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My brother lives with my husband and myself. He's 66 has dementia and right side paralysis due to a TBI from 1979. He makes all his own decisions. He does not require a guardian and we want to keep it that way as long as possible. We have siblings in other states but no one close. Brother goes to VA for all medical care. He has no service connected disabilities. I am 68 and in good health but am looking ahead. If something were to happen to me there is no plan in place to help him or my husband with him. Hubby absolutely cannot take care of him. Brother requires 24 hour supervision and guidance. I am contacting AAA in a few days to once again inquire about a contingency plan. The VA told me yesterday that if all else fails, hubby could take him to an ER and refuse to take him back with him explaining that he can't provide the care brother needs. VA rep said hubby might have to be firm. It's a plan but not what I had in mind.
Can someone help me with how I can approach this conversation with AAA? Is there such a thing?
And I apologize if I have posed this question in the wrong category. If it needs to be moved, please do so.
Thank you all for your help.

Hi, Kay. I just received an email from the Caregiver Action Network, which is sponsoring a free program for caregivers of veterans. Here's the description:
"Join Caregiver Action Network (CAN) for an informative and supportive webinar designed specifically for veteran caregivers.

This session will provide caregivers with essential information and practical strategies for navigating Veterans Affairs (VA) resources and supporting a loved one throughout their care journey.

In addition, CAN will offer guidance on understanding available benefits and accessing caregiver support programs tailored to military families. Whether you are newly facing a diagnosis or further along in caregiving, this webinar will equip you with trusted resources, actionable tools, and reassurance that you are not alone."

Good luck with your brother. He's fortunate to have you as a sister, caregiver, and advocate.
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Reply to Rosered6
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Hi Brandee. Thank you for responding. I feel sure you are correct. The VA has mentioned there are support services he would qualify for. I have just never asked about them. I always have so much to do around the house that I don't go anywhere unless it's for hubby or brother. And truly, my brother is not hard to take care of. He has a very pleasant disposition and is forever saying thank you. If he were any real challenge, I would have probably been begging for support services. Thank you so much for the suggestion.
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Kay,

I saw you live in Pennsylvania. MIL qualifed for free CNA's to come out to her senior living apartment through some kind of program in PA. If your brother has right side paralysis he may qualify for the free CNA's to come daily to your home in PA.

While he is living in your home I'd look into this. Even if you had someone come out for 4-6 hours in the mornings it would take a load off.
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You might contact a few long term care homes and ask for a tour and meet with an admissions director. Tell them that you are looking for a contingency plan in the event that you can no longer take care of your brother.
Have one of your siblings involved and leave instructions for them. If you have a will, it would be good to detail your plans for your brother if you predecease him.

Have your brother sign a POA listing you as primary POA, then add a secondary person who takes on the responsibility if you are unable. This does not have to be a family member, though I would consider a sibling or niece or nephew you trust to make arrangements for your brother.

I agree with others that the time to place your brother in a care home is before it becomes an emergency situation. At least know what the care options are in your community, and have your favorite place chosen in advance. Then, leave instructions for your husband or your sister to have him admitted to the place you have chosen.

If your brother qualifies for any Medicaid assistance, or VA assistance with managing activities of daily living, get supports in place now - that is, hire someone to provide assistance at home for at least a few hours a week.
I think having established services in place now will make the transition to a skilled nursing home easier when needed later.
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Kay418 19 hours ago
Thank you CaringWifeAZ. Yes he qualifies for VA and Medicaid support assistance. VA has even mentioned respite care if needed. I have not utilized any of these support systems yet. I never thought about actually touring a nursing home. In the past I was understanding that it was a premature move and I had to wait until we knew he was ready. I will definitely check this idea out. It sure couldn't hurt anything. You gals are great. We appreciate you.
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What kind of plan do you have in mind?
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Kay418 22 hours ago
Hi Rosered6. I have tried to answer this question 3 times only to lose my response. Hopefully this time works. I spoke with Area Agency on Aging and they do not do contingency planning. So what I was hoping to do isn't done. As it stands now, hubby will have to take brother to ER and leave him. The court will step in at some point and appoint a guardian. A sister in Michigan will try and have him relocated near her if he is sent to a local NH. This is not currently doable to move him there. She will do only when/if he goes in.

My brother has no assets other than a small burial policy. I am unable to help him financially.

I looked into the Alzheimer's Associations guidelines for what is considered legal capacity and he falls within the range in my opinion. He needs alot of help but he knows what he wants. Evidently the VA believes he is capable as well.

I am putting a plan in place now. It's not what I wanted but it's better than nothing. It feels very much like I am on an island and I don't know how to get help. I reached out to you all in hopes I would see something I missed. I appreciate the wisdom, experience and kindness on this forum.
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Denentia and he make his own decisions. I hope you have POA for him, financially and medically. You husband should be backup. As a person who has a disabled nephew with a Neurological problem that will cause Dementia sooner than later, I would get brother placed now. Don't leave the problem for your husband to sort out. From what you discribe, your brother is 24/7 care and over 65. He could be placed in a nice LTC. Maybe a group home somewhere. Believe me, he is not going to get better and you are getting older.
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Kay418 Aug 16, 2026
Thank you JoAnn29. I appreciate your thoughts. It's a tough situation.
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I understand you and your brother not wanting him to be under a guardianship for as long as possible. But it seems that your husband (and your other siblings?) cannot be relied on to help your brother at all if something happens to you. For example, if you make a plan for your brother and you die suddenly, would your husband even follow the plan?
Thus, I think you might want to initiate moving your brother into some type of supported living situation, such as an assisted-living facility. Whether or not you do this, I think you should talk to a lawyer about getting some financial protections in place for your brother. That might involve setting up a trust for him, and you deciding whether you want to leave money or other assets to him when you die.
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Kay418 Aug 16, 2026
Hi Rosered6. Thank you for your reply and perspective. You raise good points. I am somehow not explaining myself very well. Perhaps I am just trying to do something that isn't possible. I very much appreciate your insight.
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There is a "new" program that might be of help. (I put new in quotes as I do not know how long this has been around...I do know that in my area there are not a lot of them)
The VA has Medical Foster Homes.
they provide Private rooms
Home like setting
Supervised setting
There are specific requirements for the home and that may be why there are not a lot of them (one being the home needs to be within a 40 mile service radius of a HBPC (Home Based Primary Care) team
And more.
How this works is a family choses to open their home to a Veteran (or more than 1) and the VA checks and approves the home, checks and approves the family.
the Veteran pays the family. The cost would be less than a regular facility.

If you want more info
Medical Foster Home Program Coordinator
224-610-3784
John Zidek, LCSW
John.Zidek@va.gov

The other thing you should do is talk to an attorney and have a plan in place and someone that can be named in an event of an emergency on your part.
At what point will he need a Guardian?
With the TBI is he LEGALLY able to make decisions? By that I mean if an Attorney or anyone else talked to him would he be competent to answer questions (under pressure or in a stressful setting?)
Far better to get this done and not need it or need it and not have a plan in place.

As far as his "service connected disability" status...keep checking that, the VA is always adding conditions that may have excluded a condition in the past but is now included.
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Kay418 Aug 16, 2026
Hi Grandma1954. Thank you for the Foster Program information. This is news for sure.
Honestly I don't know how other agencies would view his competency. He goes to Urology, Podiatry and Neurology at the VA every 4 weeks. We have ER, urgent care and other testing appointments during the year. He is always conferred with first, during and at the end of the visit. Sometimes, most of the time, he forgets why he's there. I fill in the blanks for him. After close to 4 years, they no longer work around me and include me. I am not sure legally where he would stand.

Thank you so much for your help.
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What does AAA mean?

Aid And Attendance?

Or, Area Agency on Aging?

Neither of those will be helpful.

Get him assessed for LTC by a doctor. Then I would find a good, local LTC facility that accepts Medicaid and get him in on private pay until he is a few months away from running out of all his money (except about $2k, but this varies by state). Then apply for Medicaid for him (you don't need to be his PoA or guardian). Once on Medicaid he will receive all the same care at the same facility.

If he already doesn't have the money then you may still be able to get him on a waiting list in a good quality facility. Look for faith-based ones (in my personal experience they give better care).

If you leave him in the ER he will most certainly go to a county-run Medicaid facility and they are mostly not good quality.
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Kay418 Aug 15, 2026
Hi Geaton777. Apologies. I guess I did not explain well. AAA is Area Agency on Aging. I live in Pennsylvania. I do not want him placed now. I am hoping to put a plan in place in the event something happened to me. My husband cannot care for my brother. As it stands now I am consistently being told nothing can be put in place until something happens. I was hoping to establish a person/Agency that would be familiar with my brother. I approached AAA two years ago but I worded my conversation terribly. They thought I was looking for a "bed hold" type scenario at a nursing home. Of course they can't do that and I understand. Maybe my question to this forum should be changed. I have the cognitive test recorded for last 3 years. I have the things he requires daily assistance with recorded in his VA records. I am contacting the local AAA to see what he actually qualifies for but more importantly, what we can do now to facilitate his move should something happen to me. I was hoping someone here would have some words of advice or insight. I am in good health. He does not have a guardian. He would only go to nursing home if something happened to me.
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The only AAA I'm familiar with is a motor club company, which obviously has nothing to do with health care, so can you please explain what AAA is in your world so we can better help you?
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