Beautifully written piece.
As a granddaughter of dementia I'm with you.
As a home health care nurse, I feel compelled to share some things with you.
Firstly, jeez! That camera suggestion, the nerve. That really pisses me off. I'd recommend changing agencies if they think that's an appropriate suggestion.
I've come across this exact situation before. The "with it" partner is hospitalized and the partner with dementia no longer has needed supervision. This is what I do in that situation- find a family member who will provide personally or pay for 24/7 care they need. If that is not feasible, I will call older adult protective services and report self - neglect. (Not saying the partner is neglectful , just that they can't take care of themselves). I've sent someone to the ER along with their partner for a social services type case if protective services can't get there. Protective services usually has emergency funds for a short term situation like this.
This is what I can guess from your situation: Grandparents receive funding through the state or a waiver program that entitles each of them to a home health aide say maybe 2hrs/day. When grandma is home, they get the 4 hours and both benefit. When grandma is in the hospital or a snf, the program that pays for those hours doesn't pay because her care needs are met by the hospital. The aide agency that your grandparents have is nice enough to provide the same aide for a 4 hour shift, but really the aide agency could send 2 different aides at the same 2 hour shift.
Yes, he may NEED 24/7 care, but in no way is any program able to provide this service to all elders who need 24/7 care.
In the US, we're in a tight spot right now. The alz pop is exploding and the resources are stretched thin. Elders are being sent home sicker with no way to care for themselves. Just like when you're a baby, your family is expected to take care of you. Someone else can take care of you, sure, but you're going to have to pay them. We have the unfortunate situation in the US where not everyone can get FMLA and not everyone can take off from work to meet the needs of their aging parents.
If you are in the US and are privately paying for the agency home health aide hours and they are refusing to provide more - CHANGE AGENCIES. There are a million agencies and they will happily accept new clients and provide the requested amount of hours.... if you pay for them.
I often suggest people go without the agencies and find a person they know/trust and pay them privately. Agency home health aides cost about 20$/hour and are only paid 9$/hour. By going privately the aides make more and you are their boss, no middleman. But it's sure hard to find a replacement if they get a cold!