Is this a thing? POA abuse?

[Momma1RN, MSN, RN, APRN]

Nursing home resident came to the ER after a fall. About to be discharged, patient himself (who is alert and oriented) asked for a chicken salad sandwich. Overbearing daughter at the bedside whom the patient is obviously annoyed with states he may NOT have chicken salad. "He doesn't like mayonnaise", to which patient replied "yes I do, I would like a chicken salad sandwich please". Daughter states she is secondary power of attorney and if I gave him the sandwich she would pursue legal action.

I was under the impression POA was invoked when patient was unable to make decisions for themselves. MEDICAL decisions. She was obviously on a big old power trip and needless to say the patient did not get food before leaving our facility. I was just curious if she had the right to choose patients food preferences as the secondary POA?? My charge nurse seemed to think yes but I was unsure.

[JustBeachyNurse, LPN]

Depends on the POA. If AAOx4 POA is not in effect and she's just a trouble maker

[crazin01]

I would tend to think she's on a power trip & how sad for the patient. IF he is A&OX4, then why does the POA get the final say? I'm sure, somewhere, as most POA's state, they are only POA IF (key word) the patient is unable to make decisions for themselves due to current conditions (coma, cognitive deficits etc).

I feel so sorry for that man. To say "no you can't have a sandwich!" to your own dad? geesh

[KatieMI, BSN, MSN, RN]

POA starts when patient is not able to make his/her own decisions. Which ones, it should be written in the POA papers. Sometimes POA can make only medical decisions, sometimes financial as well, and sometimes it is only financial ones in regard of medical care and not, say, estate planning.

The craziness of situation (and the daughter, obnoxious or not she was, very well might know it) is that the moment of "patient losing decision-making capacity" may or may not to be determined as obvious. In theory, it should be written in that paper as well, with specifying details but, due to the availability of generic POA forms, the details often go missing. In LTAC we see all the time patients with GCS 7 and below but family insisting that "he sees, hears, and understands everything, he just cannot speak" so that Court-appointed POA (as family is not willing to designate anyone) is not able to act and family insists on full code and everything possible to be done. On the other hand, POA may act when patient is, by assessment, A, Ox4 and delurium-free because "I know him and he doesn't act as usual" or "he was recently given drugs and cannot think clear", and so cannot ask for comfort care only, intensifying pain management, stopping treatments, etc.

Only one legal way to stop it is declaring the patient "competent" or not. It requires, at least in Michigan, two MDs, one of them being psychiatrist. It takes time and hurdle to organize. So, in cases like described sometimes it is easier to negotiate, explain, "trade" and figure out what is the problem with the daughter before throwing battle royal.

[Guttercat, ASN, RN]

What a little sandwich nazi.

Poor man. Now I've heard everything.

[RiskManager]

Geez louise. As the risk manager, I would ask her to produce the paperwork for my inspection giving her the claimed legal rights. In the absence of such paperwork, and if I felt the patient was competent to make the decision, would provide the chicken salad sandwich. I would bet you dollars to doughnuts that no such paperwork exists, at least providing the rights claimed by the daughter.

[Been there,done that, ASN, RN]

AS PP have said, POA kicks in when the patient can no longer speak for himself.

Someday, and probably soon... she will be sorry she didn't let him have all the freakin' sandwiches he wanted.

[quazar]

Geez!!! In that case, I would probably be making several phone calls: risk management, the house supervisor, and social work all would get a call. In addition, I would document the entire exchange, verbatim, in the chart. No judgment call on it, just a note describing the incident and EXACTLY what was said. Given enough rope, she'll hang herself eventually.