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He had a stroke and lost his ability to use the left side of his body. My mother has been helping him but can no longer do it due to her health issues. He refuses to go to an assisted living place. What can she do?

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Call the number on this website and hopefully there will be someone to help you find resources for your stepdad and your mother.
https://southplainsadrc.org/

If step dad is competent to make his own decisions then he will need to do so regardless of his disability.
Does your mother need 24/7 care herself? Is she competent to care for herself? It looks like they are in a rural area and resources may or may not be available. I would start with the agency referenced and see what you learn.

If your parents are common law, they are held to the same laws as any other couple.

Let us know what you find out. We learn from one another.
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This is a very complicated question with many "it depends upons" involved.
1. It depends upon what common law marriage LEGALLY means in your area.
2. It depends upon who has POA over the common law husband and whether he is competent to make his own decisions.
3. It depends upon whose name assets are currently in.
You are going to need elder law attorney help to answer these issues and you will need social services to help these two decide what their next move is.
Do they want to move to care together?
Does only the husband need to go to care, and if so how will the wife's assets be protected.
Many states don't have good common law laws any more and there is little protection for a common law spouse. For this reason I really suggest starting with legal help in your area and with a list of assets of this couple and whose names those assets are in.
Then decide on what care level is needed A) for the husband and B) for the wife and what the plans are with MD and Social Services help.
Much also depends on who is legally able to act as POA at this point for either, and have they appointed someone to act in this capacity.
As I said, so many "ifs" involved here that you need professional advice. Start with an elder law attorney after a sit down talk with Mom and her husband.
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I agree, Mom needs a lawyer. I read that common law is still allowed in Texas. What Mom needs to do is protect her half of the assets. Her spouses half going to his care. When its spent down, then Medicaid is applied for. Mom stays in the home and has a car. Be aware, though, at spouses death, Medicaid will put a lien on the house that will need to be satisfied when Mom passes. There's more to this but I have given the basics.

Can Mom afford to hire an aide? If low income, she may want to check into Medicaid in home care.
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I think it would be worth getting local legal advice on your mother’s options for insisting that her partner leaves the house, if that is what you are asking. The question gives no information about the legal ownership of the house. Co-habiting couples could hold jointly, or as tenants in common, or in single ownership with other ways to secure rights. The effect of ownership types on Medicaid (if that’s important) is another different issue.

Joint tenancy as a land owners is not restricted to couples, whether married or not. It’s less common in other circumstances but quite possible, for example between business partners, or between a parent and child. Tenancy in common is a reasonable option for couples whose relationship is less firm than marriage, because it gives each one clearer rights to their share if they are no longer co-habiting.

Beatty’s answer is obviously correct about being forced to be a carer, but rights regarding the house are a different matter.
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He can refuse AL.
But..
She can REFUSE hands-on caregiving.

Married, legal or not, no-one has the right to insist another person use their own two hands to provide them physical care.

Is she says no, he must arrange alternative help. That's how it works.

With high physical needs that can vary a lot. ?2 x visits a day to dress/wash & reverse at night. Or if unable to toilet himself, all day aide. This will cost $$$$$.

Or he moves into an AL with staff on hand to meet his needs.

Can he understand this?

If not, your Mother will need to speak to his Doctor. This could be a quick green light for any POA to take over. Or it may inc referral for full neuro tests on his mental & legal capacity.

(Note: it is common after a major stroke to have a degree of anasognosia (lack of insight). If indeed so, he has lost ability to understand or use his reasoning or judgement. This is not just stubbornness - but due to damage to the brain). Eg My stroke survivor LO also refused all care except from spouse. Any empathy & reasoning that this was too burdensome was absent. Doctor told spouse to IGNORE that & book the care.

Either way, a needs ax will be required to plan for his care.

Advise Mother to start the conversation with his Doctor asap.
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If the marriage is not in one of these seven states, it's not common law. https://en.wikipedia.org/wiki/Common-law_marriage_in_the_United_States

If they acquired the asset (assuming it's a house) jointly and they're both on the deed then states are going to handle it saying that one person's on the deed and one owes Medicaid if that becomes necessary.
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