the documentation you need all ready to go, the fiduciary there to help you apply. Do remember, you want a fiduciary that is hired to do this, not to invest money (that's a financial manager or some such.) Your elder law attorney works with fiduciaries you can bet and will have a recommend for you, as often courts need to appoint them when there is no family, or a family-at-war.

Please, for the sake of your life and your frightened mother's get her to Adult Daycare so she can socialize. I wish I would have used my CC and hired Senior's Helping Senior's more often. Mother and I both suffered unnecessarily. The few times I hired them (4 hour min) she was smiling and so happy entertaining the senior retired nurses who understood dementia far better than I ever did. My health has suffered from the constant 24/7 stress for over 6 years. A little credit card debt would have been so worth it as I look back. I am still totally exhausted.