POA and power to decline drugs, where do my rights as POA stop?

Is your POA financial or Healthcare? Or do you have both? If you only have financial, then no you have no saw in medical decisions.

If you have healthcare POA, then I think it is worth having a conversation with his doctor or neurologist and discussing the pros and cons of the medications. You need to fully understand the consequences of him taking or not taking the medication. Could he stay where he is if his behaviour is not under control? Is he a risk to himself, staff or other residents?

His wishes were made when he was of sound mind. His mind is not sound now. Would he have wanted to put other people at risk when he was of sound mind?

You mention alternatives, have you fully explored them with the MC and doctors? They may have tried them in the past with other residents and found them lacking, or they may be willing to try something new.

You are in a tough position.

I have medical POA for my father who has just been evaluated and is no longer able to make medical decisions. I had to make the decision to place him in a secure facility with dementia services.
I am a speech therapist that has worked in nursing homes for 20+ years. I have never seen nursing just “throw” psychotropic drugs at a patient just because they are a little difficult. I have heard patients screaming through a shower, refusing to let anyone bathe, dress or direct them. I have seen patients strike out physically at staff that are just trying to change their sheets.
I suggest you take some time and go spend the afternoon and evening with your charge and observe what is happening.
Nursing staff is not allowed to stop or start any medication without notifying the healthcare POA. However, they can refuse to keep caring for him if he is endangering himself or others and you refuse something that might help him. They do have some facilities that are for very aggressive patients, but they have lots of oversight with medications used for behavioral management. Well, all SNF’s have oversight for medications.

I am curious as to alternatives that you would like to try. It may be they would try them also.

It is a very difficult responsibility that you take on out of love and caring. None of it is black or white. And each person has their own unique situations. Comparing them is like comparing apples to zebras.
This is no responsibility for the faint of heart.

IF the POA you have is a health care one, then yes...you absolutely have the right to ask them to contact you before any medication is given or discontinued or changed in any way. Since he can’t participate in the decision then that is why a healthcare POA is given and that person is in on any decisions. My sister and I do this for our dad and once they stopped a medication without our knowledge and we had a meeting of the minds if you will, and made sure they understood we were to always be involved.

If family refuses meds that control the agitation, and patient becomes unruly or dangerous, they WILL get rid of the patient. Maybe not overtly, but they will send him to the ER for something and then refuse to take him back. It happens all the time.

Also keep in mind that the agitation is also very difficult for the patient. Delusions and hallucinations are difficult for the patient. Sometimes medication is for the patient's good.

This reminds me of 'One Flew Over the Cuckoo's Nest'. Jack Nicholson decided, 'hey there's nothing wrong with these people, they are being stepped on and held down by Tha Man! I will set them free! Free as birds! They will go out into the world and live rich, full lives, unhindered by shrinks, or medications, nothing wrong with them that a fishing trip won't cure!'........No, they were in a mental hospital because they were very ill. Not just troublesome, but mentally ill. Today most of them would be living on the street, or in a cheap motel room, and who would be looking out for their best interests???.......If the man you have POA for has advanced Alzheimer's, so what if he gets medications to 'make him compliant'? He is never going to get better. He has no big jolly loving family to make his life better. Do you want him to live in a state of agitation, and possible endanger his living arrangement, not to mention the other people around him? Why??? Doctors do not (supposedly) go around over-medicating people just to make the institutions lives easier. I have a friend who was hired for a few days to sit by an Alzheimer patient's bed for 8 hour shifts, NO BREAKS, to watch and make sure they didn't get up and try to open the window, calling over and over for someone from their past life.  My friend was ready to get over-medicated herself after 8 hours of that!  It was excrutiating and a lot of noise and angst for...for what?....it would have been a mercy if that patient had been properly medicated, but the family thought hiring my poor friend to sit there watching him for 8 hour stretches till the next shift was 'better' somehow.

I felt my Medical POA gave me the right to ask questions. I also have a daughter RN that I could run things by. Talk to the Director of Nursing and tell her you want to talk to the doctor. I feel that the DON tells the doctor what she/he thinks the patient needs and the doctor prescribes it. Your friend asked you to make his decisions when he couldn't. As his representative I think you have a right to ask.

As POA, you have the right to question everything!

However, if they are medicating him to keep him compliant - what will be the ultimate outcome if he is not longer compliant? Will the facility put him out as too hard to handle?

It's definitely time to speak with the Administration and possibly an Elder Attorney.

I think it might help to have him evaluated by another doctor. One that is not associated with the facility he is now in.

If that doctor says the drugs are NOT necessary then you could have a law suit, if they continue to give them to him.

Yes, some workers in these facilities will over medicate to keep the patient compliant, whether or not the patient is violent or hurting himself. This should be uncovered and stopped, if it is happening.

However, it might be that he is aggressive and may either hurt himself or others, unless medicated.

I agree with Lassie & Prairie Lake, my mother has dementia and had to be strapped down at the hospital, because of the agitation. It is painful to watch but I know that it was for everyone's safety. There is nothing wrong with medications to calm him down; imagine yourself living in a state of agitation, it is exhausting. I understand the reasons that they must medicate. Dementia/Alzheimer's is heart breaking; why make it any worse for the patient. It is hard to move past the anger and guilt especially guilt that these diseases bring to family members, but you have to; if not for yourself then the person that is suffering. What I did with my mom is called the Alzheimer's Association for an assessment, as I had so much guilt with her being in memory care. They told me under no circumstance should I let her go back home. Her moods switch on a dime, and it is dangerous. It was the best decision I ever made, and freed me of the guilt. Once the guilt is gone, you can make the right decisions. Remember, safety for staff, others, and the patient comes before anything else.

First of all staff in any institution can not give any medication without a Dr's orders, although there may be standing orders for all patients which does give staff a choice.
This is especially true for hospice patients which allows staff to do something like place a urinary catheter which usually needs a Dr's order. They are also allowed to use the medications where provided in a hospice comfort kit. This kit contains a very limited supply, just a few doses and further supplies have to be prescribed. It allows the RN to have immediate access to a medication when a patient develops severe pain or continuous vomiting.
I do not know if such standing orders exist in residential institutions.

As far as antipsychotic medications are concerned has anyone considered what happened in so called "lunatic asylums" before the invention of these drugs.

Psychiatriic hospitals are a very different place these days thanks to modern science as are all branches of medicine and many people who formally were confined can live productive lives these days in the community and hold responsible jobs

Everyone needs to be vigilant about their loved one's care, but try and look at both sides of the picture.

If you refuse medications and your loved one is uncontrolable and the facility discharges him are you prepared to control the behaviors at home without meds?
It is not enough to hide the knives, he could pick up that heavy lamp and hit you over the head, push you into the fire, set the house on fire. How about getting the garage and cutting off this feet with the lawn mower or maybe warming the cat up in the microwave when you thought he was heating water for tea.
There is no end to the things that someone with a damaged minds can do.