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Activating POA for placement-have question
Posted: Friday, June 7, 2019 6:52 PM
Joined: 9/16/2018
Posts: 27

My MiL has been living with us since August.  She is in her 80's and has vascular dementia.  We have seen a very rapid decline and having been seeing her doctor on a regular basis while trying to get a handle on her meds and all the necessary changes.  (lowering doses of HBP meds, and increasing doses for agitation meds).  My husband found a facility that has an open bed and would be a good fit for her, and we are ready to have her placed.  He and his sister have been operating under a durable POA, but in order to fill out the application and sign it for this place, we were told we need to activate the document by having 2 doctors sign off.

Since she just saw her primary two days ago, that should be a simple process on Monday, but how difficult will it be to get the 2nd doctor?  Do we need to make an appointment and go through an exam just to get another signature?  Can her foot doctor sign it?  We are seeing her on Monday for a nail trim.  What has others done in this situation?

If we bite the bullet and get MiL to sign everything herself, will that be a problem?  Does that mean that she could possibly sign herself out of the facility in the middle of a confused rage?  She is not able to take care of herself or make any good decisions, so I'm thinking doing the activation is the right thing at this point.  Please comment with suggestions or experiences!

Posted: Friday, June 7, 2019 7:38 PM
Joined: 10/24/2018
Posts: 1068

Where my mom is here had a similar type protocol, although the timing went differently. They needed a signature from her "before" PCP, and would have their once-a-week dr do the assessment and second signature after she moved in (because she was 600 miles away until move-in day!).
D in law
Posted: Saturday, June 8, 2019 6:53 AM
Joined: 4/24/2017
Posts: 589

I would try the Dr. on staff at the facility.  We only had 1 dr sign. 

Sorry I’m not familiar with the 2nd Dr rule.  

Posted: Saturday, June 8, 2019 7:54 AM
Joined: 7/6/2014
Posts: 660

LoriHolz wrote:

He and his sister have been operating under a durable POA, but in order to fill out the application and sign it for this place, we were told we need to activate the document by having 2 doctors sign off.

This sounds like the requirement for a “springing POA”. Are you sure what you have is a “durable POA”? Check the language of the document. If it is, I would question the facility as to why they’re not honoring your legal document. Sometimes the “office people” (admissions) don’t know the difference between the two and assume everyone has a springing POA.

Posted: Saturday, June 8, 2019 3:03 PM
Joined: 10/21/2016
Posts: 2558

Facilities will usually do whatever is necessary to get someone admitted.  Push back on them saying that you only have one doc (which is true).  They probably have a staff or consulting doc that will do the sign off.  They may even accept staff RN if you push back.
Posted: Monday, June 10, 2019 7:10 AM
Joined: 2/16/2019
Posts: 79

We only had one doc. In our state a POA is financial and a proxy is medical, and mine is "invoked." But at every facility or hospital, a new doc from that facility or hospital has to invoke. I wonder how much variation there is from state to state. Two docs seems onerous.
Posted: Monday, June 10, 2019 9:11 AM
Joined: 3/28/2018
Posts: 70

I had the facility doctor act as the second signature. I lived quite a distance from my mom and tried to orchestrate the second signature by having her primary doctor look at her.. What a disaster,The doctors policy was not to talk to me even though she had permission from my mom. I explained in a letter what I needed and the doctor choose not to sign the letter even though it was obvious that the disease had taken it's toll. Needless to say I was livid. I got a lot of lip service about their policy. It would have been nice if they expressed their policy at the time of the appointment reservation. The facility was happy to provide their assessment and signed the document. I had to ride shotgun through the process as I have found that the medical community in these facilities are difficult. The nerrologist I took her to for the second signature had no problems.
caregiving daughter
Posted: Monday, June 10, 2019 9:48 AM
Joined: 11/27/2012
Posts: 2130

See if you could start mc with respite. During respite you could have mc physician evaluate your loved one. Respite would also give you time to get all the paperwork, banking, doctors, move, etc. in place.
Posted: Monday, June 10, 2019 11:09 AM
Joined: 9/16/2018
Posts: 27

Thank you to those that gave suggestions.  I guess in Wisconsin, there is a rule of needing 2 doctors to sign off after an exam is done.  We are in communication with her primary that will sign off.  I'm taking her to her regular foot doctor today, but guessing that she would not want to get involved, but it is a possibility.  Otherwise we will see if the facility has a doctor that would be willing to sign off.

The idea of seeing if we could do respite first, while we get everything in place is interesting.  I will see if that is an option.

The good news is that we are moving forward.  I just need to be patient and get through the next couple of weeks with lack of sleep and and coming up with new ways to deal with the delusions.

Posted: Monday, June 10, 2019 11:42 AM
Joined: 9/3/2016
Posts: 215

I'm not sure what is meant by having to activate the POA. The POA I held for my dad and the one I have for my mom both went into effect as soon as the three of us signed and the attorney notarized our signatures. My dad passed in November, but for the last 4 years of his life I signed everything for him as his POA, and for my mom I am still doing that. When my mom could no longer be cared for either at my home or in assisted living and we had no choice left but a nursing home, there was no question about my signing there either. Her doctor did sign a statement and sent her medical records, but we had only one doctor do that. After she was admitted, the doctor for the facility did examine her but it was after she had already been admitted. That doctor still sees her periodically although mostly she is seen by PAs or NPs now other than the charge nurse, floor nurse, etc. She is in a skilled care facility. My mom is in Stage 7 now, but was in late Stage 6 probably last year when she first entered the nursing home. She has been there now a little over a year. It broke my heart, but it was the only option we had left. I hate it, and so did she at first but now she really isn't alert enough to pay much attention to it. She has a roommate but doesn't even realize there is someone else in her room as she is blind, and the lady in her room is even further along than my mom and thus is very quiet. The POA is very important, and I have never had anyone question it. I have both a durable POA for financial, etc. issues and a medical POA for my mom. She and my dad also had Advanced Medical Directives in place so I know exactly what their wishes are. That was an invaluable help when my dad passed seven months ago.
Posted: Monday, June 10, 2019 1:06 PM
Joined: 10/24/2018
Posts: 1068

Re Windyshores' comment about invocation, so far as I know all of us sibs have had POA and Medical Everything since Mom set it up many years ago; once signed and notarized that was that.  None of us has gotten any guff from anybody in NY nor VA. The hospitals in particular aren't fussy except at the front desk where they Will Not Let you back into the ER until it's too late to forestall unnecessary testing. I think, though, that if she's admitted, they ask for a document, but aren't in a rush. This was so in NY. Very oddly, with MIL, her caregiver was able to get in bc she happened to be wearing a labeled uniform that day. 4 family members cooled their heels in the waiting room for an hour. We were extremely glad the carer had worn that particular shirt that day. But Mom doesn't have carers whose job it is to be where their charge is.
Posted: Monday, June 10, 2019 6:33 PM
Joined: 10/25/2018
Posts: 238

NoSiblings, a POA can be revoked at any time, unless there is a doctor's letter stating that the person is completely incapacitated and no longer able to act in their own best interest. When my dad went into the hospital, he revoked my POA verbally. The staff there wouldn't give me any information until I provided the POA along with the letter from his neurologist.
Posted: Tuesday, June 11, 2019 12:38 PM
Joined: 9/3/2016
Posts: 215

Thanks Pidgeon92. Yes, I am aware that a POA can be revoked. Perhaps I misunderstood the original poster. I didn't understand that was the case here, and I never had to deal with that issue with my dad nor will I expect to with my mom as her AD is so advanced now she would not be capable of doing so any longer.
Posted: Tuesday, June 11, 2019 7:27 PM
Joined: 9/16/2018
Posts: 27

Today we were able to complete the activation with the doctor at her Adult Day Care signing off.  She will be moving to the Memory Care facility early next week.  In Wisconsin the rules must be different than other states.  When my MiL moved into our house, we went to a lawyer to have her sign an official contract that she would pay us rent and a set amount per hour for giving her care.  We needed to have her be deemed capable of signing the contract and she was aware of who had PoA.  Then when she was not able to do that on her own, we needed to have two doctors verify she was not competent.

Now on to figuring out how we are going to move her without her knowing until it is time.


Posted: Wednesday, June 12, 2019 4:08 PM
Joined: 7/12/2017
Posts: 1596

For my mom, we got her doctor to refer us to a "brain center' at local hospital.  Took some pushing.  They ran all the tests, MRI, etc and they created the letter to activate the DPOAs.. I think becuase it was coming from the brain center, there was no doubt it was needed..
Heather C.
Posted: Wednesday, June 12, 2019 6:12 PM
Joined: 6/26/2018
Posts: 1

Laws regarding powers of attorney vary from state to state.  You need to read the power of attorney.  If it has what is called "a springing power" that means it is not activated until she has been certified incompetent.  The number of drs required will also be stated in the poa.  sometimes it's one, sometimes it's two.  I used to advise my clients to utilize the springing power but it has become so difficult for children to get the certification that I now suggest having the power of attorney go into effect immediately.  This of course, can only happen when there is an absolute level of trust.
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