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My mom has dementia and is in a memory care facility. I am her financial POA and trustee and was her medical POA until a sibling made changes about 2 years ago, but never participated or was able to help care for her leaving me to help my mom in all of her care before and after being declared mentally incompetent.


Before my mom entered memory care I ensured that I was the contact for her health care provider. Bills, notices and any information was sent to me at my residence or emailed to me.


My sibling finally had her medical POA recognized by the medical provider and pushed the member services to reset the master password and mailing address to have everything sent to her. She also had delegated access to login and communicate with all of the Dr's on my mom's behalf taking away my ability to manage her care in any way and has told Dr's not to talk to me and asked them to report to her if I inquire about anything.


I'm thinking that my sibling has crossed several legal and ethical boundaries and I'm not sure what to do about it. I wonder who has the authority to change my mom's coverage, myself as her Financial POA and trustee or the sibling that is her medical POA. This seems to be a delema for which I have no answer.


I had suggested that we try discussing this with a mediatior or a neutral party for help, but that didn't happen. Unfortunately we see things quite differently and we do not get along.


I'm not sure what to do and wonder if anyone else has encountered a similar situation and what you did to take care of it.


Thanks

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I think I would try to let this go.

You are paying the bills from mom's monies, right?

What does it matter if sibling takes over mom's medical care?
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It's not about the care, it's about what the care is, costs and financial decisions. For example does the sibling have any authority to make a decision to move our mom closer to her, which would raise the cost of care? I've got to try to make sure my mom has enough money to pay for her care without running out of it which could happen as her needs are likely to increase raising the cost of her care.

Also, I think I have the right to ask questions about my mom's care with her Dr. and the sibling asking the medical staff to tell her if I have asked anything or interacted with them and also telling them to not talk to me seems to cross ethical boundaries since my mom never wanted to block me from interacting with her doctors.
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Gnarley, do you have any idea why mom set it up this way?

My mom made all 3 of us kids her medical POAs, so that any of us could make those decisions; she made ONE sibling financial POA.

Being financial POA doesn't mean you become responsible for paying for mom's care if she runs out of funds, if you are worried about that.

What is the sibling's basis for disagreement, do you know?

Is s/he secondary on the financial POA?
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Gnarley Mar 2023
Well, why did mom do this? She didn't know any better and when my sibling had my mom sign a new POLST for her medical provider not knowing one already existed and did not include the other 2 siblings leaving only her to make decisions. I'm still not sure that she can shut us out of communication with moms Dr. and ask that they report any communication to her.

For now, I'm trying to collect info before taking any action or changes including involvement with APS or an ombudsman. My mom can still make decisions and stated none of her children should be restricted from communicating with her Dr. and she could sign a new POLST listing all of us.

The problem with her dementia is that she is unable to recall why she made a decision so if she were to make a change with an APS or ombudsman present APS said that they would recognize the new one which would allow all of us to to communicate with the care team without being hassled by the current sibling. I still question who should be listed as the main health care insurance provider contact.
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If mom is still competent, she can sign HIPAA forms, allowing you to communicate with doctors, insurance, etc.

Have you considered involving mom's lawyer in this, at mom's expense?

That would appear to be the most straightforward way of dealing with this if sibling is actively trying to block you.

Is sibling stating that is her intent?
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Gnarley Mar 2023
Mom is not competent, but APS stated that they do not look at the competence the same way as Dr's. They ask in a more neutral way and help intervene based on person who may still be able to express their feelings, but I'm waiting before going to this step to be sure I'm legally justified and doing the right thing.
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In our case, the financial POA was listed as contact for insurance.
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Gnarley Mar 2023
I'm thinking the medical provider should have guidelines for who should be listed but unfortunately most of their staff are unable adequately route me to the right person and I get stuck in endless hold times trying to get an answer.
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Gnarley,
We accept that the definition of insanity is doing the same thing over and over again, and expecting different results.

Have you considered, are you familiar with , TRIANGULATION? The psychology of it.
Maybe research it, as a possibility that your Mom has set things up to be this way. In order to remain in control, as much as she is able. Maybe the sibling is following your Mom's instructions?

To do this, she (your Mom), must attempt to block each person trying to help her from knowing what the other person(s) are doing for her.

Once you all become a care team, coordinate between you all and the doctors, her game of control and manipulation will become useless, and she might actually get the care she needs.

Otherwise, back away for awhile and observe.

Do you think a mentally incompetent ill person might try Triangulation to get her way?

GO Team!
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Gnarley Mar 2023
Interesting concept and suggesting of mental illness? Few people are 100% in control of their mental faculties in their mid 90's and quite doubtful at that age someone with dementia could triangulate without the ability to recall previous actions.

There is no control, did you see that she has dementia and was declared mentally incompetent?

Suggesting we become a care team was not embraced years ago when it was needed, it's to late and the damage is done. I'm not sure how you read this but it seems that you really extrapolated several things that are not in the context of the facts I shared.

I have stepped back to observe and collect additional information from others in how they may have dealt with a similar situation.
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"My mom can still make decisions" you can't say that and in the next breath say she has Dementia and is incompetent. She forgot she had already assigned a POA.

If she assigned sister after a diagnoses of Dementia that "new" POA may not be valid. Mom cannot sign contracts. Is sisters POA from a lawyer or the internet? From a lawyer it has to be signed in front of him or his representative, witnessed and notarized. The same if done via the internet. Someone should have been in the room to witness it was Mom who signed it and notarized.

I think you need to consult a lawyer even talk to the lawyer who did sisters. Maybe he was not aware there was already a Medical POA in place and that Moms competency was in question at the time sister had Mom sign the paperwork. You maybe lucky and her POA will be revoked.
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Gnarley Mar 2023
Seems logical right?

"My mom can still make decisions" you can't say that and in the next breath say she has Dementia and is incompetent. She forgot she had already assigned a POA.

Adult Protective Services said they don't follow the diagnosis of a patient who has been declared incompetent and has dementia. They will consider what the person is saying if they are able to communicate, she clearly can. Each case is different. In my mom's case given facts she can make a decision like you or I, she just won't remember why the next day and APS will intervene in situations like this. Regarding the more recent medical POA, it was signed and witnessed before a second MD had determined her to be incompetent.

Again, for now I'm just collecting info.

Thanks
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Forgot to answer the question. I would say the person who is paying the premium. But then the medical POA should have access to. I am both, so I don't have this problem.
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As medical poa, I never had cause to talk to mom's insurance or be involved with them in anyway.
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