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She is 94 able to speak and understands what is going on. She has 3 children does my cousin need our approval?

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No but your mother has to be competent to sign. You can’t sign for her.
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You need your Mothers approval this is her life and Money and you need her signature and witnesses . I would consult a elder attorney and make it legal .
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If your mother is capable and not diagnosed with dementia, if she understands, yes she can attend a lawyer with the cousin and the lawyer hopefully will help them with a POA. There may also be social workers to help with a POA if it is simply for health care directive; then it would require witnesses and/or notary only. One of the children should be appointed as a second in case the cousin is temporarily unable to act for her. I think it is also very worth checking out the rules as the pertain to Puerto Rico, as they may differ from your own area. Wishing best.
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As said, your Mom needs to assign the medical POA and be competent to sign the paperwork. You can't turn it over and no one needs to sign off its OK for Mom to assign nephew. This is Moms choice no one elses. If someone already holds medical POA, tge lawyer will need to revoke that one before Mom assigns a new one.
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i hope, dinardo, your intentions are good.
it almost sounds like you're fishing for information, to see whether your plan is legal/illegal (as in, you are the "cousin", and you're worried about the children).

POA (power of attorney) law varies from country to country.

for example:

in norway, you can't just get the parent's signature + witnesses, etc.
you MUST officially notify all the children/spouse/all potentially interested parties, that the POA is taking place. otherwise, it's not valid. all the documentation then MUST go to a government authority who checks it all, before validating the POA.

this is done on purpose to protect the person.
otherwise, thieves can convince a vulnerable person to sign.
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Puerto Rico is a territory of the United States. They get the same benefits we do. I don't think their laws are that much different than the US.

I think informing everyone is a good idea. We should have that in the States.
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