With a semi-divorced parent, who makes the care decisions?

Good questions. Given the instability of their relationship, talk with doctor and case management about placing mom into rehab as her "best option."

Please consult a local lawyer that specializes in family law. Ask him/her to outline your rights and responsibilities as medical POA in your situation.

CaughtInTheMid: Perhaps you require an elder law attorney.

I would opt for rehab. Period. You are POA. Embrace that. You may NOT be able to get care and coverage once refusing it. These things don't go by if this and if that. Your father is of an age and is not trained in 's. This is important. The improvement in my brother, his balance, strength, determination, certainty was enormous after a month in rehab. I am an RN and never could have done it. I couldn't even make him keep up with his exercises afterward and much of the work was lost thereby.
Just my recommend. The decision is your and the POA is along with it. You should be able to explain this easily to Dad, and if not, explain it the hard way. I wish you the best with a decision now in your hands, for your Mom's own good. But do the best you can with what you think is best. Often advice, and too much of it, only lends more confusion.

I just had TKR 6 weeks ago. It is considered out patient surgery now and unless the surgeon indicates it is medically necessary to go to a rehab, you go home the next day. You are offered in home care for PT, OT and a nurse, usually 2-3 days a week each. After a week in rehab I was ready to go home. If there is no one at home, you will have to hire a 24 hr caregiver to stay with her. If you don’t already have it, you need a cane, walker, shower chair and elevated toilet seat. Driving isn’t recommended for at least 6 weeks so going to outpatient PT might be an issue.

If mom is competent then your medical POA is not in effect until she has been declared incompetent.
(side story about Knee Replacement, I had been talking to my Dr. about it and when I asked about rehab he said he advises OUTPATIENT rehab and if I wanted Inpatient rehab he would not do the surgery. He said the chance of infection and other complications INCREASE with inpatient rehab)
Back to your mom.
If dad is there to help her, and she has no problem with that great.
I would also say she should hire a caregiver from an agency to be with her until she can manage.
With a caregiver from an agency if dad decides to leave mom still has help.

If this were me..I would opt to come home, if necessary hire a caregiver to help until I can manage on my own. I would have PT come to the house until I could safely drive myself to rehab.

In-patient rehab is limited to a specific time period following a hospital stay, usually 30 days if patient is making appropriate progress. After that time the patient is discharged, PT and PT may continue in the home until patient is able to get to outside PT, but help with care and daily living is the responsibility of the patient or patient's family.

If your Mom is competent to make her own decisions then your DPOA for financial and you MPOA are not in effect. With financial they are usually Springing which means Mom needs to be found incompetent to make informed decisions by one or two doctors. Medical same thing Mom has to be diagnosed incompetent or, for example, she is in a coma and cannot make decisions, then you do based on what her Medical POA says. Should list what she does and doesn't want medically.

Your POAs override your father. Your Mom has made you her representative and as such your pretty much in control if she is found incompetent. Dad being her legal husband means nothing.

The only way someone gets Rehab is if they have been in the hospital 3 days (I think it is) and needs therapy. So if Mom has her knee operated on and Rehab is suggested, she should go. She will recuperate better. Dad will not need to come and care for her. If she does not except Rehab at the time its suggested, I think she has a certain amount of days to change her mind. Medicare pays the first 20 days 100%, 80 to 100- 50%. Mom pays other 50% out of pocket unless her health insurance pays partial or all of it. The 100 days is not a given. If Mom progresses well and hits a plateau, Medicare will have her discharged and she will go home.

Having DPOA and MPOA does not mean you have to physically care for someone. They are tools. Makes life a little easier. As the financial POA, if Mom has the money, you can hire someone to care for her or apply to Medicaid for help for in home care or care in a facility.

Are they legally separated? Have they filed for divorce? If he lives far away is he really going to come stay with her for some unknown period of time? Does she live alone? I would suggest that the plan be for her to be more independent. Get the surgery and go to rehab because there is no one to help at home. When she's physically able, ,then she should go home.

CaughtintheMid, one consideration for postponing their divorce might be the fact that they loose the ability to file taxes as a couple. The might both be pushed into much higher tax brackets.

Ex DH and I remained separated for nearly five years and didn't officially divorce until we were each ready to re-marry.

Not your decision = not your problem.

Your mother is 72 and of sound mind; and in any case your father is still her husband, so your MPOA is not in effect. You have no influence over decisions they make, therefore you cannot accept responsibility for the consequences of the actions taken by either of them. What will your options be? - is a non question. You will have no options, including not the option of moving in with her as her caregiver-by-default. Your father cannot be allowed to use you as a safety net. Either he commits, or she makes alternative arrangements; but in any case this is for THEM to sort out and not you.

Have they been kicking you back and forth for all the years they've been discussing divorce? Aren't you getting a bit of a headache from it yet?

I'm still sorry that your mother has this painful knee injury and wish her a successful operation and swift recovery. But as long as they want to continue their game, I honestly would keep out of it. Make that very plain to both of them.

"Can she go back into inpatient rehab if she cannot remain at home?"

No, rehab is prescribed as medically necessary by a doctor or PT -- the patient or their family doesn't get to decide this. Her Medicare wouldn't pay for it anyway unless it was medically prescribed. And, while in rehab, if she doesn't make progress they will release her if she plateaus or is uncooperative.

If her estranged husband "leaves suddenly" then you will need to step in, but if he may be prone to doing this, why go down this path of chaos to begin with? Consider hiring an aid with her money or contact social services to see if she qualifies for an Elder Waiver and in-home services. Whatever you do, be wary of becoming her full-time caregiveer. She needs to use her own resources to pay for her own post-surgery care.

Being a spouse does not trump MPoA. But the MPoA authority usually doesn't kick in until the conditions specified in the document are met. Do you know what they are? Usually it's one or two medical diagnosis of mental incapacity and outright physical incapacity. Them being separated has no bearing if he isn't the actual MPoA.

Who is the FPoA? This is where it might get stickier. If you took your mom to a consult with a certified elder law attorney, this professional can probably give a more clear picture of the down-the-road impact of their marital state financially. She should also see a Medicaid Planner for her state so that there's no surprises. It will get complicated with Medicaid and this resource needs to be preserved should she need it (and many elders do).