When to take over as POA?

What does the POA document say? If it’s springing, then your POA isn’t in effect and won’t be until your sister is declared incompetent.

You and niece should talk about what types of care sis needs that her hubby can not or isn't providing. Discuss how to get sis this kind of care and the costs of time, money, having "others" in their home,

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.

Tagging onto worriedinCali's post, we can't help you with this question. It all depends upon the POA document's wording. I hope it's a "Durable" (or "springing" depending on the term used), which means the POA remains in effect upon mental incapacity.

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.

Now...ASAP. Hubby is in Denial.

Since the documents are already put in place, start small. Take over payment of some bills to make it easier for 'both' of them. Then tackle other tasks. If/when you see need for some home care or cleaning, add that to the list. Eventually, you'll have everything covered and will have removed hubby's involvement in most/all of his decisions in her matters.

While it varies a bit state to state I think the terms are getting a bit mixed up here. POA which enables you to legally act as your sister in financial matters is always “in effect” but that doesn’t allow you to act without her agreement. If and when decisions need to be made in her best interest but not to her liking (she doesn’t believe she needs to move) or she simply isn’t capable of agreeing or disagreeing, is when DPOA kicks in and there are different parameters about what it takes to invoke that. MPOA is different in that it is all about medical decisions and stuff, this allows the appointees to make medical decisions when the patient can’t, talk to providers, order and pick up medications and adjuncts etc. DMPOA allows the appointee to make medical decisions in the best interest of the patient even when they don’t agree, usually dementia/Alzheimer’s patients I think but again the D(durable) part usually has qualifiers. This is logical when you think about it because it protects the patient who has all their faculties and is willing and able to make their own decisions but needs help getting business done as becomes the case with probably 95% of us as we age. It also gives us the control over who to hand control to if and when we are no longer in control of ourselves and a way to predetermine when that happens. It isn’t uncommon for the MPOA/ DMPOA and POA/DPOA to be different people, in our case we all three have both but we split it up a bit (I don’t remember if we put it in writing or not), the brother who lives closest is in control of financial stuff though the other brother and I can help with anything needed and do stuff is he isn’t available because we also have the authority. We can all also have full access to medical stuff etc but if the time comes for any life and death decisions I will be the one making or voicing them.

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.

Who is the main POA? I assume you are. Your sister probably knew that her husband would not be the best choice and choose you and your niece to be her POA.

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

Before you get in trouble, get a lawyer and seek Guardianship.  POA's don't just "take over" unless the grantee is incapacitated.   It takes a judge to decide whether she is incapacitated, not just a doctor.

Have you had a recent cognitive evaluation to determine the progression of dementia? Once you have an idea where she is cognitively, I would start by speaking with the involved person's prior to assuming responsibility. State that a physician or neropsychologist evaluated your sister and they feel that the POA needs to be enacted. I would ask and inform her attorney as well.

Thank you all for your information and encouragement. My sister's life has always been very complicated with many twists and turns. My niece is wonderful and doing a great job trying to coordinate services, etc. As they say, "Getting old isn't for sissies"