What happens to the person who can’t afford care, not even a nursing home, and the family doesn’t want to provide care?

It seems to me it's the in between phase of life that is most problematic, the part where you are older and need some support but are not eligible for the level of care that is covered by government safety nets. My mom lived in her own home for decades after loss of eyesight made her house bound but that was only possible because she had family who could fill in the gaps. Today there are more options for senior living communities that were not available to her in the 90's, but many senior's apartments and independent living communities have a policy to evict those whose care exceeds their mandate - where does that leave lower income, childless seniors?

Arp, I am one of those folks who says "people have a lifetime to prepare for their old age".

I DO understand that many folks have difficulty saving for retirement.

But by the same token, we often hear from folks who are supporting multiple adult children, addicted relatives and taking out loans to pay for cars for grandchildren.

People need to know that their financial choices are going to have an impact on their ability to get care down the road.

Folks need to appoint POAs, Health Care proxies and make their end of life wishes known.

They need to educate themselves about how Medicare and Medicaid work in their state and talk to the Area Agency on Aging about
case management, low cost senior housing and transportation options.

Becoming elderly should not come as a surprise.

The family does not have to pay or provide care. What typically happens is a concerned neighbor or maybe even family calls APS or the police and the state social worker will begin to find suitable placement if the individual needs it. If by preparing for your own care means moving into assisted living, many many people simply do not have the ability to "prepare for their own care", simply because they don't earn enough money. What you can do to be proactive is visit the local area Agency on Aging and seek whatever support you can. You will hopefully then be on their radar and and they will find you support when needed. Those who cannot afford assisted living or memory care and have no family support or insufficient community support will be taken under guardianship of the state and placed in a facility.(usually a nursing home)

One potential possibility would be if you do not have capacity to make decisions for yourself a Guardian would be appointed by the Court.
If you have limited funds application for Medicaid would be done.
The best thing to do would be to prepare for your own future.
Make arrangements now to have someone act on your behalf for medical and financial decisions if you can not make decisions for yourself. Your doctors should be aware of your decisions about your wishes for EOL or End of Life care and the documents should be given to your Health Care POA as well as keeping a copy on your person at all times and a copy posted in your house where it would be visible to first responders.
A visit to an attorney to make sure all your papers are in order, POA’s, Will, and Trusts if needed.

The person applies for Medicaid for LT or Memory Care (in some states Medicaid will pay for some or all of AL).

You prepare for your own care by educating yourself about financial planning. There are myriad books, podcasts, websites, videos, etc. to be found. Dave Ramsey is a good place to start.