Long Term Care Insurance

My mother has Long Term Care insurance that she purchased through John Hancock over 17 years ago. She paid a couple of thousand dollars a year for this policy which provides up to $100 of home care per day. If you use $100/day it will last for 3 years. In order for it to be activated I had to file a claim with John Hancock, prove medical need and finally a nurse was sent to assess her. The nurse was very sympathetic and felt my mother should have 24/7 home care and so the policy was activated. First it was necessary to get all home care attendants approved by John Hancock. I did this and went through a number of people before finding two I felt comfortable with. I learned that $100/day pays for 8 hours at $12.50/hour. Before John Hancock would begin paying the policy it was necessary to get through a 100 day "elimination" period. This is standard, from what I know. This means I had to show I was paying out of pocket for 100 days before they began reimbursing me. You don't have to pay $100. You can pay less but you can't really hire people for 1 hour a day. I chose to hire people for 4 hours/day for about $50/day. 100 days never seemed so long. The insurance company requires time sheets be sent in showing what the aides are actually doing and they must be signed by both the aide and a representative or policy owner before being sent in. I did this for 100 days and now they are reimbursing me up to $100/day. It's been very helpful but 8 hours/day does not seem adequate at this stage. Usually 5-20 minutes after the aides leave my mother calls me because she is alone in the house and no longer remembers that anyone was there....so she is alone and feels like she has been alone for a very long time. She has not context to judge her aloneness. She is also pretty helpless as she cannot really cook a meal without someone. The knobs for the burners have been removed to avoid her forgetting to turn the burners off. She nibbles on fruits and food that has been prepared earlier in the day. I have to leave cash for the aides so that they can shop. I had tried having my mother manage her cash for a long time but she would keep on losing it or finding cash I hid and then losing that. This system works better.
One option for dealing with this "income" being added to your spend down is having the long term insurance company paying the money directly to another agency. John Hancock can do this but it is not clear how this would work with a Manager Long Term Care Insurance Company and if they could pay directly to another insurance company.