When does a POA ( medical) get to override patient consent for sedative medication?

The woman is showing signs of Dementia and anxiety. POA medical is in effect when the woman has been declared incompetent by a doctor usually. The partner needs to read the POA to see if its immediate or needs a doctor to sign off.

She has "not exhibited any signs of dementia ".....except for anxiety, paranoid delusions, insisting random items are listening devices, and extreme OCD.....plus she's a stroke victim! Which are ALL signs off dementia. Neither you nor her husband are allowed to force medication upon her that she refuses to take, with or w/o POA.

Next time she states she wants to kill herself, immediately call 911 and have her transported to the ER for a psych evaluation where they WILL put her on meds and get her diagnosed.

You should have this person in Hospice or Palliative Care--they will come to the home if needs be.

Many people get this way as they age--free floating anxiety that cannot be 'talked down'.

It's considered illegal to drug someone w/o their consent, yet I myself have done so with the drs approval a couple of times.

It would be best if you get her on a benzodiazepene and keep her on a schedule with those. Maybe also some anto-psychotics too.

No, you cannot reason with someone whose brain is basically broken.

You say she's NO showing signs of dementia? Hon, she's the poster child for it.

An evaluation, soon as possible and the appropriate drugs to calm her and everyone will be better off. She won't be cured, but you'll be able to live with her.

I'm sorry for this. We're going through this with my MIL. Without a dose of Ativan or Xanax or both in her system at ALL TIMES, she becomes a screaming harridan. Not fun for anyone, including her.

Why does she get to decide if she goes to the doctor or not? She needs to go to the ER in an ambulance and get checked for a bladder infection. You don’t need to run these things by her and get her permission.

Southernwaver is absolutely right. This needs medical evaluation. You could be looking at a severe UTI or other medical problem involving too much or too little of any electrolyte. She needs medical evaluaton.

It is not your job to force medication upon this woman.
I would not continue in this particular job whether through agency (explain everything to them as you did to us) nor on your own.
Let the husband know his wife needs medical evaluation NOW, and that you will not be medicating her when something may be physically wrong here.

You may want to consider asking APS to evaluate this if you are working without an agency. You are a mandated reporter of things you find suspicious at all.

"When is her partner "allowed" legally to give her a sedative or meds against her will - or without her knowledge?"

My understanding is NEVER!

Yeah, giving sedative without permission or authority can be murder.

Cici,
Thanks for your update below that you have left this position. So few return to update us. I do hope that you left the husband with advice to get his loved one medically thoroughly checked, as Jem and others are right here; there could be a lot being missed, such as an acute or chronic UTI.

She needs a medical evaluation. This could also be a major depressive episode.

Seek legal advice. My understanding is that POA responsibilities are limited if their person is competent. Incompetency is determined by trained medical and legal professionals, not based on opinion/perspective. EMS and/or APS may need to get involved based on what you have shared.

Are you certain her increased anxiety and paranoia are not signs of Dementia? If she refuses to go to a doctor, she has probably not been recently evaluated. It usually requires a doctor (more often 2 doctors) to declare someone incompetent so that a Medical POA can take over decision making. Getting her anywhere to be evaluated is a hurdle for sure.

I would take a look at her will, trust health care directives. It is usually two certification from two qualified doctors that work in the field of dementia. Then the POA of medical can be applied to authorize medical and medications.

This can also be sign of a urinary infection. Possibly one that's been going on for a while. UTI creates terrible confusion, paranoia, etc.

If she is not trusting everyone all the time, call her doctor and ask if he will order urine test that you take in to the lab. You might have to be creating in collecting the urine. Dr's offices have a hat looking device that can go into the toilet and urine collected and put into a sterile urine cup. The dr or the lab he uses can probably give you some of the cups and the urine collection (hat) bowl.

There's all kinds of labs now located around neighborhoods - Quest, Labcor, etc. You could call them to see if they'd give or sell you the collection cup and toilet hat.

If she refuses to go to dr, at least you could rule this infection out by taking the urine directly to the lab or dr office and have it tested.

Cici, if you are still in touch with the husband you might consider telling him about the possibility of mobile medical services. I looked up your location on your profile and at least one option shows up. Here at least we have several companies that function like a primary care but the APRNs make house calls! For Mom, visits are covered by Medicare like normal with an extra small trip fee ($20 in our case).

I love the one we use. Our first APRN might be a literal angel and the psych APRN who finally sorted out Mom’s med disaster is my hero.

Your former client sounds like something physical has happened if she suddenly started these behaviors. Others have mentioned UTI or electrolytes. We also found that dehydration, low blood volume, low blood pressure, or pain from unrecognized compression fractures could all spark very similar behaviors. Adding sedatives to any of these without knowing the root problem can be dangerous. The nurses came out, did blood work, got urine tests done, all of the basic stuff, and we never left the house. It was way less stress on everyone.

Working with someone in this state IS very hard. I sympathize from too much firsthand experience.

Also the husband might call the local area agency on aging who might be able to refer him.

Cici22: I did see your update; thank you for that. If this woman utters the words "[I] want to kill myself," she needs to call 9-8-8.

If she is mentally incompetent - declared unable to make decisions for herself - by a doctor, then the POA kicks in.