How do families notice that things no longer work at home?
Usually not at one event but in the home and on the body. Spoiled food in the fridge, unopened post, reminders, a cooker with scorch marks, the same clothes for days, trousers gone loose, bruises with no explanation, cancelled arrangements. Single observations say little. What counts is that several accumulate and stay.
On the telephone everything sounds fine. You ask how things are, and the answer is that it is all right. On a visit, by contrast, you see where daily life costs more effort than it used to. That is not mistrust; it helps to offer support where it really takes weight off.
- Fridge and cupboards: things past their date, spoiled, or nothing left at all.
- Kitchen: burnt pans, scorch marks, pots forgotten on the cooker.
- Letterbox: unopened post, reminders, bills paid twice.
- Medicines: packets started, a pill box still full in the evening.
- Home: washing left lying, scrapes on door frames, chairs used as handholds.
- Weight: trousers and rings sit more loosely, the face looks narrower.
- Clothing: the same for days, stains, unsuited to the season.
- Skin: bruises that nobody can explain.
- Contacts: appointments cancelled, the club dropped, the telephone left alone.
A single point proves nothing; a full letterbox happens in every life. It becomes meaningful when several observations persist over weeks and concern something dangerous: the cooker, the medicines, the stairs, the night. Anyone who has already fallen will find the effective measures in the article on fall prevention.
In what order do everyday abilities decline?
As a rule the demanding ones first: finances, medicines, shopping, cooking, trips by public transport, the telephone and the household. They need planning and an overview. The basic activities last longer: washing, dressing, going to the toilet, eating. Within that group washing usually declines first and eating last.
Specialists separate two groups. The instrumental activities keep a household running: shopping, cooking, cleaning, telephoning, preparing medicines, managing money. The basic activities concern the body: eating, dressing, washing, going to the toilet, moving from bed to chair.
- Money matters: bills are left lying, payments go out twice.
- Medicines: the pill box is filled wrongly, tablets are missing or come twice.
- Shopping and cooking: only bread and tinned food, hot meals are dropped.
- Trips out of the house: bus and train are avoided, driving becomes unsafe.
- Household: cleaning and washing are left, both used to be a matter of course.
- Personal care: showering is put off, because it takes strength and balance.
- Dressing, the toilet, eating: those go on unaided the longest.
This order is the rule, not a law. A stroke or a fractured neck of femur reverses it in a single night: then dressing no longer works while the tax return still succeeds. For family members that means the quiet forerunners usually lie in the letterbox and the medicine cabinet, and not in the bathroom.
Which of this belongs in a medical assessment?
It is worth paying attention above all to changes that are new or that appear quickly. Forgetfulness, weight loss, falls, dizziness or withdrawal are alarming, but they frequently have causes that respond well to treatment: infections, medicines, pain, depression, the thyroid, or poor sight and hearing. That is exactly why an assessment is worthwhile.
The commonest mistake is to put everything down to age. In geriatrics the opposite sentence applies: in old people the first signs of a physical illness often show in behaviour and in thinking.
- Note things concretely and with a date: “left the cooker on, 3 May”, not “is getting forgetful”.
- Take all the packets along, including drops and sleeping remedies bought without a prescription.
- Ask about hearing and sight. Deafness looks like confusion.
- Clarify beforehand whether you may be present. Without consent nobody will talk to you.
Bruises belong to be shown but not interpreted. Blood thinners, thin skin and unnoticed falls leave the same marks. The specialist literature becomes attentive at marks in places that are hard to reach, at grip marks on the upper arms, and when somebody shows fear of a particular person, and that is a reason to look, not a reason for an accusation.
If a memory disorder is confirmed, the question becomes daily life. What carries it then is described in the article on dementia at home. Your doctor makes the diagnosis, never the therapy and never the family.
How do you raise it without taking over?
Talk about a single observation, not about the whole. Ask before you suggest: what has become difficult? Avoid test questions and proof. Offer help that takes a task away, not independence. And have the conversation while nothing is yet on fire.
The conversation fails on its form, not on its content. Anyone who turns up with a list produces resistance, and that resistance is aimed at the person holding the list, while a single thing raised and then listened to brings more to light.
- “I noticed the post is piling up. What has become awkward about that?”
- “What do you want to go on doing yourself, and where could somebody take something off you?”
- “If you fell at night, how would you get help?”
- No exam questions. “What is today’s date?” is recognised as a test.
- No proving your point. Putting the spoiled food on the table loses the conversation.
- Do not talk about somebody in the third person while they are sitting in the room.
- One subject per visit, not at the family party and not on the telephone.
It helps to offer the help small and for a limited time. “We could try the meals service for four weeks and then look again” is accepted more readily than “you need support now”, because people agree more readily when they decide themselves when something stops.
What if your mother or father does not want help?
Then the person’s will applies. Anyone with capacity of judgement may live as they wish, including at risk. Swiss adult protection law says so explicitly: official measures are to preserve self-determination. What family members can contribute is support in making the risk smaller; the tasks are agreed together.
Under the Swiss Civil Code (ZGB), a person has capacity of judgement if they can act rationally. That is presumed, and it always applies only to a particular question. Somebody may no longer be able to keep track of their finances and still decide clearly where they want to live.
Self-neglect is nevertheless rarely only stubbornness. Behind it there are frequently dementia, depression, untreated pain, a medicine that takes away the drive, or an unprocessed loss. A medical assessment therefore stays sensible even when help is refused, because a treated cause sometimes changes the attitude by itself.
- Take the smallest offer that is accepted.
- Separate safety from tidiness. An untidy flat is not an emergency; an unsafe staircase is.
- Talk about an advance care directive and a patient decree while capacity of judgement is there.
- Get advice for yourself. Advice centres for older people (fremde Seite, öffnet in einem neuen Fenster) advise family members too.
The limit runs where somebody, because of a state of weakness such as dementia or a mental illness, can no longer look after their own affairs and where support from family and services is no longer enough. The adult protection authority can then appoint a deputy, including for somebody who has capacity of judgement, and it has to order as little as possible in doing so. Until then it remains the case that a person may choose a life you do not approve of.
What support is there in Switzerland?
The first route leads to the GP practice, which assesses and prescribes. At home there are nursing and housekeeping, meals services, transport services, visiting and respite services, day centres and short stays. Advice centres for older people in the municipality and the canton know what is available locally. Occupational therapy comes into the home on prescription.
Help at home is more widespread than many assume. According to federal statistics, just under half a million people a year in Switzerland use home care and nursing services, a good five per cent of the population, and a good 40 per cent of them are aged 80 and over.
- GP practice: assessment, medicines, prescriptions for nursing and therapy.
- Nursing and housekeeping at home: personal care, medicines, wounds, the household.
- Meals service: hot meals, often the first step that is accepted.
- Transport and escort services: for medical appointments and shopping.
- Visiting and respite services: care by the hour to relieve family members.
- Day centres and short stays: care by the day, stays for a limited period.
- Advice centres for older people: an overview of what is available locally.
On payment: nursing and therapies prescribed by a doctor run through the insurer responsible, with the deductible (Franchise) and the retention fee (Selbstbehalt). Housekeeping, meals and transport are usually paid privately, often graded by income. What arises in your case is something the insurer responsible will tell you; on the helplessness allowance and supplementary benefits, the local branch of the Old Age and Survivors’ Insurance.
Occupational therapy can take place in the home on a doctor’s prescription, if treatment at home is ticked on the form. How that works is described in our article on occupational therapy at home.
When is a move into a care home the right decision?
There is no point at which it is settled. A move becomes a subject when care around the clock is needed, when the nights are unsafe, when a home cannot be adapted, or when caring at home is making the family ill. The person concerned should have a say in deciding.
The question is usually asked too late: in hospital after a fall, under time pressure and often without the person concerned. Where the relationship allows it, it is worth asking the essential questions early: what would have to happen for you to consider a move?
- Is help needed at times when nobody can come, above all at night?
- Are there repeated falls, getting lost outside, or a fire risk in the kitchen?
- Can the home be adapted, or is it on the third floor without a lift?
- How is the person providing care, in terms of sleep, health and a life of their own?
The burden on the family is a legitimate reason, and it is kept quiet too often. Anyone who wears themselves out will not last, and a collapse of the care arrangement is the worst outcome for everybody.
Between home and care home there is more than the question allows: assisted living, day centres, short stays, an adapted flat. What is possible structurally is described in our article on the age-friendly home.
What does an occupational therapy assessment at home achieve?
It watches rather than asks. At home it becomes visible at which step things fail: at the drive to begin, at the order, at strength, at sight, at balance, or at the home itself. From that come goals the person has set themselves, and measures that start exactly there.
At a table in the practice much succeeds that is harder at home. So the assessment happens where daily life happens, and at an activity that really occurs in daily life. That can be preparing a meal or the way from the bed to the toilet; which activity fits depends on what matters to the person. It is not about right or wrong, but about seeing together at which place a small adaptation achieves most.
- Which steps still succeed independently and which do not?
- What does it fail on: strength, balance, sight, overview or drive?
- Where does it become dangerous in the home, and what can easily be changed?
- What does the person want to be able to do again themselves? That is the goal.
- What do the family members need so that they do not take on too much?
On the evidence: that an assessment of this kind prevents a move into a care home is not evidenced. What is evidenced is something smaller. Removing hazards lowers the fall rate markedly in people at high risk of falling, and not in people without raised risk.
The way there is short. The GP practice issues a prescription, and it often starts with an assessment over two sessions. Which assistive devices carry is described in the article on assistive devices in daily life; for treatment at home the way leads through our geriatrics page or the contact form.