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I am being left out of the loop about the nursing home doctor visits to my mom's room, their findings, and why they are recommending certain medication changes. I am her medical POA. I asked one of the nurses if it wasn't the law that I be contacted on medical visits by the doctor, their findings, and medication changes. The nurse told me they do not have to contact me because my mom is able to make her own decisions. It is not only my opinion that my mom cannot make her own medical decisions, but she does have a cognitive diagnosis, and several speech language therapists have given me information concerning her cognitive and communication abilities since her stroke.

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Own456,maybe contact 20/20.Agree with countrymouse.I was a LPN in a nursing home.50 patients per nurse,speak with the social worker/DON,day nurses and doctors office.some doctors do have a specific day they visit so you maybe there.you could make a request that there are certain meds you don't want her on.I hope this helps.
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Pamstegma- thank you for this advice!
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I am also aware of the kind of situation that own456 is referring to. It happened to a friend of mine who had assumed guardianship of her very elderly aunt. My friend (a successful career woman) was ultimately indicted and jailed for almost two years - accused of "stealing" from her wealthy aunt. Who benefited? The lawyer who became guardian and the judge who made her so, both benefitted substantially from the elder aunt's estate. This was in NY. I couldn't believe it when it was happening, and have a hard time believing it to this day - but it DID happen - within the past 10 years! Yes there are criminals of all sorts out there, and it's best to know that the worst CAN happen to innocent caring people!
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I'm the POA for my mom as well as a speech pathologist. Part of the problem may be due to the crazy HIPAA regulations which will not allow medical information of any type to be emailed. Two MDs (Mom's PCP and a geriatric psychiatrist) wrote letters stating that my mom was no longer competent to make her own medical, financial or legal decisions. I did not have to go to court. These two letters along with my documentation of being Mom's POA have made it possible to communicate to her various MD's. Some MDs have a medical information "portal system" through which you can access their medical notes regarding your mom. Please ask the MDs directly how you can access their info - once you provide them with your POA documentation. Good luck!
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countrymouse - don't assume. I live 25 minutes away. Call nearly everyday. Visit 2 to 3 times a week. Not asking for an appointment. Simply asking for a phone call, or to leave a message, or to simply inform me when I say hi to them as I pass their desk on the way to see my mom. Families NEED to keep up on when doctors see their loved ones and if there are any medication changes, especially if their loved ones cannot always remember if the doctor was in to see them or even what their symptoms were the other day! Residents get better care, plain and simple, when families stay involved, and are informed!
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tw1129, bring your original MPOA document and have a sit down with the DON (director of nursing) and tell the DON you want a weekly meeting and update on your mom. Keep the appointments. Explain "prior consent" to them, nicely explaining that you get the information before they get the consent for anything medical.
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Well it is happening and it can happen to anybody just check out stopguardianabuse.org for yourself you don't have to take my word for it and look at the videos on youtube for National Association to stop guardian abuse. If you don't take my word for it at least follow the evidence!
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Wow, own456, what on earth would be the motivation for a care center to make their residents wards of the state? Why would the state want to accept that role when there is one or more family members willing to be responsible?

Record and take pictures of the "perps"? What kind of a crime fiction script are you writing?

The poster here needs suggestions for improving the communications with the care center staff. She does not need conspiracy theories.
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Keep your cool? Are you being intentionally ironic?

Look at it this way round. You run a nursing home with fifty residents in it. The retained PCP comes once a week and does a round of anyone flagged up to see him, on a Tuesday, say. On Monday night Mrs X has a bit of a sniffle and you add her to the list, along with fifteen others. Oh, wait, can the POA who lives 350 miles away make it tomorrow morning..?

Get real. The people who look after our relatives in these facilities are there to look after *them*, not to look after you and obey your commandments. In a good facility, good working relationships with families are extremely important and properly respected; but even then they're not the aim of the whole enterprise. It is totally impractical to expect them to obtain your consent to every appointment, every px adjustment, every Advil.

Do not take their failure to do so, then, as a sign of sinister intent. They're busy. Meet them halfway.
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You do have to be living near her if that is the case. Although you are the Power of Attorney Does it say on the form this Power of Attorney takes place on. This Power of Attorney will terminate upon death. They are not cluing you in because they are getting ready to make her a possible unwilling ward of the court. That means if they are to make her an unwilling ward of the court these people can go to the courts and have an emergency guardian meeting. They can pay off a judge to get custody of your mom read up on this at stopguardianabuse site They can back door a judge as we speak and already have the paper signed and that is why they did not elect to call you. That is why they are changing her meds. They are getting ready to keep her indefinitely. When they change the meds and she is not able to take care of herself she is in a vulnerable state which means get a lawyer stat. These people could be even changing her Power Of Attorney and Living will so be aware of the documents you have. Look over those documents if they were signed in black ink people can change those documents. If you did not sign the documents in blue ink although the documents were witnessed you may have to have a video of you and your mom signing those documents. Some states require that there was a video of the signing of the documents some states don't. If your mother lives where the Admission coordinator is a notary and has a stamp then if she notarizes the documents in some cases a Power of Attorney can be fresh out of luck unless the state says she or he cannot file that paper on the patients behalf. In a lot of states they can have a person so full of meds that they will sign anything because they are afraid of the people taking care of them such as the POA could get revoked so what ever you do keep your cool when you visit your mom and go to the court house to find out if they changed anything, get a lawyer either way in the event that they changed the POA or in the event they made her a ward they will have to tell you. Some states or counties have civil documents you can look up under you mom's last name and first name and if you find out her documents have been changed by a judge that kind of county courthouse website under county or circuit clerk would tell you of such. But don't ask the doctors or nurses so many questions, don't be quick to anger with them, just observe gather info all you can. Keep your phone on vibrate no ringer and record what they say if you can regarding your mother, set the phone to have the back light go out every often so they do not know you are recording. If you can keep cool and take pictures of the perps. And at all times be there for your mother and don't loose your cool and get thrown out. If possible have your lawyer if you have one meet you at the nursing home dressed like a friend of the family none the wiser. Have him or her observe, believe me you have a right to do this during operating hours but above all else keep your cool.
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Jeanne, thank you for that information! It answers many questions I have had since my mom's move. I have asked my sis (mom's POA) repeatedly about meds, mom's weight, and a variety of things never to receive a reply. The only thing she has told me was in the very beginning was about Mom's trip to the ER for behaviors thought to be caused by a UTI, that ended up with admittance for geri psych evaluation to get meds figured out. Sis then told us that "from what she read" it may take mom a few weeks to adjust. Yes, that is what sis said. Mom is still adjusting evidently as they have just changed meds again.

When sis did not respond to questions I then posed them to the director of the facility. Mostly I do not receive reples from them either which has been very frustrating. Though that appears to be changing. I have not been told of quarterly care meetings. Not sure at all if they are even occuring. Sis will not provide any information and she signed the HIPPA release for mom that authorizes release of information to me.

Facility is very aware of dysfunction in this wacky family. In spite of that when I was caring for mom I would send extensive reports to sibs about mom's doc appointments and other occurrences. It is hard when after providing everything for my mom to go, so to speak, cold turkey.

What happens, Jeanne, since there is a POA, my sis with me as successor? Does the facility take over POA in effect? Does sis sign something that allows facility to make decisions for mom? What about instructions in the POA? They do not matter? Initially sis was very good about getting over to see mom, which has tapered off significantly, it seems.
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gladimhere, the HIPAA waiver ALLOWS the facility to share certain information, but it does not REQUIRE them to.

Someone in our family (me or one of my sisters) attends every quarterly care conference about my mother. It is very clear to the staff that we have a strong interest in her care. We are complimentary and enthusiastic about their services. They say they appreciate our advocacy and wish all their residents had family involved.

And they answer all of our questions, promptly. No one has medical POA. They've asked us to designate a communications point, since they don't want to contact all 7 of us. They have never refused to provide information because of HIPAA or for any other reason. The DON has called me in the morning saying "The night shift noticed your mom has a rash and I have a call in to the doctor for xxx cream for her. I've inspected it and had the other unit's head nurse look at it also." And I say, "Thank you. I'll tell my sisters." We also initiate med conversations: "We're wondering if Mom's night med could be decreased now. She seems so much less anxious to us. Does she need to keep taking that?" And they either explain why it should continue or agree to ask the doc about reducing the dose. They don't even ask Mom at this point if she wants a flu shot. They call us to sign the consent form.

This is all done on an informal basis. It is based on relationships. If my brother who is never involved showed up and wanted information I'm not sure how they would react. They might refer him to their contact person (me). I just don't know.

The law probably doesn't require them to call the MPOA if the patient hasn't been declared incompetent. But common sense should tell them it is a good idea to contact you before (or soon after) they change medications or doses, if that is what you want.

Building a relationship with staff is an asset!
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Is it a standing or springing POA? Springing requires incapacity as determined by two doctors before it goes into effect. Since mom is competent by doctor's determination and you cannot get information the POA must be springing. In order for you to get information Mom must sign a HIPPA release; without it the facility would be in violation and they do not want that. See if your mother will sign a HIPPA then you would be able to get information, but not make decisions.
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MPOA
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I believe you have to have her doctor sign off on the fact that she is NOT COMPETENT since you're the MOOA.
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Babalou explains the point about informed consent well: it's a sliding scale, not an on-off switch. And in any case, at this stage you'll get further relying on good manners and good practice than on legal niceties. Explain to the NH that you wish to be kept informed and advised of meetings, be polite but persistent, make personal contact with the doctor so that s/he knows you are taking an informed interest - plenty of POA's don't, you know - and see if things improve.
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My mom has dementia. She's been in a NH for two years. She's not incompetent. Her doctors talk to her about her condition.

If you want to be informed about what is going on, talk to the social worker and unit manager. Let them know that you'd like to be updated on any changes the doctor makes. Call in and speak with the facility doctor if you have questions.

In a facility setting, make sure that you are talking to someone with authority and someone who is accountable. Not " a nurse". But DO find out who your mom's regular daytime nurse is, bring treats, and you'll find out when the doctor is coming.
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You don't have to use their doctor. As long as u can tranport her, you can take her to whom u want. I have had this problem with hospitals. I ask that doctors not talk to her about her health. She has hard time processing what is said and only gets partof what is said. Asked the doctor talk to me. He called and left a message she was doing fine.
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Here's the deal. It's not up to you to declare mom incompetent. HOWEVER, if you have evidence through a written diagnosis that mom has dementia, the nursing home will most definitely honor that. If - IF -- you put your directions in writing and send them Certified Mail RRR.

The nursing home told you that for its own convenience. Insist on a doc call before meds get changed unless it's an emergency.
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