My 85 year old aunt, who never married, is contemplating back surgery due to persistent pain. Her back has been an issue for years, and she has done her best to deal with it in a healthy way. The doctors are currently suggesting steroid injections and pain killers before trying anything more drastic. My aunt also suffers from recurring bouts of vertigo. My aunt gave my sister power of attorney (over exactly what, my sis says is unclear). My aunt lives a six hour drive away from my sister, on the East coast, and I am on the West Coast, thousands of miles away. There is a supportive community around my aunt where she lives in her own home, but we don't know any of these people. My sister has a very hard time setting limits and asking hard questions, while (after years of therapy), I do not. I don't want to get in the middle of something that has not been made my business, but I want to be there for my sister and aunt in case the worst happens and our aunt is incapacitated, perhaps permanently, by surgery. Should I push my sister to ask more question? Should I ask them myself? I tend to be direct and "cut to the chase," but that may not be the best approach in this situation right now. Our mother, my aunt's sister, is also still living and in AL near my sister, so it is concerning to think about another elderly relative needing our help with so little information to go on.
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I'd also be surprised that a doctor would seriously consider surgery on an 85-year-old's back, so first and foremost, pressure Auntie to get the cortisone shots before anything else.
Medical PoA will still not allow your aunt's doctors to discuss her personal and private medical information with your sister unless the aunt is present physically and mentally. Your aunt needs to request the HIPAA form for Medical Representative at each of her doctor's offices and assign your sister as her MR. This will allow the docs to freely discuss your aunt's info without her being present on the call, and also allows your sister to give them info about your aunt's medical issues that they can "use".
Does your aunt know that some anesthesia can cause some elders to never regain their full cognitive function post-operatively? She needs to talk to a geriatric anesthesiologist to agree on what will be used.
Assuming she will require rehab after surgery: who will be checking in on your aunt in rehab? "Supportive community" tends to disappear pretty quickly when the commitment is daily. Supportive community can send banana bread and mow her lawn but will they be driving her to follow-up appointments? Who will be managing that? Your aunt cannot arrange for volunteers and manage this while she's in recovery.
Who is going to be at her home when she's released from rehab (which can be up to 20 days or more)? Who will be paying her bills if she can't? What if her mobility is impacted? Who is going to administer and monitor her prescription pain meds so that she doesn't under- or overdose or become addicted? Who is going to help her shower or go to the bathroom? NOT "the supportive community" from my personal experience. The best that can be done is someone from her church or religious community be designated the volunteer coordinator for her care, but this person needs to know what they're doing and have enough people to do it. But your sister will still need to be in the mix to advocate for her when she's in pain and needs help. Neither she nor her aunt can afford to assume a "best case" scenario for recovery -- especially at her age. In my opinion your sister needs to plan to be there for at least before, during and immediately after the operation, and then maybe again if she requires rehab and also when she is discharged. Or at least some family member needs to physically be there. I know it seems like a lot but surgery at 85 is not the same as surgery at 45 or even 65. Recovery can be very slow and many times, not full. Wishing your family success in getting a realistic plan in place and a pain-free future for your aunt!
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By "guiding" her you won't seem like you are being pushy or "know-it-all" but you are being a sister looking out for her.
If there is a way that she can arrange to accompany your Aunt to a doctors appointment under the guise that she will be helping arrange care after any procedure. She can then ask the doctor other questions that may come up when one of her/your own is answered.
Even though it is a distance she, your sister, should be there when your Aunt gets these treatments in case there is a problem. And it would give your sister a chance to meet the "supportive community" and see what can be arranged regarding caring for your Aunt.