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My brother had a serious fall which was probably alcohol induced and has apparently sustained profound brain trauma. He was competent before the fall, and now is entirely mentally incapacitated. I do not believe his wife, his medical POA, is acting in his best interest in securing care and rehabilitation for him. Family members have attempted to talk with her to no avail. I believe she has a basic conflict of interest in that if he were to recover enough to come home, she would default to his main (sole?) caregiver. She is not willing or able to do that. Can I have her removed as his medical POA? Confounding this is Kaiser Vacaville's apparent and reported neglect.

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If he is completely out of it he can not do rehab.

I have never seen a rehab not do everything that they can to get the patient to do what needs to be done, but there is a point when it is not happening no matter what they do. Whether that is because your brother can't or won't participate doesn't change the fact that they have to draw lines somewhere. You say the prognosis is not good, please be sure that you are not blaming her for something that is completely out of her control. Not knowing what is going on and what medication he is on could very well be because the rehab doctors are still trying to get him stabilized and changing things so often that she can't keep up.

He made choices that have led here, don't take it out on his wife, she couldn't control him anymore than you could. She needs some support right now, it has to be really difficult to be in her shoes.

If he is in a facility he is getting care and she is fulfilling her obligations as his POA. Don't think for one minute that a court appointed conservator is going to care more than she does.

I do know that I would not be talking to my husband's family if they were treating me like the enemy in a bad situation. I have all the power and I don't have to tolerate being kicked while I am down. Be sure that you are not treating her with the same tone you have here about her, you will get nothing from her and rightfully so.
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More details needed. How long ago was the fall and what level of care has he needed since? What do you as his siblings want SIL to do? Do you want her to take brother home and have her care for an incapacitated bed bound person? That is a 24/7 job in itself.

What does she say when you discuss your brothers care at home? Your SIL may be tired of caring for someone who is careless and continues to drink. It may be that she cannot continue taking care of him because she is just plain tired. She shouldn’t be forced into taking care of your brother 24/7. Maybe his needs are such that SIL really can’t handle his care.
If that’s the case give her credit for recognizing this and planning accordingly.

From your post it appears that now he is unresponsive. Has he had EEG’s to determine brain function? If his prognosis is poor he may need hospice.

Does she work to bring income into the household? Raising children? Grandchildren? No matter, SIL deserves a life of some sort as well.

Do you as his sibling have an alternate plan and are you willing to care for him in your home if need be?

Not saying your brother is alcoholic but from your post that may very well be. We don’t know your brother’s medical condition or history. If he is an alcoholic no doubt that has taken a toll on his wife.

Also b/o brothers insurance he needs to go to his HMO’s providers l. Kaiser has their own network of providers and due to his choice of Kaiser his choices are limited to them.

Sure you can get guardianship but it will close you a good amount of money and you will have to provide proof of why you want POA over his wife. Unless she is negligent & you can prove it.

I say work with SIL and not against her. Brother is somewhere getting the card he needs. Let it be.
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You think that a State appointed guardian or conservator is going to try be more aggressive about getting him therapy?

Your "highly qualified" family members are of course able to speak to his doctors; his doctors cannot respond to THEM but they can certainly use the information.

I'm very sorry for your distress over your brother's injuries.
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He’s 73 with major TBI. The prognosis isn’t good What if his wife IS acting in his best interest? Quality over quantity. What if keeping him comfortable & giving him the best quality of life if better? Do you realize for there to be any change he will likely need years of rehab? Who is going to pay for that? Medicare won’t.

Do you realize that no one will have a say in anything if he is appointed a state guardian?

if these family members were so qualified to speak to the doctor, they would do it. They would know they don’t need anyone’s permission.
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A family member was cared for in Kaiser Vacaville, so I will have little BAD to say about them. They were absolutely stellar. If you have problems there, contact a social worker.
You need to understand that the wife is the next of kin, she is the spouse, she is the power of attorney. You will have ZERO input unless she wishes you to, and she will now be making decisions for your brother. SHE is the Lioness at the Gate, meaning you go nowhere unless she is OK with it.
You, if you care for your brother, now have only one choice that makes sense.Offer your love, your assistance and your support to his wife as she faces down the needs of your brother.
I do not think that she SHOULD be willing to bring home your brother. She will decide what is in HER best interest and in HIS now. That well may be placement.
Again, the wife is in charge now of fulfilling as she sees fit and to the best of her ability what happens going forth. Her husband has apparently self-medicated himself, or chose this path for himself; likely she ALWAYS had to deal with it, and she certainly does now.
There is no way on earth that you can intercede as POA unless you can prove abuse of your brother on her part.
Step back. He married this woman; he made her his POA to act for him when he cannot. And that is what she is doing.
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If you think you can do a better job and you are prepared to take over, you can petition the court for guardianship.
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dlivia Jul 2020
A POA is bound by California law to make decisions in the best interest of the incapacitated, not of the family. I have every sympathy for my SIL. I know she is not able to take care of my brother even if she we're willing. But we would like to see my brother receive the rehab that will enable him to recover to the greatest extent possible. He will probably never be independent again. My SIL refuses to let highly qualified medical family members speak to his doctors, and admits she does not know his diagnosis, what drugs he's on, or what treatment/therapy he needs. Kaiser is not providing. Therefore she is not acting in his best interest. I was thinking of a state appointed conservator. There is no family member that is able to care for him. The level of care he needs now is quite high.
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If you think that your brother’s wife is “not willing or able” for him to come home and for her to be his sole caregiver, what do you think is the best outcome? What is she doing wrong now? Even if you become his guardian, you can’t force her to be his sole caregiver, particularly if you say she is not able to do it. Have you talked with her about the options available, and what she could manage? There is absolutely no point in telling her to take him home, if she can’t and won’t.
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Just to clarify.

Do you mean that your brother's wife is *not* securing the right care and rehabilitation for him, because she would rather he were stuck in a nursing home than that he might recover sufficiently to go home with her as his primary caregiver?

If you could describe:

what care is he receiving on her instructions as his medical POA

compared to

what care you feel he ought be receiving and perhaps would be if his wife were not obstructing decisions

it would be helpful to our understanding.

And then, looking ahead, suppose you were able to have her "removed." What then? What's your preferred outcome for him going forward? Who's going to look after him? - because you sure as heck can't force his wife to do it if she doesn't want to.

The potential impact of care options on herself does not exactly constitute a conflict of interest. If she wanted to switch off life support and claim the insurance, that would; but this is more to do with weighing up the pros and cons of a decision. Her taking into account her own capacity to support his care is not at all opposed to his best interests.
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dlivia Jul 2020
He is receiving no therapy or rehabilitation four weeks after his fall. He is highly agitated and not cognizant. He is 73. The prognosis is not good but literature says that he could improve with rehabilitation and therapy. A POA is bound by California law to make decisions in the best interest of the incapacitated, not of the family. I have every sympathy for my SIL. I know she is not able to take care of my brother even if she we're willing. But we would like to see my brother receive the rehab that will enable him to recover to the greatest extent possible. He will probably never be independent again. My SIL refuses to let highly qualified medical family members speak to his doctors, and admits she does not know his diagnosis, what drugs he's on, or what treatment/therapy he needs. Kaiser is not providing. Therefore she is not acting in his best interest. I was thinking of a state appointed conservator. There is no family member that is able to care for him. The level of care he needs now is quite high.
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How old is ur brother? Did he have rehab after the fall? Is he now in a NH because he needs 24/7 care?

Has his wife allowed you to speak to his doctor's? If not, what are you basing ur feelings on?

If your brother needs 24/7 care then maybe he is where he needs to be. Like said, if he is an alcoholic, your SIL has had enough. She is no longer willing to care for him. She is protecting herself.

You cannot have her POA revoked. Your brother is the only one who can do that. You can file for Guardianship but that is expensive. But you will have all the decision making and will deal with the State. I do think you would have a hard time showing she is neglectful. He is getting care. She doesn't need to be doing it.
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dlivia Jul 2020
He's 73. The prognosis is not particularly good no matter how much rehabilitation and therapy he gets. But I believe he is entitled to the best care that will enable him to recover to the fullest extent possible. A POA is bound by California law to make decisions in the best interest of the incapacitated, not of the family. I have every sympathy for my SIL. I know she is not able to take care of my brother even if she were willing. But we would like to see my brother receive the rehab that will enable him to recover to the greatest extent possible. He will probably never be independent again. My SIL refuses to let highly qualified medical family members speak to his doctors, and admits she does not know his diagnosis, what drugs he's on, or what treatment/therapy he needs. Kaiser is not providing. Therefore she is not acting in his best interest. I was thinking of a state appointed conservator. There is no family member that is able to care for him. The level of care he needs now is quite high.
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You have said there is no family member that is able to take care of him. What are you hoping to accomplish by removing your SIL and getting a state appointed conservator? You will have no more say then than you do right now. If your SIL remains "in charge" so to speak, you *might* still be able to patch things up enough to have some influence in your brother's treatment...good luck with that if you let the state take over. Once that happens, you relinquish your rights, since by going that route you are saying you expect the government - and hence the taxpayers - to take over the case.
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