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He started out in ICU, moved to nuero stepdown, has some brainstorm activity. Won't wake up, does not respond to pain stimuli. Mother is making decisions but eldest sister has medical POA. What say do two other siblings and mother have in father's continued treatment and care and next steps? Dr.s say without any improvement next is to move him to a LTC facility, or pull vent and start supportive care.

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It sounds like every thing happened very fast and several family members are in denayal. I assume the doctors say there is little to no chance for full recovery. In any instance this means ling term care. If he cannot come off the ventilator, that will also mean that LTC with a ventilator will reduce the number of facilities which may mean several miles away from mom.

What the docs and social workers cannot tell you unless you ask are the financial ramification and financial ruin that can effect your mom. For instance after 21 days, she will have to come up with $170 / day for the next 100 days (see Medicare enrollment info on medicare.gov). Afterwards she will have to come up with full costs out of pocket from 120 to 150 K per year. Does anyone feel lucky enough for dad to make a full recovery before this happens?

You and the holdouts should think about what further suffering he will have besides the vent and tracheostomy. He chose his medical POA and may have expressed his wishes to be carried out. No more enjoying participating in meals, pneumonia and superinfections, but wiping, skin breakdown, etc. I have seen too much of this dynamic, and the doctors are nearly always right about the outcome unless your family feels they will be the lucky ones. Sorroy to sound so harsh.

Your experience sounds similar to my dad, except even though my mom had cognitive problems she stated that if dad could no longer drive, then he would no longer wish to suffer.
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Hi, I believe the person who is "health care proxy" determines all medical care. POA is not same thing.
(I copied this link for u)
https://www.t-mlaw.com/blog/post/avoid-disagreements-between-your-power-of-attorney-holder-and-health-care-proxy/

"Avoid Disagreements Between Your Power of Attorney Holder and Health Care Proxy".
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I am Mum's Healthcare Representative and she has a 'living will'. My brother is second if I am unable to continue as POA.

Mum has been very clear in documenting what she would want to be done if she were in your father's position. My Step Dad was clear in documenting what he wanted too and Mum found this to be very helpful when he died 10 months ago. He had children, but Mum was the Healthcare Representative and her word stood.

So in your family, the medical POA comes first. And her first concern should be your Dad's comfort.

It can be incredibly hard for some families to accept that a family member is going to die. I have an aunt who would try to stop the nurses from administering morphine to her husband, as she thought they were killing him with it. She could not accept that the cancer that had metastasized to his bones was incredibly painful and he needed the morphine. He was dying, nothing could change that.
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DC, are ALL the treating physicians in agreement on his prognosis?  I've found that this sometimes doesn't happen, so I got prognoses from everyone involved.   

Have any of the doctors explained the level of "some brainstem activity"?    I'm only vaguely familiar with this from my father's long-term illness and recovery, but I did spend some time watching the monitor when he was in an induced coma.  And it fluctuated, rising so I'm told by the nurses when I sang to him.   They said there was clear evidence of response.    

I find that somewhat miraculous and inspiring, that someone in an induced coma could tell when he was being serenaded.

Regardless, I think that getting a good sense of what the prognosis is, on a more detailed level, is the first step to making any decision.

As to LTC facility, there are also LTC hospitals, where vent weaning can take place once cognition has been re-acquired.

You don't address the reason for your father's unresponsiveness.  Did he have a stroke?  Something else?

If it's any consolation, it's worth getting all the information you can, and quietly discussing it with the family, especially your mother, regardless of whether or not she has legal proxy authority to make decisions.  After all, it's HER husband, and she's probably closer to him than any of the siblings.  She deserves a right to be heard.

And, if it's also any consolation or inspiration, my father was in an induced coma for  weeks, gradually came out of it, then spent the next 6 months in LTC hospitals going through vent weaning and dysphagia treatment, and eventually transferred to rehab for a month, then came home with me.   He lived another 14 years, productive years except for the last 2 which were challenging.

And this was despite having been told by a pulmonary doctor and an ICU nurse that he would never walk again or live to get out of the ICU.   He showed them!
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The medical POA should be speaking for your father, and the hospital should be listening to her. Unfortunately, lots of hospitals fear being sued by family members regardless of whether or not they have actual legal standing. It's horrible.
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After three weeks it is very unlikely to improve and it can be a slow and torturous death without hospice and withdrawal of heroic measures. Will go to artificial feedings that often cause diarrhea, bed sores, loss of muscle, difficulty with airway clearance. I hope doctors are being supportive and honest about the options. The POA was designated by your Father to make his decisions when he is unable; the power of attorney will do that now. I hope all can sit together and come to a conclusion together. I am so sorry for the pain, grief, loss.
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So sorry. This is a difficult time for you all, I'm sure.

Did dad also have a living will? If not, are his desires well known to you and your family, including the POA? Is there a disagreement on how to proceed?

Hopefully your family can talk this through and come to a decision but it ultimately the final say will lie with the sister with the POA.

Almost 3 years ago my dad (73) was in a similar situation. He'd had a stroke, only brainstem activity, we knew he would never want to live on a machine, he had a living will, so the next morning we had everything turned off and a few hours later he took his last breath. Mom was in charge but my sister and I advised her and we were all on the same page.

Again, sorry you are dealing with this. I hope your family can come to a quick and amicable decision on this.
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Usually the holder of the medical POA makes all the medical decisions while the spouse and other siblings do not have any voice in medical treatment. You would need a lawyer to challenge an existing POA document, usually first filing an injunction to stop some treatment plan you dislike.

I am so sorry that during this very difficult time your family also apparently has some division over your father's care. Please remember your father had a reason for naming your sibling POA, maybe the spare your mother the pressure of making high pressure decisions in her advanced years. The POA document may also contain end of life directives, like not wanting to be kept on a vent for a prolonged period. Or your father may have verbally given direction to his POA. My parents had differing directions: my father wanted life prolonged at all cost and my mother doesn't want vents or feeding tubes if she was already terminally ill or wasn't expected to recover. I'm not sure there is a "right" choice, there is only the choice the person wanted or would want if they could still make their own decision.

I can only share being the POA is a very difficult road, full of self doubts, guilt, and second thoughts. The POA is not responsible for the events that resulted in your father being ill and is most likely doing the best she can when making difficult choices. Please try to not take out your own anger, frustration and pain over your father's health issues on your sister. Consider carefully before any steps that could fragment your family for years to come.
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Your father’s designated medical POA ultimately makes the decision. Is there no reason why you and your other sibling can’t speak to your older sister about your feelings?
Brainstem activity is usually basic control of breathing etc. If there is no cerebral brain activity via EEG in essence your father may be clinically dead. The ventilator is breathing for him. He may or may not be able to be weaned off the ventilator but it sounds like after 3 weeks his brain tissue is dead from lack of oxygen and even with brain stem (cerebellum) activity it appears from your post he has no cerebral function. We don’t know the background here (age, why in a coma now, etc) but that’s my educated guess.
This is a difficult time for you, I know, but your father chose your sister to make those decisions.
I hope you all can come together to support each other.
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