My mother has some short term memory loss but is still very mentally competent. She shares everything with me. I call her daily as I live a distance away. She lives in assisted living in MI. My sister has DPOA and has meetings as needed with the doctor but even though my mother has expressed interest in attending these meetings and I have expressed similar interest my sister "insists" on meeting alone with the doctor.

Isn't the POA expected to carry out the wishes of their loved one? Neither my mother or myself wish to "rock the boat" but I am frustrated. Is my sister misusing her POA?

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Your question is important and well worth talking about with your family members, and the people who care for your mother. A NIH summary explains how our legal system protects "the principle that all persons are competent to make reasoned decisions unless demonstrated to be otherwise."

The protection is based on our Bill of Rights, and on law and medical practice in the state where your mother lives. Also, the terms written into her Power of Attorney document determine what powers she has granted to your sister and any powers that she has withheld. Health Care documents can also be tailored to limit and agent's authority and provide directions.

There are different categories of capacity that you have to consider. Capacity to make health care decisions, manage finances, or sign a will document each require different levels and types of capacity.

A Merk manual summary explains how people who have clinical and legal capacity are considered able to make health care decisions. But even if a patient lacks clinical capacity, a physician cannot override a patient's treatment preference unless a court gets involved and finds the patient lacks legal capacity to make the decision.

The NIH Summary does acknowledge that:
"One of the most vexing issues facing physicians is the management of medical treatment when an individual's rational decision-making ability is questionable." But you indicate that your mother is able to express herself rationally, so it is difficult to understand why your mother is being excluded from care meetings.

Regulation of Assisted Living facilities in your mother's state of residence will be according to state or municipal regulations. Federal law protects people who live in a more restrictive nursing home setting. Specified rights include:
"The right to choose a personal attending physician, to be fully informed in advance about care and treatment, to be fully informed in advance of any changes in care or treatment that may affect the resident’s well-being, and (except with respect to a resident adjudged incompetent) to participate in planning care and treatment or changes in care and treatment."

It may be worth contacting an Elder Law Attorney or Geriatric Care Manager in your mother's home state to get some objective guidance and advocacy for your mother.
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AlvaDeer Sep 2019
I absolutely love it when you weigh in on the Forum; I wish you were here so much more often!
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YOU have no right whatsoever in the meetings.
I think your mother should be allowed. and her case should be discussed with her. and in front of her with honesty and forthrightedness by the MD and your Sister. But that is up to THEM at this point.
The person who judges whether or not your mother is competent to participate in such things, including who is her POA, is her MD who has run tests of her competency. If competent she can fire a POA and put another in place. Often messy and with consequences no one will like. If incompetent, it is over.

The DPOA carries out the wishes of the person represented as directed; when that person is adjudged by the MD as incapable of making rational decisions on her own then the POA acts in that person's behalf as they understand it.
Any sibling rivalry only makes things MUCH worse for all involved, and especially for the Mom. She ends up as the Thanksgiving Turkey Wishbone being dried up and rent in two; whoever ends up with the head portion wins.
Your Mom chose her POA. Now it is for you to offer support, to ask to be informed when the POA feels that they need your support. To offer help.

Your only recourse going forward is when you feel that your mother is being abused, misrepresented, fraudulently stolen from. That would be a court action.
My honest advice is this.
One: Your Mom chose the POA
Two: That is your Sister
Three: Trust her to act in your Mom's behalf and offer her your absolute support. If Mom complains to you tell her to take those complaints to your sister
Four: Do not play the middle man. The one in the middle that both sides complain to you when things don't go as they may wish. Your Mom,when dissatisfied, may be playing into this one quite nicely.
Again. Offer your support.
To your Mom it is : "Mom, I am sure Sis is doing the best she can for you"
To your Sis it is : "Sis, can I help in any way"
If there is fraud, take it to court, and good luck with all that.
I hope it irons out. Best wishes and update us.
Helpful Answer (2)
NoTryDoYoda Sep 2019
Wonderful answer!
nellie1234 wrote: "My sister and I are on good terms so I'm not sure why she doesn't want my mother or myself at these meetings."

Although nellie claims they are on good terms, her sister would disagree---in fact, sometimes they will not even talk to each other. In reality, these two sisters are at loggerheads over their mother's care.

The sister has worked in the medical field for many years, much of that time in a nursing capacity, and has for the last 4 or 5 years worked in an elder care facility, although not the ALF where their mother lives. She knows what goes on in these types of facilities from her position as a legal advocate for her mother and as an employee. She is comfortable with western medicine, although not blindly so.

Nellie, on the other hand, has never worked in the medical field, but has for more than two decades been a dedicated mother and advocate for her severely handicapped child. She spent countless hours trying to learn what treatments might be available, and in the process developed a distrust, maybe even a fear of western medicine. She is convinced that if she had blindly followed the advice of the medical establishment her child's suffering would have been much greater, and she learned that advocating for her child sometimes required not taking "no" for an answer. She also believes that their father's death was hastened by the drugs that are typically pushed by Big Pharma for the sake of profits.

A couple of months ago their mother almost died of a drug overdose while she was living in the present ALF. Nellie is convinced that her sister, who had noticed the sudden onset of ominous symptoms, should have known that something was terribly wrong---after all, she works with many elderly patients day in and day out and considers herself able to notice even minor changes in her patients. But the sister seems to have concluded that their mother's time on earth was rapidly approaching its end and calmly contacted hospice. Staff at the ALF contacted the doctor who ordered a blood test which revealed the drug overdose. As soon as the levels of the drug returned to appropriate levels their mother returned to her normal self, and less than a week later one would never know that only a few days earlier she had been at death's door.

Many years ago the sister acquired POA for both parents without the knowledge of her siblings. She was the only sibling who lived near the parents at the time, and may have been the most logical person, but the fact that it was never discussed with the siblings does not sit well with nellie.

Nellie accidentally met with their mother's doctor before the doctor had had the chance to meet the mother. There is every reason to suspect that nellie's distrust of western medicine came through loud and clear during that chance meeting, and subsequently she has attempted to get her sister to question some of the decisions the doctor made, claiming that there might be alternative therapies which might be better.

The sister apparently has a good working relationship with the doctor, and they sometimes exchange brief phone calls when either party feels it is necessary. If nellie had the same type of access to the doctor there is good reason to suspect some phone calls would end up being lengthy arguments over possible alternative therapies, and any face-to-face meetings might go in the same direction.

To what extent is their mother "very mentally competent"? She was diagnosed with dementia some years ago and is easily overwhelmed if a discussion involves unfamiliar terms and phrases. For example, if given a choice of therapy A or therapy B along with a list of possible side effects, I doubt she could make an informed choice...and she knows she can't make that type of decision. Also, she sometimes fixates on certain things, and I suspect that might be the case if the sister and doctor included her in every meeting.

Disclosure: The mother, sister, and nellie are personally known to me
Helpful Answer (1)
AlvaDeer Sep 2019
Absolutely fascinating. I think it is a reminder that when we hear stories or are asked questions on the forum, or are attempting to answer them, it is good to understand that there are two sides in every story, and we are only hearing one side. This is especially true when siblings are at it over a parent. I always get this picture of the wishbone we used to save out of the Thanksgiving turkey. We would let it dry a week or so on the sill and then two would get to pull on the wishbone. Whoever ended up with the top piece won. I always see the elders as that sort of human looking stick figure wishbone with the kids pulling on either side.
It is so sad for the parent who is the object of the pull.
The doctor signs your birth certificate.
Signs your absence from school or work notes.
Signs your immunization records.
Signs your death certificate.

The doctor is required by law to actually see and make contact with the patient they are treating, whether the patient is declared competent or not.

Something does not sound right.
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What sendhelp said. As a POA, or relative for that matter, it's OK for your sister to be there. It's not OK for the doctor to meet with her about your mom without your mom. I don't even know why the doctor is doing that since the doctor is required to see your mom.

When I take my mom to her doctors, for various reasons they only talk to me but mom is sitting right there next to me.
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NoTryDoYoda Sep 2019
It is ok for a medical POA to talk with the doctor alone.
People can go in and out of competency. The physician and the agent on the health-care POA have at least a moral and ethical obligation to return decision-making power to the patient if the patient regains competency.
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Just for clarification: of course the doctor also does visits with my mother but then there's these meetings that are just between the doctor and my sister when something more serious arises. I just can't understand a meeting about someone who presents as "mentally competent" when they are not personally present at this meeting. It's scary to think my mother may not have a say. My sister and I are on good terms so I'm not sure why she doesn't want my mother or myself at these meetings. When I ask her she says it's just too confusing to have so many people there. Whatever!
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Hi, nellie1234. I'm with you on this one. I think it's vital for your mom to be at these meetings about herself, and I think it would be good for you to be there, too. That one person has the POA doesn't mean that other people aren't supposed to hear information. After going to several appointments with my parents over the years, I've decided that having at least three family members or friends at an appointment or in a situation in which a health-care provider will be conveying information is best.

Whether or not the patient can communicate clearly, he or she should be there. But even if he or she can communicate clearly, he or she is likely to be very stressed and to not understand things as well as the nonpatients. One or two people (e.g., the patient and the POA) can ask questions. Third person can just listen and take notes.
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If your Mom wants to be included than she should be. But, I would ask sister why she doesn't want Mom involved. It might be the doctor is not comfortable talking about Moms Dementia in front of her. My Moms neurologist had no problem this way. Maybe sister has questions she doesn't want to ask in front of Mom.

I hope that Mom is present at the meetings even if she is sitting in the waiting room. Otherwise, the doctor should not be charging Medicare under Moms name if she isn't present in some way.

DPOA is used to carry out Moms wishes when she is no longer competent to make decisions. If she has not been found incompetent, then she is able to make her own decisions. Sister can be present to make sure Mom has all the info correct. Tell sister to read her Medical POA. Is it immediate or when Mom is found incompetent.
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"DPOA is used to carry out Moms wishes when she is no longer competent to make decisions. If she has not been found incompetent, then she is able to make her own decisions."

Exactly. Many organizations consider a DPOA meaningless unless it's accompanied by a declaration of incompetence from a doctor.
It depends on whether your mother is competent and what are the terms of the POA. Your sister could be misunderstanding her POA obligations and it is not unusual - or your mother has been assessed as incompetent and your sister is making decisions for her, legally. Many people wrongly believe being POA is making decisions for a person without the person's input and without consultation - it's not unusual unfortunately. POA's are drafted with specific instructions, for example, to take effect immediately, or to take effect only when a person is incapacitated. And to take effect immediately in the context of competency, it would mean giving someone powers to act on their behalf, according to their wishes. When a person is alert, it would be highly unusual and irregular for a person to give someone POA and give over rights to making decisions with no consultation with the person. That would be like your mother saying to your sister, I give you POA and I don't want to know what decisions you make. I can't imagine that would be the case. So, I also have a feeling that your sister may be misunderstanding her POA obligations OR your mother is incompetent and your sister is acting in her best interests. The bottom line however, is that everyone is deemed competent unless they are assessed to be otherwise, and you mother should be consulted and be included as much as she is able in any decision making. Competency can be assessed by a neuropsychologist.
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