Most families do not decide to arrange home care. They notice something, explain it away, notice it again, and eventually a fall or a hospital admission makes the decision for them.
The signs below are the ones that reliably come before that. None of them is proof of anything on its own. Two or three together, over a couple of months, usually mean the margin someone has been managing on has got too thin.
In the kitchen
1. The fridge tells you more than they will. Out-of-date food that has not been thrown out, or an empty fridge with a full cupboard of tinned goods, both point the same way: cooking has become too hard, and something easier has replaced it.
2. Weight has changed and nobody mentioned it. Clothes hanging differently is often the first visible sign, and it is rarely about appetite. It is about a stove that has become frightening, a jar that cannot be opened, or a meal that is not worth making for one.
3. The kettle, the hob, the smoke alarm. A scorched pan at the back of the cupboard. A smoke alarm with the battery taken out. These are not clumsiness, they are near misses.
In the house
4. Post is piling up unopened. Especially anything official. Unopened mail can be an early sign of cognitive change, and it has expensive consequences: missed appointments, lapsed insurance, unpaid bills.
5. The house has stopped being kept the way they kept it. Not untidy: different. Somebody who was meticulous for fifty years and no longer is has usually not changed their standards. Something is stopping them meeting them.
6. New damage nobody explains. A dent in the car. A cracked door frame. Bruises on arms and shins that get waved off. Ask, gently, twice.
In how they are
7. They have stopped doing something they loved. The choir, the bridge night, the walk. There is often a reason underneath, such as a fall, incontinence, or embarrassment about hearing, and the reason matters more than the activity.
8. Repeating within a single conversation. Not forgetting a name, which everyone does. Asking the same question twice in ten minutes is different, and worth a GP visit. The Alzheimer Society’s warning signs of dementia are worth reading before you go.
9. Medication is being missed or doubled. A pill organiser with the wrong days empty is a clear signal. So is a cupboard with three years’ worth of a drug that was stopped.
10. They have become anxious about ordinary things. New reluctance to answer the door, to go out alone, to be left. Anxiety often precedes a diagnosis by a long way.
In the family
11. One person is quietly doing everything. Often one family member, usually nearby, usually saying it is fine. Look at that person’s health, not only your parent’s, because family caregivers get ill, and when they do two people need help instead of one. Family Caregivers of British Columbia is there for them.
12. Everyone is bracing. If the family has started planning around what might happen, the situation has already changed. Deciding while everyone is calm produces a much better outcome than deciding from a hospital corridor at 11pm.
What to do about it
Start with the GP. A great many of these signs have treatable causes that are not dementia: a urinary tract infection, a thyroid problem, depression, poor hearing, a medication interaction, undiagnosed pain. Rule those out before assuming decline.
Get a health authority assessment. In British Columbia, publicly funded home support starts with an assessment by your health authority. It is income-tested, it is often cheaper than private care, and if it meets your needs you should use it. Our costs and funding guide explains how it works and who qualifies.
Talk to the person, not about them. A capable adult decides what happens in their own home. Arriving with a plan already made is the single most common way this conversation goes wrong. Ask what they are finding hard. Most people know.
Start small. Two hours a week of help with the shopping is a much easier thing to accept than “caregivers coming in”, and it establishes a relationship before there is a crisis that needs one.
If you would like to talk it through with a coordinator, there is no charge and no expectation that you become a client. Get in touch. We would rather help you work out that you do not need us yet than sell you something you are not ready for.
