If my sister-in-law is POA and health care proxy, isn't it her job to find someone to take care of my mother-in-law even if she is refusing to do so?

I think I would say to sis,, good idea you had,, I'm in total agreement and my last day is ...
Thank you for showing me this can be done. As you are in charge.. you get to be! Call me if I can handle some paperwork for you! Call her bluff.. of he is going to be stuck with more and more. If sis won't step up,, its on her to handle APS, etc. Hard I know, but she is in the drivers seat right now, and you are the screaming passengers

Hi Pokey1, I can share my experience with you as I am in the same position as far as not being on the health care proxy or POA. So, first let me say I am in New York state. The state does matter when it comes to Medicaid options.
My mom lives with me and has since June of 2013. She is now in the later stages of dementia. I get no help from my siblings including the sister who lives locally that is joint POA with my younger brother who lives in Florida and she is the primary on the health care proxy. So because she does not participate at all in mom's care, here is what I had to do. Keep in mind that I am not on the health care proxy nor am I a POA.
What I am is mom's primary caregiver and she resides with me. That has allowed me to do quite a bit. When I needed the POA I would go between my sister and brother and usually one of them would sign whatever needed to be signed and notarized, usually my younger brother because his partner is also a notary so that made the process much easier. Any documents and financial info had to come from my sister because she will not communicate with any of the siblings. She communicated with me in beginning but then completely backed out of helping and talking to me in March of 2016.
When my sister told me after Thanksgiving last year there was no more money to pay the aide for 40 hours a week (so that I could go to work!), that was the tipping point for me. I knew my mom had a trust in place so I knew I had to hire a Medicaid attorney (which was in the same offices as mom's attorney of 30 years) and a private care manager. My younger brother agreed to pay the cost of both of these people (since he is in Florida and can't help any other way). Let me also add, that the objective of keeping mom at home was promised by my younger sister (POA and Primary Health Care) but not by any of the other siblings. The other siblings feel she should be in a nursing home. Mom was always very adamant that she did not want to be placed in a nursing home. Here is what I had to do:
1. I had to drag my sister, the primary health care proxy person, into mom's doctor to complete the MOLTZ form. Also to let them know that she is not involved and that she is ok with me making decisions. Apparently, that conversation was good enough for the doctor to allow me to continue working with them on mom's care and medication adjustments. Every doctor is different, so you need to ask the question of the doctor.
2. I contacted the Medicaid attorney as to what was needed, which was to ask the question if mom was Medicaid eligible and what needed to happen to make that happen. She put me in touch with a private care manager. This was a slow, difficult and expensive process but somehow we managed to get mom approved for Medicaid in just over 2 months. Which was a miracle because it was the end of November thru January, the holiday time when everybody is on vacation :) It was a matter of me keeping on top of everyone and pushing them to get things done. In the end, mom qualified with a spend-down to a trust account.
3. Then there was the waiting for the evaluation for home care. That evaluation took place on February 8th. It was 3 1/2 hours of questions, rather intense, but in the end, they approved mom for 24/7 in-home aide service! Alleluia! I was shocked and speechless. The privately paid care manager was present at the meeting and she was shocked as well. Normally you do not get 24/7 care right out of the gate. The RN who did the evaluation said that mom was at nursing home level care and she didn't know how I was doing what I was doing with so little help and a full-time job. So, there are good people in that system, thank God.
4. The next step was picking the agency to use to get the aides hired, paid, etc. I opted for the CDPAP program which is consumer-driven by me. So I hire, train and fire the aides as needed. I basically take care of everything to do with the aides and the agency pays them every week. This has been quite the learning experience in and of itself. Has not been an easy road, but I'm learning and working thru it. The bottom line is, the program is setup to keep people in their homes and out of nursing homes. Yay!!!
That is a very condensed version of what I went thru to get everything in place. By the way, once the Medicaid application was approved, I did not need my brother or sister (POA or health care proxy) to get all of the other things set up. Alleluia!!
So, your husband, with your help, can make things happen for his mom. You just need to use good old fashioned determination and don't ever give up. It's a process, but the time and cost were well worth it because mom is where she wants to be and I have the help I need to keep her home. The story absolutely has a happy ending. Good luck. If I can be of any further help, please let me know. Take care of yourselves first and foremost so that you can take care of your mother-in-law.

Sounds to me like your mom needs care in a facility. It's rough to care for someone with Alzheimers in a home if there's no one person living there 24/7. Sounds like you're all burned out. Rather than try to find in-home care, why don't you all work together to get her somewhere where there are three shifts of people caring for her?

Having POA does not legally compell a person to be a caregiver. This lady can fulfill her duties dealing with her mothers financial and care issues without being hands on as long as the person is cared for properly.  If SIL walks away completely, doesn't pay bills etc., she could be in some trouble.

Your family needs to hash this out, bury some hatchets, and either get in home care or get mom placed in a facility.

But....SIL as POA is in the drivers seat. She has the authority to make these decisions on behalf of her mom.

You can make decisions on behalf of you ... or rather your husband can make decisions about what he will do. He can say, for example, "I will continue to to the half of the care I agreed to, but I will not do all of it. My last day for doing both halves is next Friday."

POA can make decisions for Mom, but cannot make decisions regarding her brother's role in the care.

Pokey1, what state are you in? In most states the Medicaid waiver program does not provide around the clock in-home care.

There are some good ideas here as to how to move past the impasse. I think pointing out that your husband is not POA over his mother, and that the POA does not impose duty upon your husband is a good conversation starter!

That being said...

Is your husband a co-POA or a successor POA? If so, might his sister resign so that your husband can do what needs to be done?

If no successor or co-POA language, and no resolution through discussion, there is an option of applying for a guardianship (person) and conservatorship (property). In my line of work, I see this quite a bit in that either a person had no POA, or the POA in place isn't working out (financial/physical abuse, POA doesn't provide the necessary powers needed or the Attorney-in-Fact under the POA isn't fulfilling their duties). Yes, it would cost money in the application fees and perhaps bond, if ordered, and while it can be done on your own, an elder-law attorney is an incredible asset in this process. But if you can't resolve the impasse and the work is falling on you two, it may be worth it because it would allow you to make decisions, your actions are reported to the court (there are filings as to asset use, you obtain court permission to make moves to a facility, etc.) and you have the court's backing for many decisions. It would also negate the POA while your mother is under a guardianship/conservatorship - unless the court specifies otherwise.

I hope you can work this out with his sister. If not, there are some options out there that might be worth exploring.

Best wishes.

DonnaF, thank you for sharing your story, it sounds very similar to what we are going through. We are also in New York. The Medicaid program that my mother in law is in the process of being approved for sets up all aides for in home care and pays for them. It's called the waiver program but that's all we know because my sister in law does not share any of the info., when we ask she simply says it's a program that will set up care for mom 24/7. I have thought about calling Medicaid myself but I have been told they won't talk to me because I'm not POA or health care proxy. My husband would of loved to have interviewed and hired the people caring for his mother, we didn't know we had a choice. My sister in law has told us that it won't be the best people coming in for her care. Basically you get what you get. We've been doing this for a year now and the whole situation is bad for both my mother in law and us. I don't know how you have been doing it on your own but God Bless you for caring for your mom.

If you SIL with POA isn't making sure she is cared for or providing 24/7 care you could call Senior Strength / Center for Prevention of Abuse. Your Husband needs to be very clear that it is her responsibility to ensure mom has 24/7 care; and that he will do all he can, but all he can is half, not all.

I have a POA in the event that it becomes necessary. I chose my POA knowing that he would do everything I asked him to do in the documents. I would imagine if she can afford it, you should look into Independent living and eventually Memory Care. It is a darn shame that seniors are living so long that their own children are caring for them long after the children's children are gone. If she has alzheimers, it is important that she be in a place where she is not disturbed emotionally. She needs peace and quiet and a routine. If family cannot afford to spend money on Independent Living, then look into Public Assistance for the payment. Social Security etc.

I met a man once that was just starting to have issues. He did not wish for his children to care for him. He moved to Independent living. While working he accumulated a great deal of money and homes. He wanted to leave it all for his children. Well, the powers that be found out he owned so much and he was forced to either go home and family care for him or start liquidating his holdings. For the Kids sake, I hope they worked out a system to keep him at home. Work your a** off your whole life, pay your bills on time, carry insurance and are responsible. You get screwed when it comes to latter day care. Be irresponsible and you get a free ride through life to the end. What is wrong with this picture.

I sooo much agree with you Oregongirl!! The words in your last 4 sentences rings loud & clear for me & my Mom. But the laws in Iowa (where Mom is) are so weird, seems like the system there is only worried about getting the taxes first & foremost, then "let's see whats left for your mom" none of my siblings who all live there near her, help her... & I'm on the east coast... I have to go up to keep Mom's interests straight, while they(the siblings) only stick their hands out from around the corner, & don't offer to help !!