I'm just so overwhelmed for you just reading about all you're having to deal with and the limited options seemingly available to you.
Brings back memories of my precious Zachary. I was so worn out towards the end of his life ... and you've dealt with it twice as long as I did.
I was so excited about the nursing home possibility ... is there any chance you could speak to anyone else to intervene? I agree it's hard to believe that they've never dealt with Ryan's issues before??
Might they consider taking Ryan in on a trial-run type of thing? Even for a week? It's possible they would find they could handle him. I don't know if anyone knows someone there who might be your advocate ... but that nursing home sounds perfect.
I do think a mediator is absolutely essential for you! The agency head is a bully and you're too overwhelmed right now to be on your game with her. You need help and a respite from her constant nagging.
You are so blessed to have Josh ... he is a literal godsend...
I don't know much about the pressure relieving air mattress you're investigating ... but from since both the agency and Gabby mentioned it ... I take that as a sign that you should probably find a way to get Ryan one. Expensive or not ... this may be one of the best things you can do for him right now.
I don't know why all this has befallen you suddenly ... but it's reaching a crisis point ... which always means things WILL start improving b/c SOMETHING is going to change.
