Who is responsible for appointments in MC?

babsjvd: In house medical appointments should be arranged. An individual in a memory care unit can't be expected to go OUTSIDE the facility for these needs.

I am going to echo what Lealonnie said, our circumstances are parallel ( except my mom is 180 lbs and I have one sibling…who does literally nothing )

I’ve ratcheted mom’s outside appointments to Absolutely Essentials only. Asked around and do use the roving dentist for example when able. The goal is comfort over perfection with smaller issues. Her glasses are good enough. Her teeth aren’t lovely and cleaning them herself is a big to-do but when the dentist comes through they pull a miracle and work on her.

One outside appointment she has to have is a pessary change ( urg ) Great pain and discomfort without it! When I can’t make that appointment - I live an hour away and have other issues - I’ve utilize the services of a wonderful geriatric care manager to take her.

Geriatric care managers are expensive but oh boy has mine saved my bacon on numerous occasions. This could be an option for you guys. I took in a lodger to help pay for her. Now mom’s own funds are helping pay for the geriatric care manager, thank the goodness! And again, I really try not to ever take her out of her home base as it’s physically and mentally a real kerfuddle.

Good luck with everything!

You can hire caregivers to take her to appointments. That may be the best solution if POAs can't do it. Some facilities have doctors and dentists that come to the facility. That also makes things much easier. It's worth changing doctors to get that service. Watch for signs that it's ok to back off from certain kinds of medical care. My mother stopped wearing her glasses at one point, and was no longer able to understand the instructions that the eye doctor was giving for her eye exam. We agreed that the doctor would just renew her glaucoma prescription, without requiring visits.

Since I posted , the MPOA has reached out to the memory care for in house care.. (finally!)… I’ve been recommending/ suggesting that be done for 6 months. This will solve the problem of FPOA being adamant that my SIL be the one to take her , regardless that she works 40+ hours and lives 1 1/2 hr away.. he stated she needs to schedule time off and do her duty .

A big reason for having a parent in MC to begin with, in my opinion & experience, is to AVOID taking them to all these appointments outside of the facility. My mother, for instance, was in no condition to be taken outside of the MC to doctors, dentists, eye appointments etc., so I set her up with in house doctors and dentists to visit her on site. As an only child, I was the chief cook and bottle washer, POA for financial and medical, and the only one in charge of everything for both of my parents. My mother was 190 lbs and wheelchair bound, so no, I was not going to hire vans to transport her to doctor's offices who would then expect ME to figure out how to get her onto THEIR exam tables, etc. Been there/done that with dad and had no intention of doing it again.

I know that's not your question, but I suggest you and your POA siblings arrange for in house doctors and dentists and the like to visit your mother in the MC now. It will cut down on A LOT of fighting and aggravation, and a lot of anxiety on mom's part too. The visiting dentist alone was such a relief, I can't even tell you. To have mom's mouth worked on in her RECLINER in her ROOM was worth it's weight in GOLD. When her eyeglasses broke (which she ran over with her wheelchair a few times), I'd drive over to the Optometrist's office and have a new pair made FOR her w/o her even needing to come along. If her RX changed a bit, who cared? The old RX was better than nothing. MC is the last stop for these elders, so imo, it's not as important they're getting to see all the 'specialists' as it is they're getting decent BASIC medical care, and letting nature take its course while they're living out their last days in comfort, w/o poking and prodding to the Nth degree. Even traveling lab techs visit the MCs on a regular basis for blood draws, xrays and even an echo cardiogram was given to mom on site in her MC.

Best of luck.

My 2 brothers and I were all MPOAs, middle brother was FPOA.

We hired medical transport and and aide from the NH. Someone (usually I, sometimes SIL or once a cousin) met mom and asked the questions and got answers. I live 90 minutes away and worked.

Dentist, audiologist and dermatologist came to the facility. The ONLY thing we took mom "out" for was a followup with pulmonologist after a lung tap and the derm's office for a biopsy.

Not sure why you would drag a dementia patient around to outside appointments. Isn't there a geriatrician who sees patients ts "in house"?

I’m gathering that there are only two siblings? Appointing one sibling medical and the other financial POA doesn’t mean one can’t do the other thing it simply means one has the final say. First there may be an option from the facility for transport and accompaniment to appointments, it may mean an extra charge for this but it could be worth it if the two siblings can’t come to a meeting of the minds.

I do think the best thing for everyone would be if these two start working together though, it’s probably what was intended when the mother or parents set this all up. Since it’s the medical POA who sounds like they are having the hardest time because of distance maybe they could offer to help with some of the business chores and work together trading off. My brother and I for instance share POA but he is the main financial POA and I am the main medical, I live 4 1/2- 5 hrs away and he lives in the same house as Mom so we share each other’s responsibilities. I do all the financial and medical stuff I can from another state, applying for and meeting Medicaid needs, setting up caregivers and managing them, doing grocery shopping at setting it up for pick up, setting up Dr appointments, messaging with them and phone calls when necessary, managing prescriptions…you get the idea and my brother takes her to the majority of appointments, takes care of her needs when caretaker isn’t there, gets her out of the house, things “on the ground” and we share the duties of reminding her to do things and overseeing her taking medication, using the bathroom, walking again when the caregiver isn’t there and pre caregiver. My point being someone needs to make the effort to share the duties better and see if that helps the local (I am also assuming the financial POA is local) sibling feel more comfortable sharing responsibilities. They might find that that local sibling is feeling like they have the bigger burden and aren’t getting help, correct or not it may be the perception which is why they are digging their heels in. Maybe they feel the sibling who lives further away doesn’t make enough of an effort to visit mom, maybe they think everything else is covered without his or her sibling having to do anything, unaware of the fact that even in a facility their is a lot of time and effort that goes into oversight and management still. Once they discuss these things maybe they can come together and even vent to each other in a healthy way rather than a divisional kind of way, at least that would be the ideal and what I hope can happen. I do recognize this may not be that simple or successful which is why I would check on other transportation options, there are bound to be some even if not from the facility themselves, plenty of patients need this type of service I’m sure and they would at least be able to give the MPOA some options.

POAs does not mean they are physically responsible to do. The POA could hire someone to do it but is not obligated to do it.

POAs are set up so the persons wishes are carried thru when they no longer are competent. FPOA makes sure the bills are paid and the principles money is used for their care. The POA does not use their own money. The MPOA is there to make decisions when the person is no longer competent to do so. The POAs decisions are based on what the principle put in writing how they want there health handled. Yes, I agree that the MPOA should be available for certain Dr. visits, like physical check ups and Specialist but not so much for dental and vision. but its really not part of their responsibility. They can ask some to go in their place.

I would first see if Mom needs to see all these Drs. Is there a PCP associated with the MC, then I would allow him/her to oversee Mom. The doctor, or his Nurse Practitioner, probably come to the unit. Dentist, I would make sure he is seen 2x a year and eye doctor 1x a year unless he feels 2 is OK. I stopped taking Mom to Specialists once she was stable. At that point I felt the PCP could carry on. If he saw a problem, back to the Specialist.

Maybe you all can take turns. The MC may have transportation. Check to see if an aide goes with them.

You could hire a freelance caregiver to do that at extra cost to the patient.

Whoever can do it should do it. The POAs have no special meanings except for decision making responsibilities for their respective POAs. One makes medical decisions, one handles the bills. Neither has anything to do with being an attentive child to a parent.

Tell both of them to grow up.

The MPOA is responsible for making sure the healthcare happens, not necessarily doing the work in person.

The FPOA is not actually debarred from making him/herself useful just because it's not his/her responsibility, of course.

Has somebody been taking somebody else for granted? What triggered the squabbling?

Well, since the medical POA can speak for the person, it makes sense for that person to go to appointments. Do they absolutely have to accompany the person to the doctor, not necessarily, they can follow-up later with the doctor if they have any questions. Since the person is living in a memory care facility, can we presume that visiting the doctor isn't an everyday occurrence? I think a lot would depend on how frequent the appointments are. If there are appointments every week, for example, the other siblings might be drafted to fill in so that the medical POA doesn't have to take a day off from work as frequently.