Dementia and loss of judgment: This is important to consider

“I think you should get a dementia test.” The daughter hesitated for a long time until she finally decided to say the fateful sentence to her father. His failures had accumulated too much over the last period of time. There were more and more frequent reminders because the bills had not been paid. He also missed the bank appointment to renew the mortgage.

But are such incidents still part of normal forgetfulness, or does it already represent a loss of judgment? The question is difficult to answer – and at the same time represents a serious intervention in one’s personal fate. If relatives have trouble broaching the sensitive topic, they can understand that, says Annina Spirig, prevention specialist at Pro Senectute Switzerland: “It is quite typical for the course of the disease of people with dementia that they initially do not notice their impairments or even deny. In addition, the condition of those affected often fluctuates greatly – depending on their condition on the day.

What criteria determine whether dementia is present?

There are numerous tests available online for an initial assessment of dementia or Alzheimer’s, which only take about 15 minutes. Memory and mental capacity are tested. In the supermarket task, for example, the test person is asked to name as many products as possible that can be bought there in 30 seconds. Other tasks include repeating a series of numbers such as 3-5-7 in reverse order or writing down a three-digit number as a word.

 

However, such rapid tests cannot of course replace a serious medical diagnosis. Doctors base their judgment on the following four criteria: cognitive ability, evaluation ability, will-forming ability and will-implementing ability. To put it a little less technically, it involves checking to what extent attention, memory, perception and linguistic communication are impaired.

As debatable as the diagnosis may be in individual cases, it is clear that almost one in three people over the age of 85 are affected by dementia. Women have an even higher risk. Increasing longevity also means that more and more elderly people are losing their ability to judge.

Why is it so important to take precautions in the event of dementia?

In principle, it can affect anyone. It is even more worthwhile to be prepared for such a situation. But in practice he often finds that the topic is ignored, says Karl Flubacher, member of the management of the VZ Vermögenszentrum. “In our consultations, customers naturally talk about the will. But only a few have grappled with the idea that they themselves might no longer be capable of making judgments in their lives.”

It is in our own interest to prepare ourselves for the event of dementia – and to do so early on, emphasizes Flubacher: “If mental fitness declines, the most important thing is to protect the dignity of the person affected. Good planning can make this task much easier for both the relatives and the authorities.”

In the worst case scenario, a risk report is made to Kesb, the child and adult protection authority. Anyone who officially deals with a person who they consider to be in need of help is even obliged to make such a report. But neighbors or relatives can also alert the Kesb. The authority then organizes assistance – if necessary, even against the will of the person concerned.

How do you ensure that no one undesirable decides your fate?

The first step is to create a so-called precautionary order. This document records who will care for you if you lose your judgment. “It should be noted that this order only becomes officially valid once it has been validated by the adult protection authority,” says Annina Spirig. “In addition, the advance care directive must be written by hand or notarized. And it is advisable to report the location of the original document to the civil registry office. This makes validation by Kesb easier.”

The precautionary mandate contains three areas: Personal care concerns physical, mental and spiritual well-being. It can be supplemented by a living will, which defines the medical treatment and the type of care services. The second aspect is financial concern, which is particularly important when it comes to home ownership. And the third point concerns representation in legal transactions. This is particularly about contact with the authorities; for example, many people in need of care need supplementary state benefits.

All of these tasks can take a lot of time and also require a great deal of specialist knowledge. For this reason, the advance care mandate should clearly define who is responsible for which tasks and whether specialists such as trustees also have decision-making authority for special areas. “We always recommend that the names of possible replacements are mentioned in the document,” explains Karl Flubacher. “For example, you can define that the responsibility lies with the spouse as long as her health allows it, and then passes on to one or more offspring.”

What questions need to be clarified in the advance care directive?

The VZ expert also recommends going into detail in this document about aspects that you personally consider to be important. Anyone who wants vegetarian food in the nursing home can record this as well as information about which valuable pieces of jewelry, paintings or furniture should under no circumstances be sold. “The more detailed the orders are recorded, the smaller the risk that the authorities will take a measure that contradicts the wishes of the person concerned or their relatives.”

Decisions regarding real estate are particularly sensitive, says Flubacher. As an example, he cites a case in which there was no precautionary directive: Kesb opposed the wife’s sale of the apartment, even though the couple had agreed this before the husband moved into a nursing home – but only verbally. “It is also important: Kesb does not have to be informed about the contents of the precautionary mandate because it is a private matter. The authority can therefore only check whether the persons appointed are personally and professionally suitable to carry out their tasks.

So if you don’t want to leave it to Kesb who takes over which powers, you must have defined this yourself. However, a person responsible for precautionary measures must also be prepared to do this, emphasizes Annina Spirig from Pro Senectute Switzerland. The task can easily become overwhelming, especially when there are conflicts within a family. “Many people are not aware that they are liable with their personal assets in the event of misconduct. In addition, relatives and third parties such as the home or the bank can request an audit if, for example, there is a suspicion that funds are being embezzled.”

It is different if the Kesb appoints an advisor: In this case, the canton is liable for damages resulting from unlawful actions. The authorities have also determined what compensation a support person should receive for their work. In the canton of Zurich, this begins with a basic flat rate of 2,000 francs for a period of two years, but can increase significantly depending on the effort. If legal expertise is required, the hourly rate is 240 to 360 francs. The upper limit for a period of two years is usually 25,000 francs. If a relative takes on the mandate instead, the salary can also be based on these guidelines.

What costs do you have to calculate with dementia?

Precisely because it quickly becomes expensive, it is worth carefully planning your precautionary mandate. The industry association Curaviva puts the average expenditure for a person in a nursing home at 10,200 francs per month. The health insurance company covers around 40 percent of this – you have to shell out the rest yourself. According to a calculation by the VZ Vermögenszentrum, those in need of care should expect to pay an average of 170 to 180 francs per day. Extrapolated over the year, this amounts to a hefty sum of over 60,000 francs.

If the money saved is no longer enough, pensioners can apply for additional benefits from the state. However, since the reform at the beginning of 2021, this subsidy will only be paid if your own assets have fallen below 100,000 francs. There is a limit of 200,000 francs for married couples.

In order to protect the family wealth that has been built up over decades, one might be tempted to pass it on to one’s descendants at an early stage. But the state also takes a close look at donations: only an amount of 10,000 francs per year is permitted. For larger sums, the authorities add the money given away to their own assets before granting additional benefits. In some cases, the social welfare authorities can also claim relative support and demand additional contributions from the children.

The state is in a dilemma here, says Karl Flubacher. It certainly makes sense for people in need of care to use their assets to cover the high costs. “In today’s system, however, there is little incentive to put money aside for possible dementia. Because under certain circumstances, someone who is thrifty will not receive better care than someone who has already blown their income away.” The VZ expert believes that state nursing care insurance could ensure more fairness.

However, it is not just the state that should take better care of the demographically-related increase in dementia sufferers. Those affected themselves too often put off the necessary planning while they are still capable of making judgments. It would be time well spent: a simple precautionary order can be created within an hour – but can influence the quality of life for years to come.