Custodial or Skilled?

I hope I don't get banned from asking too many questions! Here's another situation I'm grappling with:

Patient has been on service for a year for Foley Cath Maintenance (neurogenic bladder), right sided hemiplegia late effects CVA from 2001. Has visiting physician that orders Physical therapy for home exercise program. Therapy goes in gets patient going with PTA's assisting HEP. Family has paid caregivers (taught them HEP). Patient gets d/c'd from therapy.

1 month post therapy d/c, physician orders therapy again, states patient has declined needs new evaluation and new HEP. We go through the whole thing again and then therapy d/c's.

Now it is 3 months since patient was d/c'ed from PT and doctor is ordering it again. Wife begs for therapy, she states once patient is d/c'ed from hh therapy, paid caregiver just can't assist in HEP the way HH staff does and patient gets weaker. She and the physician want to continue this on and off therapy process forever.

Is there a limit to how many times therapy can come in and treat the patient? He will always be on HH because of Foley Cath, definitely homebound, can barely get out of w/c, needs assist with any ambulation.

I worry that once you teach paid caregivers an HEP it becomes a custodial case. The physician argues that each time he orders PT it is because the patient has experienced a decline in functional status, so therefore patient meets skilled therapy criteria, regardless of how many times he has had therapy in the past.

I'm soo torn. ?????