Signs it is no longer safe at home

Almost nobody rings a care home the first time they worry. They ring after the third fall, or after a hospital stay, or after a week of holiday cover collapsed and nothing was in place underneath it.

That gap — between noticing and acting — is where most of the avoidable harm happens. It helps to know what is worth acting on.

The changes that usually matter

Falls, or near-falls that are being hidden from you. One fall is an event. Two is a pattern, and the second one is a much better predictor of the third than anybody wants it to be. Watch for bruises that come with a vague explanation; people conceal falls because they know what the conversation afterwards will be about.

Medication going wrong. Not “she sometimes forgets”. Doses doubled, doses missed for days, a repeat prescription that has not been collected, tablets in the wrong day of the organiser. Medication management is one of the most common reasons a home becomes unmanageable, and one of the most fixable.

Weight coming off. Often the earliest hard signal, because it is measurable. Shopping becomes difficult, then cooking becomes difficult, then eating becomes optional. Look in the fridge, and look at the date on what is in it.

The house telling a different story than she is. Post unopened. Bills unpaid, or paid twice. The kitchen not quite clean. A burnt pan put away. Heating off in February, or on in July. People are extraordinarily good at holding together a twenty-minute phone call; a house is less discreet.

Getting lost somewhere familiar. Driving home the long way, confusion in a shop she has used for a decade, wandering at night. This one moves faster than the others and is worth acting on sooner.

A carer who is failing. If one spouse or one adult child is holding the whole thing up, watch that person too. Carer exhaustion is the most commonly missed warning sign in this entire list, and the collapse, when it comes, is sudden.

The changes that usually do not

Being slower. Being repetitive. Wanting the television louder. Being less interested in going out. Sleeping in the afternoon. Getting cross about being asked. These are age, or hearing, or boredom, or grief — sometimes all four — and none of them is on its own a reason to move anybody anywhere.

The distinction worth holding is between difficulty and danger. A great deal of difficulty can be lived with, and should be. Danger is a different category, and it does not usually reverse.

What to do about six months earlier than feels necessary

You do not have to decide anything to start finding out. Three things are worth doing while there is no crisis:

1. Get a medical opinion, properly. Ask for a full review rather than a fifteen-minute appointment about one symptom. A surprising number of “declines” turn out to be a urinary infection, a thyroid problem, a drug interaction, or hearing loss.

2. Look at two or three places, without committing to anything. Touring while calm is a completely different experience from touring from a hospital discharge lounge with four days’ notice. You will ask better questions and you will not be choosing under duress.

3. Have the conversation once, badly, and then again later. It rarely goes well the first time. It goes better the second time, and better again the third, because the idea has had time to stop being an ambush.

On the guilt

Nearly every family we meet arrives convinced that moving a parent is a failure of love, and describes it in those terms in the first ten minutes. It is worth saying plainly: exhaustion is not devotion, and a daughter who is running on four hours’ sleep and lifting someone she cannot safely lift is not providing better care than a team of people who are rested.

The question is not whether you can keep going. It is usually whether you should.

If you are somewhere in this and want to talk it through with somebody who has seen it a number of times, that is what the phone number at the top of this page is for. You do not have to have decided anything.