After a stroke and dealing with the system. Any advice?

The max out does not end for custodial care which is what it will become, Unless there is a new diagnosis such as a fracture, the Medicare (insurance part) payment clock does not reset for the post stroke. She can keep the house under Medicaid but all her income goes to her care except for $ 40 per month as a stipend for purchasing things like haircuts. Someone else has to pay the taxes utilities and upkeep of the home if someone wants to live there. Once she passes there is a claw back to recover costs of her past care. A lein will be placed on the sale of the home.
You need to ask the doctor if he feels she can ever go home to help with decisions. If her conservater sells the home, then proceeds should be kept in an account to spend down an then reapply for Medicaid again.

It is best to get her in a good facility that takes Medicaid patients early as private pay switching to Medicaid, she can stay there. Good places have wait lists for several months. If you wait till spendown, then she goes to the first available bed and it may be a crappy place. If her conservator wants to go that route, there are 100 days to sell and private pay. Even if she starts in a crappy place, once assets are at hand, applications can be made for the good ones. But it will not work that way if applying too late. The transfer would be like climbing a mountain.

You need to quickly get educated on Medicaid as payments are limited and consistent.

So here are the costs of long care.....for everyone under Medicare coverage.
Rehab up to 21 days covered by Medicare
After, she can stay in rehab up to 100 days and copay costs will be around $180 per day equivalent to the costs for private pay AL or MC. Copays should be spelled out in her contract. You can continue to ask the doctor to write for more PT.
Next comes LTC for an average of $350 per day or 130/ k per year.
Other option is take her home and provide 24/7 care yourself or hire care which will cost over 200k per year. It is paid from whatever assets she has, depending if she has any dependants like children or spouse. Before she can apply for Medicaid she has to spend down.
From there the options are in home care where someone will come in for custodial care for a few hours a week and not full time. Or she goes into a SNF.
One other consideration is who is her guardian/conservator legally. If she needs a spokesperson, you can become the person after seeing a lawyer and going to probate court for a cost of a few thousand or let the state take over. There will be pressure from the facility to pay bills that no one can access for a few months until this is resolved. Expect this to happen. Do not just take her home based on this pressure if the discharge is unsafe or home care is not put in place

You said below the case manager is either wanting you to look into an adult family home or caregiving at home. "Caregiving at home" would entail basically 24 hour supervision and hands on care. Are you willing and able to provide that? You or anybody else does not have to take on that responsibility. The other option is "adult family home" ? I'm not familiar with such a facility. She likely will need a Skilled nursing facility.

Maltby, please ask the social worker if the "one or two week" thing is because this is acute rehab.

After acute rehab (which is paid as a hospital rate) she may be able to go to subacute rehab and get further therapy.

Straight Medicare pays for the first 20 days of Rehab at 100%. 80 to 100 days only 50%. The 50% not paid is the patients responsibility unless their suppliment pays the whole 50% or partial.

Medicare Advantages are suppose to cover A&B of Medicare with some xtra benefits you do not get with straight Medicare. You need to find out what her MA will pay. One to two weeks in Rehab is usually for those people, after a hospital stay, who need to get their strength back. Your ex has had a stroke which IMO will need more therapy than 2 weeks. She will need to continually progress. They should not release her until she has plateaued or hit the 100 days. She could be sent home with in home care and PT/OT which also is covered by Medicare. Her on going treatment should be decided by her Doctor and how much her MA will cover. That decision cannot be made until she is finished with her Rehab. Like said, she may need to go into LTC receiving more therapy there.

Strokes are tricky and depends a lot on how much damage there is and how hard the patient wants to get back to normal or almost normal.

If after the rehab stay, she hasn't made enough progress to live on her own she will need to be placed in a long-term care facility if no one else is willing to take on the responsibility of caring for her at home. If no one has POA over her, the state may need to step in and take guardianship of her if no other family member or friend is willing to get involved. The state will likely ask and maybe pressure family members or friends to step in, but they are under no obligation to. If the state takes over guardianship, they will control all of the assets she has and see to it that those assets are used for her care, and after the assets are gone her care will be paid for by state Medicaid.

Are you saying that you are looking for a facility for her to stay in long term as a resident?

Rehab is by nature "short term". It's to get the patient as functional and stable as is possible; from there, plans are made for a longer term.

Talk to the social worker at the current facility about what the possibilities are--return home with help, assisted living or what.

Medicare will pay for 20 days of rehab if the therapists deem it necessary and if she's making progress. After that, there is a co-pay of about $150/ day until day 100.

Do you know if she has long term care insurance or the funds to pay for long term care? If not, will she qualify for Medicaid?

She is your ex. Until she isn’t. That will be when you take her into your home because she has nowhere else to go. Do you want that? Before you decide, please listen: taking care of a stroke victim will consume all of your energy, most of your time, run your health into the ground, and you’ll feel as if you can’t make her leave because she is dependent on you. I’ve taken care of a stroke victim and I know. My advice to you is to explore various options and don’t let one of them be you. As she begins to recover (and rehab will help this), lead her to decide, along with her doctor and MPOA, what to do for herself. The rehab place will have services in place that can assess and advise. And when she’s where she goes, visit and take flowers, if that is your wish.

Who decides is who she designates as her decision maker if she can not make decisions herself. If she has not appointed anyone as POA for health and or finances and she can not make decisions it is possible that the court will appoint a temporary Guardian. If she is cognizant and is able to make decisions for herself then it is she that makes the decisions.
If she will need help at home they can not discharge her if there is no one to help. So arrangements should be made. If she has no one then in all likelihood a stay in Assisted Living or longer term rehab if it is needed.