My 3 siblings are fully functioning adults so why do they not acknowledge I provide care for Mom more than they do?

You are going to drive yourself nuts trying to control sibs thoughts and ideas. You visit the most to check on Mom. Yes you have more familiarity with mom and the care she is receiving. I do not read anything that would warrant a call to APS. Why would you contact them?

I would cut back on the time I spend with mom. This is effecting you and it sounds like because sibs are not as closely involved you are holding it against them. Give yourself a break and just accept that your sibs are not going to be as involved as you are. Accept what is happening and do what you think is right by mom. You can only control your own actions and thoughts.

If they acknowledged your contribution, it would force them to look at theirs’ and make them feel bad for not helping more. It seems that only when you live with someone with Alzheimer’s do you understand just how far and deep it reaches and being the primary caregiver, you’ve already had to go through all the stages of grief many times over along with the frustration and love it brings. Your siblings would have a lot of catching up to do to get as far as you have with your devotion.

It sounds like you have developed a good relationship with the staff. I seriously doubt they would start medicating your mom solely on her mPOA's request. Keep visiting. Make the staff aware that your sisters may request regular anxiety medication and of your opinion that it isn't necessary.

Your POA sister is wrong. You can always talk to the staff. You can't make any medical decisions for your mom but you can share your opinions with them. She can request that the staff not share information about your mom with you, though, so tread carefully.

I would save escalation of the issue for a more serious problem than you don't like the recommendation your sister might make to the staff. For better or worse, your mom- when she was in her right mind -chose elder sister as medical power of attorney. But she only gets to make decisions. She doesn't get to prescribe medications. The nursing home staff and doctors are the ones who will decide what medications your mom gets. Try not to worry.

I'm pretty sure that POA sis was told and then passed on to you that that there needs to be ONE person who is contacted with any issues and ONE person who makes any decisions because that's the way it is - you could be there every day all day but you aren't the one with the legal authority to make decisions or to question staff procedures. That doesn't necessarily mean nobody will talk to you, but it could if you are perceived as making a nuisance of yourself and trying to thwart the POA's instructions.
As for your sibs relationship with your mom - what exactly do you suggest should happen? It sounds like they are living in the land of denial and are unable or unwilling to take the changes to your mother in stride, the only way to save your mother from that is to cut them off altogether, something you haven't the legal or moral authority to do.

At the ALF where my in-laws stay, the family can periodically meet to hear the ALF assessment of them. The assessment includes inputs from a variety of staff members. We have taken advantage of these meetings to get everyone (staff, local family members and long distance POA) to understand my in-laws needs/capabilities without getting into siblings battles. Perhaps you can set up a similar meeting the next time the long distance sib is in town.

You are dealing with a tough, yet , not uncommon situation with sibs conflict when caregiving for an elderly parent. I agree that there doesn't seem to be a strong APS case. But still make the call to hear what they have to say. I fear there may not be much you can do legally as far as the medical POA. What screams at me is that you are spending so much of your time at the ALF. I would like to suggest that you start to focus on your self-care. Of course spend time with your mom. But you need balance and space. Caregiving will end some day. Your sibs won't come around to see things your way. Save yourself and let go of what you cannot control. Focus on your wellness and your life. In the end it is all you have.

If your mother is able to sign legal documents (you mentioned siblings having her sign notarized paperwork), then maybe you can get her to change her medical POA to you. If she is sane enough for one set of legal documents, she should be sane enough for all legal documents. Do this sooner than later. If she is agreeable, definitely consult with an attorney. It sounds like you would have plenty of willing witnesses at her facility.

Rulanme;

This is a dicey situation. I can relate to the siblings being clueless AND not really visiting or knowing how to deal with mom. I researched a lot about dementia before we had to move mom and attempts to "educate" the brothers was met with denial or, even better, being call a 'know-it-all'. One brother is not local and at this point I don't expect him to visit anymore (he's no longer welcome in my house and we sold her condo, so he would have to pay for a place to stay and eat the cost of getting here.)

I would suggest seeking consultation with an Elder Care attorney. Generally most will do a one hour consult for free - if you schedule something, have as much HARD documentation as you can get your hands on and have all your questions prepared to make the most of your free consult. Although staff may tell you about incidents, more than likely they will not submit anything for you to back you up. If there were assessments, and any of the incidents were documented, you might be able to have these subpoenaed. You can seek guardianship (medical/decisions) and stewardship (finances), but it will NOT be cheap AND the others could fight you, costing more money and headaches. From what I have read, the courts can also assign an attorney to represent your mother as well (since there is contention AND she is on the cusp of being considered 'competent') and this could result in more costs if they decide to order evaluation. If both are approved, this would override ANY POA (and likely lead to more sibling contention, but you can block them out of your life if you need to!)

Generally the costs for this process can be covered by the "client's" assets, but if you don't have control of that yet, you might have to pay up and if approved recoup from her assets. If denied, you could end up eating all legal costs. If mom does not have enough assets to cover the costs, you will have to pay out of pocket, approved or not. This is why a consult with Elder Care attorney is advised - they will not be able to give you a total cost, but should be able to give a best/worst case estimate. Given that they fight you now, I would plan on worst case. They CAN and likely will contest.

Most posts I have read about APS sounds like this is a relatively useless avenue. If they are not there to witness the berating and agitation, they are not likely to do anything. It would be your word against theirs. Also, unless there is clear evidence of abuse, either physical or financial, they are not likely to do anything. Not being able to "relate" to mom in her condition and berating her could be construed as emotional abuse, but it doesn't occur often enough, from what you describe as their interaction with mom and isn't likely going to be enough for APS to get involved. Using mom's money to pay for their 'visits' may not be enough to say this is abuse of her funds. Morally perhaps, legally, maybe not. Sometimes a POA document can allow for this. Ours does not indicate funds can be used this way, but attorney recently said it also does not say we cannot do this. We three at least agreed to cover some of non-local brother's previous visits to assist in cleaning out/fixing condo. I do not pay myself for what I do.

Others suggested cutting back visits with mom. I do not agree with that - your visits with your mom are not really what is upsetting you, it is the negativity and lack of acknowledging your care and insight from the others that upsets you most, and seeing mom upset by them as well. THAT you cannot change, you can only try to block it out and not let it upset you. I would continue to do what you do for your mom and try to just ignore them (it isn't easy, and it is hard to see the effect on mom, but don't let their crap distort things.) If mom is upset by them, do your best to redirect her focus and calm her as best you can. It is not likely she needs medication for this.
TO BE CONTINUED - see my replies (2) to this, ran out of characters again... :-(

Part of it is that saying something out loud makes it real. As long as no one acknowledges or validates it, then it's not true that you do more. The other part is family dynamics, siblings forge alliances to balance out power. If you have something on them because you're more responsible than they, then they will forge an alliance to "act as though" it's not true.
You're right you do have to protect her if they are pushing her around. You're the one there, not any of us on this site. You have to use your best judgment, not mine or anyone else's.

because if they refuse to acknowledge, they they won't feel guilty for not doing their share.