Housing options for my FIL?

My FIL is 92. He cannot use his legs or core at all and requires a hoyer (or a couple of strong caregivers) to transfer him from bed to wheelchair to shower to recliner, etc. He requires a high level of assistance with ADLs. He is mostly incontinent.

He does not have a terminal diagnosis and does not need any kind of routine medical care. His doctor has advised us he is too frail for any sort of invasive testing that might nail down a specific diagnosis (he has had some tests, but they are inconclusive and we aren’t proceeding with more tests). Hospice won’t accept him because he doesn’t have a terminal diagnosis. Home health care has dropped him because he is not showing any improvement from PT (he isn’t going to improve) and has no home medical needs, other than being sure he doesn’t get bed sores.

Yet, my FIL is relatively high functioning mentally. No dementia or Alzheimer’s. He is certainly not 100% mentally, but he is friendly, social, interested, responsive, can carry on a conversation, can remember reasonably well, and has interests.

Our dilemma is finding the right living arrangement for him. He is currently in a large AL community. While they try, the community simply cannot meet his considerable ADL needs…they just don’t have the staff. We have supplemented the AL staff with private caregivers. As his needs continue to grow, I don’t think this community is going to be able to meet his needs without us hiring even more private caregivers. And without hospice or home health support, we feel he needs more attention and potentially nursing oversight. This community doesn’t feel like a good fit for the future.

So we want to move him to someplace where he can get better and more consistent care. We have visited several small home-based board and care facilities and they seemed like they could meet his physical needs. But we need to be sure his socialization needs are met, and these places have maybe just one or two residents who are high functioning enough to carry on a conversation with him. The smaller facilities can meet his physical needs, but maybe not his social needs, while the larger facilities can meet his social needs but not his physical needs.☹️

Anyone have has ideas? Is there a middle ground? Facilities with 15-20 residents, yet a high level of physical care? Or is the solution to just continue to supplement with private caregivers? Anyone else have a LO who is mentally high functioning, but needs lots of ADL support? Where does your LO live, and are you happy with it?

I should note he has financial resources and this is all private pay. And my husband and I live very nearby and are heavily involved in overseeing his care.