Will dad qualify for LTC in a SNF?

My dad is 91 years old and suffers from chronic severe back pain from severe spinal stenosis and osteoporosis. He also has minor cognitive impairment, depression, and anxiety. He is otherwise considered healthy with no significant heart, kidney, or lung issues.

He lives in my home with my wife and I. We have been his caregiver for the past 20 years. I am the DPOA. We live in California. He has SSI benefits and his health insurance for the past few years has been a Dual Eligible Special Needs Plan (D-SNP), which is a "health plan which provide specialized care and wrap-around services for dual eligible beneficiaries (eligible for both Medicare and Medicaid)" per DHCS website.

In the past, my wife and I have utilized IHSS to help care for him and cook for him. However, over the past 2-3 years, his condition has gradually gotten worse. He has complained of gradually worsening pain. He has had many appointments with his PCP, orthopedic, and spinal surgeons who have all stated that he is not a surgical candidate anymore due to his age. My dad is also not open to surgical interventions. There were talks of less invasive procedures such as an ablation but that is no longer an option due to the severity of his pain. (See below)

He recently sustained a fall at home about 2 months ago when my wife and I were working. He was initially admitted to the hospital for 4 days for a new compression fracture of L5 and then discharged to a SNF where he stayed for 26 days with PT and OT. Eventually, he was deemed stable by the facility to discharge home given improvement.

He returned home with home health visits and PT/OT at home, but I did not feel this was enough help. He was still mostly bed-bound with severe pain transitioning from bed to chair and required oxycodone every 4 hours to "control" the pain. We tried working with my brothers and sisters to coordinate more care but ultimately, they were uncooperative and dismissed dad's medical care to my wife and I. My dad was at home for 2 more weeks until he sustained another fall at home.

He was admitted to the hospital again for 4 days. He was given lots of additional pain medications including fentanyl, dilaudid, and oxycodone to somewhat control the pain. He was then discharged to a SNF that has Medi-cal certified beds. He is now on oxycontin and is doing PT/OT with some improvement; however, he is still unable to do most/all of his ADLs without 1–2-person assistance.

My wife and I feel that we cannot safely care for him at home anymore. We do not have children and work full-time jobs from 9-5 with an hour long commute each way. My brothers and sisters are uncooperative and inconsistent with caring for my dad. They also are not willing to financially help pay for any private caregivers or private facilities despite me and my wife offering to pay our share. We have investigated the ALW program and other home and community waiver programs for assisted living but there are limited options in our area with no openings at this time. He needs someone to watch him in our home and to help him with his ADLs, or I am afraid he will sustain another fall. I have spoken to him about these issues, and he agrees that he does need additional care that we cannot provide at home.

Given that my dad has been accepted and approved for Medicare and Medi-cal for many years now, how can we apply for LTC in the SNF? We have spoken with the admissions director who accepted my dad for short-term to long-term care transition from his second hospitalization. He told me that there would be no problems transitioning my dad to LTC but I am skeptical of absolutes. We have already filled out the admissions packet for the facility and had my dad sign all the paperwork. He is currently covered through Medi-care Part A and is maximizing his up to 100 days of rehab. My concern is what will happen once we get the Medi-care non-coverage statement. Will we have to apply for LTC Medi-cal even though he already has Medi-cal?