As primary health care proxy, which is invoked, can I fire my mother's pcm?

Your profile says your Mom is living at home (your home? hers?) Where do you live (with her, near her, distantly?) and who is taking her to these appointments that you aren't present during the exam? If you say the proxy is active, is it durable or springing? More info would help...

DNA, mom is living with brother in the family home, correct? And you are at a distance, and frequently unable to be reached, I recall. And I believe you were hesitant about what your powers were as POA, but you DID have a visit with an attorney.

Is brother the one taking her to appointments?

Remeron is frequently used for seniors. It is, among other things, an appetite stimulant. My mom took it for many years. It helped her mood and quelled her anxiety.

If your Mom is competent, she can make her own decisions. My Moms financial POA was immediate. Her healthcare proxy needed her PCP to declare her not competent to make decisions. In my experience, no doctor asks permission of a HCP to prescribe a med. You not being close by is another problem. I did go in with Mom when she had appts. So I knew what she was on and questioned. When she was in a NH, I was there regularly. When she was showing signs of anxiety, I was not called by the doctor that he prescribed a med for it. I was told by a nurse that it had been prescribed and why.

Your Healthcare proxy does not come into effect unless Mom has been declared incompetent. All it really means is you make sure her wishes are carried out. If a decision concerning her needing surgery, for example, comes up then it will be up to you to balance the pros and cons depending on age and health problems.

Is there a secondary on your HCP who lives closer to Mom?. If you are not close by, you may want to step down and allow the secondary to take over. Doctors have limited time. They need the representative there when they need to talk to someone about a patients care. If Mom is competent, she can revoke the HCP and maybe assign the person who already holds the financial. Its so much better for one person to hold both POAs.

If you’re not able to be with mom in person at her medical appointments, you and mom could request that you be there by phone, zoom or other telehealth apps.

This is an ongoing situation you have written to us about before, if I recall?
I really don't have time to go through and post links to your questions in the past but this issue with sister is not new here on AC.

I think there is ongoing dissention between yourself and a Sister who holds GENERAL POA.
Often the person holding general POA takes precedence in a situation.
I do believe we have suggested before that you and sister attend an elder care attorney to work out who makes what decisions, because you currently have too many Chefs spoiling the stew.

Sure do wish you the best ongoing, D.

Health care proxy is like medical power of attorney. So you can fire the doctor and get any new doctor you choose. You can also request in writing and have in her file that you want to be consulted before new non-emergency medications are added.

I don't know about requiring a signature. A discussion and verbal approval is what we did.

Good Morning,

An MD or Geriatric Neuro-Psy doc may come in handy. It's hard to find a Primary Care Physician who will take on a person in their 80's as a new patient if that is the case.

You can "hire" a NP as long as an MD oversees everything. These pharmaceutical companies/lobbyists walk a fine line. While penicillin is a wonder, you wonder how much medication is really needed for your loved one.

I would go on the portal and read up on every single prescription that is being dispensed. You have the right to transfer records once a suitable medical provider is found.

I visited a place recently "just in case" Mom needs skilled nursing. My grandmother lived there over 30 years ago. This place went downhill and now when you walk in, it is like "zombie" City. You can hear a pin drop the residents are on so much medication.

I was stunned. Check out ALL of your mother's doctor's on your local State Board website. Our loved one's need to be protected.

I have a POA for medical and one for finances. This may not be perfect yet no one person is saddled w/all decisions..In my mothers case I am POA for everything and yes it is a challenge. Best wishes.

Healthcare Proxy doesn’t require medical personnel to run everything by you it enables them to make your mothers medical information an open book to you and take direction from you. The onus is on you to be in touch and up to date not on them to contact you. That said if the patient is deemed incompetent they shouldn’t be going to appointments alone and unless the person taking them is a paid caregiver it’s a reasonable assumption that the person they are with has the ok to hear medical info and pass on pertinent info to the other family members or healthcare proxy. Anytime my moms caregiver takes her to an appointment I make myself available and she includes me by speaker phone. But that’s on me to make sure it happens or make sure my brother or I are present for appointments. The doctors are simply going with the contact they have and shouldn’t be expected to chase down one particular person. If your mom is able to go to appointments alone then it’s a reasonable assumption that she has authority over her own health. It sounds like you have access to all of her information including what happened at appointments and a way to connect with her providers via a portal or something which makes it much easier but you need to go in and keep tract not expect them to simply fill you in.

It sounds like you may be expecting too much of this new provider but there is no real fault when a patient, paitents family and provider don’t gel and you wouldn’t “fire” a doctor you would just explore other options and move to either a new practice or just another primary in that same practice, it happens all the time. I would however urge you to go in person with your mom to meet both this current primary as well as any others you might want to “interview” before deciding. I’m guessing you will find that you have the same issue with any new provider until you meet with them and ask the questions yourself about communication etc. What I’m saying is it may be your expectation based on the old primary and methods for being an active participant in Moms care that needs to be changed and not necessarily the doctor.

Also remember your authority as Healthcare Proxy only gives you the ability, authority to speak for her not the legal requirement to act or be consulted. You need to make yourself and her wishes known. I suggest by request and not demand unless absolutely necessary. Hospitals and doctors don’t want the responsibility for decisions, they want to have someone with the legal authority to present suggestions to so you can make decisions. When it comes to medication like Remeron or anything else added at a normal visit I wouldn’t expect the doctor to go over it with anyone other than the paitent and person there with them. You could always decide not to pick up the prescription or discontinue it if you don’t agree or don’t feel it’s helping in any way. Something made the doctor decide to prescribe it however and someone’s description about what is going on at home likely played a part so please be sure to have an open discussion with that doctor about the reasons as well as your concerns. I’m not sure why you feel it’s being used “off label” in this case or what you mean by “black box warning” all medications come with warnings and while this is a serious medication and not for just anyone my impression is your so angry about not being consulted that you haven’t gotten to the place yet where you can be objective about it’s use for your mom. I know you want what’s best for her, otherwise you wouldn’t be so upset, it’s so hard being so far away and feeling left out of the loop. I am 400 miles away from my mom and it takes almost as much time from here tracking things and making sure the things that need to happen do, that’s with a brother who makes sure I have all the info he has and while there are instances when he does something I might not have or I might have done differently I always defer to him since she lives with him. Takes a village!

dnajaras: Prayers sent.

Sure, you can say “You’re fired.” But to what point? Just to antagonize? Your wording implies a desire to control rather than cooperate. Or perhaps misplaced, fear-induced arrogance (you want the doctor to seek your permission to prescribe meds or You’re fired!) To quote Westley in The Princess Bride, “Prepare to be disappointed.”

Sorry if that sounds harsh, but you led with “You’re fired.”

I’d ask:
1) Is the doctor’s office convenient?
2) Does mom like and trust the new doctor?
3) Is the doctor prescribing the right meds after all or willing to adjust based on your concerns?

If no, find a new doctor.

If yes, solve the problem at hand.
Ask mom to hold off with Remeron because you’re concerned about potential side effects. Use doctor’s office online portal to follow visits and explain your concerns about Remeron and ask about alternatives.

You have no actual authority here without a POA or DPOA; Proxy only extends to your being able to be informed of medical decisions made on mom's behalf.

Good Drs are hard to find and I'd be looking at the DO's reviews before doing anything akin to seeking a different Dr. The caveat is that she may not be assigned to an MD or DO but rather, an APN and that is the least desirable option (imo and as a retired RN).

As Proxy, you could request the DO's nurse to update you on changes but they are under no legal or other obligation to do so.

I have been following your posts. Your problem is why both POAs should be handled by one person. That way Doctors and staff have one person they deal with. Don't you live some distance from Mom? One reason you should not be the healthcare proxy, Doctors do not have the time to deal with family squabbles. Someone goes with Mom to the Doctor. If they accompany Mom to the visit, then the doctor assumes Mom has OKd that person to hear what the doctor says. He does not ask "are you her healthcare proxy, if not you need to leave" If you are so concerned, then you need to be with Mom at every doctor's visit and hospital and Rehab stay. Your proxy should be filed at every facility she enters.

I would not "fire" this doctor, he did nothing wrong. Just call the office and ask that you be notified of any change in Moms medication.

Who accompanies mom to these appointments?

This is Remeron's Black Box warning. Please note that it is aimed younger people; it is not a drug that is considered problematic for elders any more than any other antidepressant.

"FDA warning: Suicide risk
This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
Mirtazapine may cause an increase in suicidal thoughts or actions. This risk is higher in children, teenagers, and young adults. It’s also higher within the first few months of treatment and during dosage changes. You and your family members, caregivers, and doctor should watch for any new or sudden changes in your mood, behaviors, thoughts, or feelings. Call your doctor right away if you notice any of these changes."

Your sibling(s) take your mom to the clinic; do you communicate with them about what is prescribed or talked about?

Frankly, if you and your siblings can't cooperate, and if you are far away from each other and can't communicate to the benefit of your mom, then perhaps you should give up the HCP.

Definitely confer with an Elder Law Attorney for a best practice review of the health care proxy document and, recommendations going forward. Is your mother still making decisions for herself? Or has the document assigning you as POA for health care proxy been involved?
Your mother or whoever is speaking on her behalf should certainly be able to request a different doctor or change medical PCP or other caregivers. "Patient rights" should always be honored; for best practice and full understanding of the particular document (s) your mother has , please do yourself a favor and confer with an attorney, preferably an Elder Law Attorney.

What we have here is one person who is health care proxy and one person who is general and financial POA. If you research this online it says that it is CRUCIAL that the two agree, because anything else will mean constant battles in court between those two. And all attorneys therefore advise that the same person be appointed to both positions.

So this OP has a choice. GO TO COURT with an elder law attorney and take each issue to court OR get along with the Financial POA. Often in court the general financial POA trumps the health care proxy in decision making by a ruling of the judge.

This issue has been going on for some time for our op. Another member says they looked up some twenty postings about these issues and the disagreements and dysfuntion between our OP and another family member regarding care.

I doubt very much that the Forum can do much for our OP here regarding this. Our OP needs an attorney rather than the advise of a Forum full of people. I can't see how, not knowing what is going on in this apparent dysfunction, anything can be contributed by us that doesn't simply add to the confusion.

I am confused, one of your posts asks how to resign HCP and then says it's done. So, that's not true?

Power of Attorney DOES NOT give you special authority to make people jump through hoops and chase you down to get permission to treat your mom.

You need to decide what level of involvement you really want from what 500 miles away.

You are trying to make this as hard as possible for everyone involved. Your brother has been with mom for 10 years, he deals with her face to face daily, it would serve mom well if you let go of the power trip. Sorry, sounds harsh but, I would blow a fuse if you were my interfering, absent sibling making things as hard as possible for everyone involved.

Good Morning lgloocar

Thank you for your response. In my neck of the woods, there are not enough providers. I'm happy for you that you are not in our situation.

Many providers are not taking new patients but you sound like you are on top of things. I was just sharing my experiences and suggestions as to what I had to do.

Your point was well taken, thank you!

I have a question for you. If you have proxy or POA, how is your loved one seeing a provider without you being present? Is she housed in a facility of any type? Have you given permission for someone else to transport her to appointments? If a doctor was assigned before you were able to consult, and they didn't read her chart to see that she has no authority in her health care decisions, hold those incompetent providers accountable. Have them show you how they document your plan of care, and what they do when they make mistakes. My Mother accepted a sub par medical doctor when the one she was using unexpectedly became a widow. It took a year, but I got her the geriatrician she needed. We live in a city that has a medical university, but doctors are not readily available. Appointments book out a year in advance in several specialties. Best of luck as you strive for your Mother.

If she is not mentally competent, then the health care proxy takes over. If this is the case, you should be consulted for every medical decision. Take this up with the clinic.