Dementia and loss of judgment: What you need to consider

“I think you should do a dementia test.” The daughter hesitated for a long time before finally deciding to say the fateful sentence to her father. His neglect had piled up too much recently. He was receiving reminders more and more often because the bills had not been paid. He had also missed the bank appointment to renew the mortgage.

But are such incidents just part of normal forgetfulness, or is it already a loss of judgement? The question is difficult to answer – and at the same time represents a serious interference in one’s personal fate. If relatives have difficulty bringing up the sensitive subject, she can understand that, says Annina Spirig, prevention specialist at Pro Senectute Switzerland: “It is quite typical for people with dementia to initially not notice their impairments or even deny them. In addition, the condition of those affected often fluctuates greatly – depending on how they are feeling 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 around 15 minutes. They test memory and mental capacity. In the supermarket task, for example, the test person has to name as many products as possible that are available to buy 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 quick tests cannot of course replace a serious medical diagnosis. Doctors base their judgment on the following four criteria: cognitive ability, ability to evaluate, ability to form a will and ability to implement a will. In less technical terms, it is a matter of examining the extent to which attention, memory, perception and verbal 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 is affected by dementia. Women are at 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 prepare for dementia?

In principle, it can happen to anyone. That makes it all the more worthwhile to be prepared for such a situation. But in practice, he often finds that the topic is pushed aside, says Karl Flubacher, member of the management team at VZ Vermögenszentrum. “In our consultations, customers naturally talk about wills. But only a few have grappled with the idea that they themselves may no longer be capable of making decisions in their own lives.”

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

In the worst case, a report of danger is made to the Kesb, the child and adult protection authority. Anyone who has official dealings 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 a guardianship – 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 advance directive. This document states who will look after you if you lose your capacity to judge. “It should be noted that this directive only becomes officially valid once it has been validated by the adult protection authority,” says Annina Spirig. “In addition, the advance directive must be written by hand or notarized. And it is advisable to report the storage location of the original document to the civil registry office. This makes validation by the Kesb easier.”

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

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

What questions need to be clarified in the advance 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 not be sold under any circumstances. “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 about real estate are particularly tricky, says Flubacher. As an example, he cites a case in which there was no advance directive: the Kesb opposed the wife selling the apartment, even though the couple had agreed to this before the husband moved into a nursing home – albeit only verbally. “It is also important that the Kesb does not need to be informed about the content of the advance directive, as it is a private matter. The authority can therefore only check whether the people appointed are personally and professionally suitable to carry out their tasks.”

So if you don’t want to leave it up to Kesb to decide who takes on which powers, you must define this yourself. However, a person in charge of care must also be prepared to do this, stresses Annina Spirig from Pro Senectute Switzerland. The task can easily become overwhelming, especially in the event of conflicts within a family. “Many people are not aware that they are liable with their personal assets if they commit a wrongdoing. 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.”

The situation is different if the Kesb appoints an assistant: in this case, the canton is liable for damages resulting from unlawful acts. The authorities have also determined the compensation that an assistant should receive for his work. In the canton of Zurich, this starts with a basic flat rate of 2,000 francs for a period of two years, but can rise significantly depending on the work involved. If, for example, 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 when you have dementia?

It is worth planning your advance directive carefully, especially because it can quickly become expensive. The industry association Curaviva estimates the cost of a person in a nursing home at an average of 10,200 francs per month. The health insurance company covers around 40 percent of this – the rest has to be paid by the person themselves. According to a calculation by the VZ Asset Center, people in need of care should expect to spend an average of 170 to 180 francs per day themselves. Extrapolated over the year, this amounts to a hefty sum of over 60,000 francs.

If the money saved is no longer sufficient, pensioners can apply for supplementary benefits from the state. However, since the reform at the beginning of 2021, this subsidy is only paid when the person’s own assets have fallen below 100,000 francs. For married couples, there is a limit of 200,000 francs.

In order to protect the family fortune 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 gifts: only an amount of 10,000 francs per year is permitted. For higher amounts, the authorities add the money given away to the person’s own assets before granting supplementary benefits. In some cases, the social welfare office can also claim support from relatives 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. “But in today’s system there is little incentive to put money aside for possible dementia. Because in some cases, someone who is thrifty doesn’t get better care than someone who has already squandered their income.” State care insurance could therefore ensure more fairness, says the VZ expert.

However, it is not only the state that should take better care of the demographically-driven increase in dementia sufferers. Those affected themselves also far too often postpone the necessary planning as long as they are still capable of making decisions. But it would be time well spent: a simple advance directive can be drawn up in an hour – but can influence the quality of life for years to come.