How to manage a live-in caregiver who oversteps guidelines set for patient?

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We have a wonderful live in caregiver for my mother in law. However, over 3 years she has disregarded a few instructions clearly given to her. An example of this is when she was hired, was told what hospital my MIL should go to if ever needed to. When my MIL broke her hip, she was placed into a car and driven to the wrong hospital (where none of her doctors or medical records were at). We did not even get a call about her needing to go to the hospital until 1 1/2 hours later. The call we received was from a surgeon, requesting verbal consent for hip surgery we knew nothing about. That means MIL had to be taken to the hospital, register, have vitals taken by nurse, have doctor examine her, order xray, get results of fractured hip, call in surgeon. She was transferred to the correct hospital. Boy was I mad as a hornet when I saw her for not informing us, and sending her to the wrong hospital which delayed her care.
Her son had a baby at one point and she was all set to watch the infant 3 times a week, in my MIL's home while supposed to be caring for MIL. Never discussed it with us or asked permission. We nixed that! I was the bad guy!
She called and made a doctors appointment for MIL after telling her to check with us first.
As MIL's condition has deteriorated, her ability to handle too much activity and visitors has confused her. We requested no visitors after 6 pm because of sundowning. We found this time frame was disregarded when a neighbor phoned us at 7:30 to ask why there were 5 cars in my MIL's driveway, and was she ok? Caregiver, though a nice gesture, backfired when she had her family there to celebrate MIL's birthday. Would have been fine except we had spoken to her twice that day before and did not mention it. I feel she knows she is doing wrong by not telling us.
Today I found out she took it upon herself to inquire at doctors about MIL's loose stools. Now there is a stool culture ordered. And even when questioned about docs visit, she did not tell all the facts.
We were there over the weekend, I assesed this problem.... nothing emergent. Nothing to indicate a GI bleed. So after telling her last time, not to make doctors appointments for her she did. I told her today this is the last time she will contact the doctors. I said if she has a problem or disagrees with something we do or don't do, she has every right to talk to us about it, but not to make doctors appointments. She knows my MIL is severe staged Alzheimers and there are no heroic measures to take now. There are things we will treat and not treat at this point. We are very close to putting her on hospice care.
I am the bad guy because it makes me crazy when she does these things. I don't like confrontations but I know my voice is raised a few octaves and pitch when questioning her.
Arrrrgggggghhhhhhhh!
I thought boundaries were set, but find this overstepping of them. I guess this is why I feel so frustrated. I have to pull in the reigns every now and then, but her and I will be OK!

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Sorry for your predicament. Only you can decide what you and your husband are most comfortable with and what is kindest for MIL. What is right for me and/or Pam may not be right for you. Blessings
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Thanks you two for your answers. Feeling betrayed when you trust someone is a huge issue when you find they intentionally do not let you know about things. The trust we do have is we know this caregiver would never take anything from my MIL. The care is generally good.... Today, instead of me approaching the caregiver about the latest issue, I had my husband do it. He is much more diplomatic than me. However, I still let her know how upset I was. Have to reset boundaries when she crosses them. Its extremely disappointing and very stressful. It almost seems there is no common sense at times Our other choices: to go and take care of MIL myself or LTC..... since she is deteriorating rapidly there is an end in sight.
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Agree with Pam you just can not trust this person. you have no idea what else she is doing. you say MIL is late stage ALZ so she can't let you know what is going on. Do you tell the caregiver when you plan to visit. Plan a few surprise visits and see if the care is up to standard. After that well you will have some decisions and arrangements to make.
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Five cars in the driveway would have ended it for me. Too many people with opportunities to loot the place. Because she is a live-in you have to go through the eviction process. Good luck.
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