How can we change the HCPOA after a psychiatric evaluation deemed MIL incompetent?

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My husband is FPOA and trustee for his mother, who lives in another state, and handles all finances. Since his sister lives near their mother, she was named as HCPOA with agreement of all family several years ago. Recently, SIL has taken on more of a role in managing MIL's care, which should be minimal since MIL lives in a CBRF/AL; changing doctors, refusing certain medications, in opposition to MIL's requests. We suspect the psych evaluation was requested to settle the question of competency in face of differing decisions by SIL and MIL. We have asked to see the psych eval report, but SIL refuses, claiming HIPAA rules (although my husband is named later on the HCPOA). MIL has not been diagnosed with Alzheimer or other dementia, she is just cranky and outspoken, and makes crazy comments, and inattentive if she doesn't like the subject of discussion. But she also has a lot of physical ailments that required the ALF.
It appears to other family members that SIL is enjoying being in charge, and is doing all this for her own reasons. Now her claims have put her own sensibility in question, and her demands (like whether other family and friends can visit) are causing dissension.
Any advice?

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Thanks. I picked a few helpful bits out of those answers. To further clarify- I'm involved as I have a pretty good relationship with SIL, and am highly sympathetic to her concerns. But I have also caught her in many lies about MIL's care and actions, and we have been told (discreetly) by the AL staff that SIL stirs up trouble. My husband is not blind to his mother's behavior, but since this is a continuation of her life-long behavior and not a recent change, he's less likely to call it dementia. We travel to visit her once or twice a month for weekend-long visits, and talk with her nearly every day. This week SIL is threatening to take my husband to court over their disagreement of whether MIL can keep some pocket money to pay for small items brought to her by friends or family. The idea of an outside guardian sounds good at this point.
But thanks again for listening.
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I have a feeling your SIL lives near your MIL, she probably knows things that you might not. My mother for the longest time was able to sound normal on the phone and during visits from my brothers. The probably thought I was exaggerating when I talked of her dementia. One of my brothers would just say "Old folks do that" and dismiss it. It wasn't until she got really bad that they started seeing it themselves. If this is what is happening with your MIL, it isn't unusual that you don't see things because your MIL tries to act normal with you -- something we call showtiming.

If your mother has been declared incompetent and hubby is her financial POA, then he has the need to know. This is especially true if he has the springing type of POA that goes into effect when a person is incapacitated. Do you know which type POA he has? You can check the form and it will tell you when it becomes active. (Often they are active from the time they are signed, but other times they become active when the person is incapacitated.) If it is a springing type, maybe your hubby can request a copy of the statement of incompetence to put in his files.

I do hope you will be able to work through this as a family. Being a caregiver is not fun, so I doubt your SIL is trying to bogart the power. She may just be trying to avoid any arguments. Of course, I don't know your family. I am just speaking about some common problems that families have.
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My MIL is in an AL, but we still need to keep after the Head Nurse for her care. We have to go to all her MD appointments who is not affiliated with the AL. We have to oversee the prescriptions and make sure we read every test report for labs, CT, MRI, EMG, HOLTER monitors and yes we object at times.
You say mom is complaining but also that she has dementia. Our mom complains too, but we take all that with a grain of salt. The HCPOA sounds stressed, afraid to share things with you. So you dispatch her brother to talk to her. You stay home. That's right, you are an in-law and sometimes there are times when you have to bite your lip and let THEM sort it out. It's not easy.
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If there truly is a medical decision of incompetency (have you seen that much in writing?) then most likely MIL also has a diagnosis of some kind of dementia or other mental illness. People are not declared incompetent because they are cranky and outspoken.

SIL does have some responsibilities to keep MIL's health history confidential. In many families the parties involved would ignore that and discuss the situation with the entire family if that seemed in the patient's best interest. But that does not make the disregard of confidentiality mandatory. Before this recent evaluation, has your mother signed HIPAA waivers to allow her doctors to talk to you?

Sometimes family caregiving is needed to supplement what is provided in AL, especially when needs have increased and the resident is now borderline for the level of care contracted for. If a new doctor is needed or the resident needs to see a new specialist, the AL staff will not typically handle those decisions.

Your SIL is legally responsible for making medical decisions for her mother. It is impossible to tell from what you have written whether SIL is "enjoying being in charge" and is "doing all this for her own reasons" or whether she is acting in her mother's best interest as far as she can see it.

If it is true that a professional evaluation found MIL "incompetent" to make her own decisions, and you think mother is just cranky and has physical ailments, then I wonder if some strong denial is going on, or if perhaps you and your husband are not in frequent touch with MIL.

The only way to change who is taking care of MIL's health would be to file for guardianship. Would that be in MIL's best interest, do you think? (Be aware that if family members disagree over who should be guardian that a judge can appoint an outsider to provide the service for a fee.)
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