I am my 82-year-old mother's durable healthcare POA. We've had the papers in place for years, but her doctor just activated it yesterday.
She submitted a letter in July to her medical file saying she no longer wanted any testing or medications. When asked about the letter yesterday, she claimed to have no memory of it. This set off the incompetence bells, and the durable healthcare POA was activated.
Mom lives in independent senior housing. She is diabetic. She has no interest in taking her oral medications. Her average daily blood sugar is 347.
I know her wishes. She just wants to be left alone and to live the rest of her time in peace. My role as POA is to make sure her wishes are honored, no matter what, correct?
One's wishes before dementia kicks in, if sensible, are fine. After, or if there is ANY concern in judgement, I would question it. Wishes, within reason, are fine. If my mother told me to take her out back and shoot her, that would be her wish, no? Would I comply? Not a chance! If she wanted to travel to FL for the winter, like she used to, would I let her? No. She can't possibly do that, not even with help!
Given that she delivered a letter stating her "wishes" and now doesn't recall it... I would question it. If there was any way to coax her into taking her medications, even if it is for her to be able to care for her dog, I would work on that - someone other than you might have to be the one to convince her. Often they don't listen to us or dismiss our concerns, but they will work with others. A visiting nurse? The doctor?
If she doesn't recall the letter and doesn't really understand the implications of not taking her medications, she could end up a lot worse off, being disabled, bed-ridden but still alive... hardly would be able to "live the rest of her time in peace."
In 2007, my dad was diagnosed with what ended up being a terminal recurrence of his cancer and wanted to participate in the experimental option offered (even if he knew he would be in the placebo group) as he wanted to feel his life might help others. He and my mom made decisions with Hospice that wouldn't have been my choice but that I clearly understood were theirs and we respected these and helped as we were able.
Fast forward a few years to when one of kids was in med school and shared a reading assignment with us that was life changing. The book is "Being Mortal" by Dr. Atul Gawande (sp?). After reading this, and knowing that my mother was starting to show declining health, we were able to walk her through looking at her end-of-life planning with her attorney and make needed changes which were a Godsend when she had a life threatening illness and was later diagnosed with Alzheimer's. .... At this point, I want to strongly recommend you share information about this book with your loved one's doctors. After the care journey for my mom, her docs came back to me and asked what the books were that I had had kept recommending to them because they realized that the core training they received in medical school missed some critical knowledge (the other book is the 36 Hour Day - wouldn't have made it with any shred of mental health without these two books).
During my mom's last 2.5 years, my father-in-law was diagnosed with cancer and mother-in-law with frontal temporal lobe dementia. For the last year of my mom's life, both moms were in the same memory care facility which helped immensely.
When FIL's cancer recurred for the 3rd time he was still able to read, plan, and process choices about his care but wasn't being given information on any options except more surgery and debilitating treatment. We gave him a copy of this book and asked him to raise any questions he might have about his options with his caregivers. After reading it, he met with his legal and financial advisors to clean up gaps in his end of life care decisions that he didn't even realize were there or how these gaps could keep from having his and MIL's wishes respected.
Even now, we continue to see how even the most common sense decisions need to be thought about and put in writing. After losing both my mom and FIL within 10 days of each other during the summer of 2017, we are now the sole caregiver for MIL now on Hospice. We have discovered that antibiotics are still administered while on Hospice even when the end of life directives specify no treatment that will extend life because they fall under comfort care. So, we will be making sure to revise our end of life documents to address this for hubby and myself so that decision isn't going to be a "wonder what Mom/Dad wanted" decision for our kiddos.
We had talked about some of this but without the book, FIL never would have opened up (old school man takes care of his family, doesn't show emotion, doesn't want to be burden type) nor would we have had a framework for discussing the topic with our children.
Once we were in the midst of the mess with the parents, we felt totally helpless most of the time, but being able to do something where we felt we could control our decisions helped to keep us grounded.