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My mother is currently in a NH and has severe dementia that is progressing rapidly and the nursing home staff have mentioned that I should take over as the “responsible person” because she isn’t able to make decisions about her care anymore. Is there a way of becoming the medical decision maker for her care without me having to sign a contract with the NH? I have a durable POA and her advance medical directive that says that I can take over if she is no longer able to. I just don’t want to have to sign a contract with the NH unless that’s the only option.

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I'm not sure what signing another contract does... I don't remember my husband signing something like for his Mom, but all facilities are run differently. Ask for a copy, take it home and read it, then decide. If it seems concerning maybe consult with an elder law attorney.
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Has the facility actually asked for this?
and
have they gotten a copy of the existing POA?

Has there been a scheduled care plan meeting done yet? Usually they are s he very 90 days if Medicare is paying for her medical costs.
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IMO, your POAs are enough. You take in the originals and have them make copies.

Read your POAs and see if a letter from her doctor is needed to make your POA effective. I just read my Moms POA, for another question, and it turns out it was immediate. So no need for a doctor sign off on her financial but I did need a doctor to make her healthcare directive effective.

I would be leary of signing anything that says "responsible person". I would read this very carefully. You could be signing a financial responsibility.
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