What is the difference between DPOA and MPOA?

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I had a long talk with my brother yesterday who is the DPOA of Mother's estate. My younger brother, with whom she lives has MPOA (so he states, we don't have any proof, other than he says he is). The concern is this: She's getting worse (anyone who has followed my posts knows about this) and I have had some advice over the past weeks to look into long term care, to do it NOW and even get on a waiting list, for what it likely to be where mother will wind up in a year, maybe less.
Problem we have is, the brother with "MPOA" says she will go into a facility "over his dead body". Well, I don't think the decision of mother's entire medical care rests on his shoulders. He does. She is going downhill fairly rapidly, and one fall or pneumonia is going to be too much for her. I am NOT taking the reins and saying she has to go into a NH. I am trying to be proactive and see what is out there and what it will cost. She has a LTC policy that pays around $200 a day for up to 2 years. That, plus her SS will pay for a fairly nice facility here, if needed. (We're thinking if she becomes wheelchair bounds--that's pretty much 24/7 care-and her place is not wheelchair accessible)
There are 5 living sibs. My take on this is, MPOA is not much more than a person who can say "These are mother's wishes and I will see them carried out". I DON'T think it means he can control what meds she does and doesn't take and what she can or cannot have as far as medical help. He's being pretty aggressive and really, really angry about the thought of a NH or ALF.
The DPOA brother knows he's the executor and co-signs any checks over a certain amount. He's watching mom's finances and such. MPOA is being kind of a stinker and causing some unnecessary anxiety. (The "careplan" he has outlined if mother winds up bedbound or in a wheelchair are inhumane, to my thinking)
I think that all 5 of us need to be on the same page. I don't think MPOA has more "votes". Don't want this to get dramatic (again!). (Yes, I can 'google' this, and funny enough, my son is an attorney, but he doesn't answer my questions--so I am going where I know I will get the right answers!)

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Top Answer
Well, the D stands for Durable and the M stands for Medical. The 'durable' part strictly speaking isn't to do with the distinction between financial and welfare responsibilities as such, but identifies the nature of the power - i.e. that it is durable, that it continues after the person on whose behalf it is exercised has lost capacity.

But it sounds as though the DPOA brother's authority deals solely with financial matters; whereas in addition your mother may (or may not?) have drawn up a Medical POA giving authority to make any health and welfare decisions to that brother.

If MPOA brother in fact has MPOA, he should be able to produce documentation to that effect. So: can he or can't he?

But, whether or not he can, you are absolutely right in thinking that the best way forward is consensus. Because even if one child does turn out to have the Top Trump, so to speak, it's no good to your mother if that child then rides roughshod over everyone else and as you put it so aptly creates a stink. Remember that that cuts both ways, though: if it turns out that your brother's MPOA exists only in his imagination, that doesn't mean that you shouldn't give full weight to his opinion - especially given that he is the one doing the caregiving.

Now. If your brother has a formal, valid MPOA; and if your mother when she had capacity made it crystal clear to him that she was in no circumstances to be transferred to long term care, perhaps even stated that within the MPOA; and if she has the resources - governed by your DPOA brother - to afford nursing and personal and ultimately hospice care at home: IF all of those things are true, then in fact your MPOA brother would be acting correctly in adamantly opposing her transfer to an ALF or NH. He would be duty-bound to do so. But that is an awful lots of Ifs.

Your two brothers need to compare notes. Are her resources adequate to fund her wishes? If so, how can that practically be achieved?

All I can say is the two of them and your mother are lucky they have you around to ask the important questions and damp down the fires! Best of luck with this, hope you see progress soon.
MidKid, no criticism but just a clarification of some issues. The Estate really isn't subject to DPOA authority; it exists in concept pursuant to creation of a Will, but the actual legal concept of an Estate becomes reality on the death of the Testator or Testatrix (the person who creates the will. At that time the Personal Representative f/k/a Executrix or Executor in some states, takes over the Estate and DPOA financial and legal authority ceases. Or it may be that the PR is the same person who is proxy under the DPOA and carries on, in a different capacity.

I'm not being nitpickey, just trying to clarify some concepts.

So the one brother really isn't a DPOA proxy of an estate. He does have proxy authority of your mother's legal and financial affairs, assuming that the DPOA isn't contingent on declaration of incapacity of your mother to manage those affairs.


Someone named as proxy under a MPOA, or Living Will or Advanced Directive, is granted authority to make medical decisions, including those at the end of life.

I haven't read Dad's in some time but since I'm proxy under both of my father's directives, there isn't any conflict with one person wanting to do something that may require financial support by someone else holding authority.

And that's where I see the potential conflict in your situation. The brother who doesn't want a nursing home/facility involved would likely need financial assistance from the brother who would handle the legal and financial aspect, to pay for the funding. The two would likely have to work in concert.

However, what his actual medical authority is depends specifically on the wording in the Living Will/Advanced Directive. It may only be for end of life decisions and not interim placement. Someone needs to read that to determine exactly what that authority is, which of course is difficult if he refuses to show the document to other siblings. That makes me suspicious he isn't named at all, or there isn't a LW/AD.

Unfortunately, the best option is for all the siblings to agree, but it seems as if one is bound and determine that he's going to make the medical decisions. You may have to confront and challenge him, stating that the other siblings want x, and if he wants y, then he needs to provide you with the documentation affirming his authority to do so. If he fails to, perhaps he really doesn't have the authority he claims to have.

Another way to find this out is to contact the firm that prepared the DPOA; typically they're done as part of a thorough estate planning (if prepared by a competent and well qualified law firm and not just downloaded from some online site). The DPOA proxy could do this and ask what other documents were prepared and ask for copies.

I do think it's a good idea to think ahead for short and long term planning; the tough part is getting everyone to agree. I wish you luck in this project - I think you'll need it!

CountryMouse--
Thank you!!
I have seen the documents declaring DPOA to be as such. Brother #2 hasn't offered to show any documents as to being MPOA, even when I have point blank asked to see them. I don't think it means to him what it really means.
IF mother had never wished to be cared for in a NH, then why would she be so careful to make sure her LTC policy is always up to date? Seems we're at crosshairs.
Yes, "MPOA" brother does do the lion's share of work. There's a LONG backstory as to WHY my parents moved in with him--not really that germane to the issues at hand.
MPOA can be VERY loud, angry, demeaning in the way he presents himself. If anyone of the sibs other than me goes to visit her, he "helicopters" the visit. This is one reason they don't want to go visit (New info)
My personal belief is that this brother NEEDS to inherit from mother's estate. I think he is terrified that a stay in a facility will take mother's savings and annuities and deplete them and she'll die a pauper and he won't get a dime.
I do believe that his opinion carries a LOT of weight in the decision we may have to make. BUT his is not the ONLY decision. I know that he thinks it is.
I can still look at facilities and see what's out there that's affordable. He can't boss me! My biggest concern is for my mother's care, hard as she is to deal with, I do care.
I'm going to see if DPOA brother (who has ALL the paperwork) has seen any MPOA forms.
Slowly, the pieces of the puzzle are falling into place. Mother has been very crafty at keeping all of us in the dark for years.
No worries about him trying to trump us all. All 5 of us are really, really stubborn people. Well, 4/5. DPOA brother is a Dr. No-Shot. :)
Hmmm… would it be fair to guess, then, from your description of him, that if brother had that MPOA in writing he'd by now have photocopied it, folded it and shoved it up your nose?

If it can be demonstrated that his primary reason for keeping her out of LTC is conserving assets which he hopes/expects to inherit, he is not acting in your mother's best interests and that in itself is highly questionable behaviour on the part of a caregiver. Oh crumbs. I do hope that's not the whole story?

Is your mother still able to express her wishes at all, remind me?
GardenArtist--
Thanks for even more clarification!
All this was set up MANY years ago, when daddy was alive, and all that has changed is one sibling died. My parents were SUPER old fashioned in not wanting "us girls" to have to worry our heads about anything, so it's all been super secretive.
Yep, I agree, if MPOA brother HAD said document, he'd have copied it and sent it to all of us. I think DPOA brother has ALL paperwork.
Mother has a living will and Advanced Directive. Also her DNR hanging on the kitchen wall. I have seen all those. Nowhere is MPOA mentioned.
I understand the concept of trusts and wills pretty well. My hubby was executor of his dad's trust. It was a nightmare, but that's just b/c dad left such a mess behind. A literal and figurative mess, maybe that's why I am anxious about this.
Without question, my MPOA brother EXPECTS and is RELYING on a large inheritance. (Acc to DPOA, everything split 4 ways leaves an "ok" inheritance, it won't make one iota of difference to my life, but this amount will make a HUGE difference to a family that has always, always struggled financially. (I feel I should insert here that over that 17 years, ALL the other 3 sibs who could, sent fairly large amounts of money to MPOA's family almost every year--they simply couldn't make it without help.) I'm sure he's too proud to admit it. When I brought up the inheritance factor, he got very angry and since that's his go-to emotion, I know I had hit a nerve.

His words about caring for her when she can't?? "I'll put a hoist over her bed, slap a new diaper on her and plop her in her wheelchair in front of the TV. That's all she does anyway." Um.....no, sorry bud, that's not humane!
Mother does not have dementia, she's simply going through her 2nd childhood. She's petulant and pouty. She's always been this way, she just hid it better before. She is able to state her wishes, and this isn't something we're doing now--but I am trying to get the ball rolling--we can get on a waiting list and just see how she gets along. We're not going to slap her into a NH because we want to---I am just a planner, and I hate surprises. I don't want to have 72 hrs to make a decision about NH's at some point b/c we didn't think ahead!
Mother states she wants to live the last 20 years of her life playing Bingo, going to lunch with people who LIKE her and not be smothered, bothered or palavered over by us kids. Hm. 7 days before this declaration she was moaning about "nobody ever calls or comes by". (I HOPE she doesn't live to 106!)
How very sad to refer to someone's mother as just putting her on a hoist like a transfer of cargo from a container ship.

From what you write, I doubt if this brother has any authority at all; I think you've got the situation figure out: MONEY. I think you'd be justified to just kind of ease him out of the planning phase and do it with the other siblings.

Check the Living Will; it may address long term care.

And BTW, thanks for raising this issue. I'm going to get out my father's documents and check them out to see what updates might be necessary to make sure everything's covered.
Ah. As long as your mother has mental capacity, and the back up of the brother she's living with, there's no question of moving her without her consent - you can't. At least that makes it simple :/ ?!?

But that doesn't mean you shouldn't do exactly what you plan to do: look ahead and find out what the options are. God willing you will never need them; sparing your feelings, may your mother happily play bingo 'til the end of her days; but what possible harm can it do to have them in reserve? You're right about surprises - they leave frail elderly ladies with nothing to fall back on but horrible choices, or rather no choice at all about where they can go in a hurry. E.g., God forbid, what if something happens to your brother? What then?

I don't like the way he put it, either, but I wouldn't take too seriously his stick her in front of the tv comment. What he means is, we'll cope somehow, leave us alone. Be nice if he'd like to put more thought into how, exactly, I agree; and in fact that's something else that could do with being researched - by him, this time.
Business head on here. One brother is going to try to manage all the medical care and think he can do that without giving the DPOA the relevant documents? Hmmm so just imagine you are stopped By the police and say I have a driving licence but I am not sowing it to you now leave me alone to get where i am going....not going to fly is it? And the same will be true for the DPOA. he should not be paying for anything that is not in his mother's best interests and that is where the working in concert comes to the fore.

There has to be a strategy based on Mums wishes - it is HER care after all. So that should be written down, with contingencies ...ie what if

From that can be devised plans about what is needed to enact that care - i.e. a plan - included in that plan HAS to be forecasted costs. if not how on earth can anyone tell whether the plan is viable. Mid kid this is insane. before I would act as DPOA I would copy all the POAS into a folder to show I had done due diligence. It's no different from due diligence over buying things. You hold the copies of quotes for things....you get three quotes from reputable people, look at the offers and using a checklist and a points system determine which offers best value for money. As for his helicoptering attributes. I would go in mob handed....family on tour sort of visit then he can be hijacked now and again so you can have a good old chat with mum. not about the POA leave that for your second visit, but it would give you all a chance to sit round the table and work out a sensible plan, even if you have to handcuff him to the chair to prevent outbursts
Again--thanks for all the advice.
After mulling this over the last couple of days, I can see that mother has kept enough information from each of us (whether by choice or just through forgetfulness) that none of has the whole picture. It is beyond frustrating!
I am not able to get access to all the documentation. Just can't. DPOA brother seemed content with what he gleaned, all he is going to do is see exactly how much mother's LTC policy pays per day. He said to go ahead looking into a few facilities and even putting mother's name on a waiting list if I felt like it (w/o his approval I doubt I can). I'm not looking for more trouble, I am trying to plan ahead. Of course we aren't going to "put her in a home"..just for the sake of doing it. I, personally, am a planner and I don't like surprises. I want to know in advance where we have options for mother to go, should she need it.
I am not going to ask brother with MPOA if his "title" is legal or not. No need to stir that pot. I'm pretty sure it's a verbal agreement, or he simply thinks b/c she lives with him, he is in charge.
Mother is competent to make her decisions. None of us wants to override her autonomy. This is simply something that I think should be addressed, sooner rather than later. She signed on with a rehab facility for her last hip surgery based on the "cute little gal" who told her about this gorgeous facility..and mother bought it hook, line and sinker. I found out about it and let her know the place was a total dump--but she still went there and within hours was screaming at all of us "get me OUT of here!!". It took 4 days of maneuvering and just plain awfulness to move her to a much more posh rehab facility. She decompensated so much in those few days--we cannot take a chance on a "permanent" living arrangement being the same experience.
I'm going to do some research, keep it to myself and just wait and see what happens. None of the sibs wants a "family meeting", so I cannot force that. I was just lucky that my DPOA brother even stopped by to tell me what he'd learned.
At the very least, through all of this, my siblings now KNOW without doubt, that mother wants to see THEM, and hopefully they will step up. I have not been to see mother since the first of December--so 6 weeks? where I was going at least twice a week before that. I doubt she'd even missed me--in fact, I know she's mad at me, so I'm going to let her settle down a little and then pay a VERY short visit. Depending on her mood, we will or won't discuss anything "sensitive".
Thanks again--Big help!
If mum is competent make decisions does she realise she can stop any POA whenever SHE wants?

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