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I would discuss the issues with your sister, as much as you can, to determine her wishes. You may try to find a list of pertinent issues, such as ‘does she want to go to into memory care when you or the doctor deem it necessary’, what are her finances? Does she have control over her finances? Property? Do this soon so you can determine her wishes- not that you can always follow them- for her own safety and care.
Secondly, I would discuss the situation with her husband. You want to know clearly where he stands - perhaps discuss the pros and cons. This is difficult in any case., but sometimes it is best to discuss and share concerns.
Thirdly, or firstly, I would speak to her Elder lawyer. If she doesn’t have one, perhaps your senior center has an adviser on the issues in this case.
Each State has different laws. I would think that you DO have decision control over the husband, but check your State laws. Either ask a lawyer (best choice), senior center, call State Elder Dept, or talk with a senior advisor.
This can be messy, but know the law and you may even be surprised that your brother-in-law is reasonable
Best wishes
Back to your situation, I would advise you to make sure you are clear about what legal responsibilities you and your niece actually have, are you simply POA do you have MPOA, does your POA/MPOA become durable when the need arises and what if any hoops do you need to jump through to invoke the D? Then you and your niece can decide how to proceed but it sure sounds like you at least have POA so you can take care of anything legally right now as long as you’ve discussed it with your sister and she agrees or she has asked you to take care of it, nothing needs to be done for POA to be in effect once the document is signed. The medical stuff gets a little more confusing because there are various ways for one to be given various access and responsibilities to medical stuff, simply being added to the approved HIPPA list with each provider includes you in all medical info and discussions, Medical Proxy is another one that is often used or at least was and it’s always been my understanding that is just like DMPOA. maybe that’s a state to state thing too I don’t know. I don’t think the medical community is all on the same page with this either which probably contributes. For many medical things and actually cc companies even all it takes is verbal ok from the primary person on the phone to add someone to the “approved” list.
As far as “taking over” it doesn’t have to be like that exactly, it seems better for everyone especially most individuals needing the help when this happens more organically with say you and your niece going to all doctor appointments from now on, arranging on line bill pay or billing to make it easier which gives you access to what’s going on each month as well, that sort of thing depending on the areas you are most concerned with. It may not be that her husband doesn’t have her best interests at heart which sounds purposeful to me, it may be that he is no longer capable of taking care of things either and having to take over responsibilities she has carried is just too much, he’s overwhelmed and either won’t admit it or doesn’t see it. He may need help too.
Hubby may have dementia problems of his own. Review POA with him and talk about how you can "lighten" his burden of caring for sis. Start implementing plans to care for her, and him, slowly. He needs time to adjust to the new arrangement.
Remember that it should come across as kind and loving not controlling.
Review it with your sister and your niece so you're all three on board with your sister's desires for finances and medical issues. If it's not just right, then now's the time to get it just the way your sister wants it. In other words, is the medical POA exactly the way your sister wants to be medically treated, or does your sister want to be kept informed of her finances in a certain way?
For that matter, take it a step further and talk to her *I'm sorry, happyjack* about assisted living care, and her will and funeral arrangements. I know this sounds way premature, but as the disease progresses, getting knowledge from her now can help a lot down the road. Thank you for taking care of your sister.