Dad does not say the stairs have become a problem. He solves the house around them. The laundry basket waits at the bottom step. The bedroom upstairs becomes the spare room, and the bed moves downstairs. The mail gets carried up once and then never again. Each change looks like a reasonable choice, which is why it gets missed until the first real fall happens on those steps.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
Look for the trips that stopped
Stair avoidance shows up as a set of small reroutes rather than a single event. Start by listing the regular reasons anyone used to go up or down: laundry, bathroom, bedroom, mail, the basement, the attic, the back steps to the yard. Then check which of those trips still happen and which ones now get handled another way. Write down the trips he has stopped, the room he now uses instead, and who carries the things that used to go upstairs. A rough list on paper is enough. You are looking for direction, not a precise count.
Check how he uses the rail and the light
Watch the stairs themselves the next time he goes up or down. Does he touch the rail at all, or only with one hand, or not at all? Does he turn sideways, pause at the top, or take the steps in a way he did not use to? Check whether the light switch at the top and bottom can be reached without stepping onto the first or last tread. If he has to cross a dark landing to find the switch, that is a route problem you can fix without a conversation about his balance.
Ask what he wants to keep
Dad is more likely to accept a change when it protects something he cares about. Ask him directly which trips he would rather not give up, and which ones he would be glad to hand off. Some options that keep his routine intact: a chair at the bottom of the stairs for resting, moving the laundry basket to a landing he already passes, or keeping his bedroom where it is and changing only the route to the bathroom. Let him choose between two options rather than offering one that feels like a verdict.
Compare who carries what
Decide who takes over the stair trips, and compare the options honestly. A family member may be available for some trips and not others. A hired non-medical caregiver can carry laundry, bring up the mail, or run errands, and that is a real alternative to a family member making the climb every day. A caregiver can give reminders and pick up prescriptions as an errand, but medicine stays with the family, the doctor and the pharmacist, so any question about how he takes his medication goes to them. If the change in his routine also comes with new unsteadiness, ask his doctor at the next visit whether the stairs need a look, and report the specific trips he has stopped.
Set the next move
Tonight, write three things on one sheet of paper: the stair trips he has stopped, the room or floor he now uses instead, and what currently sits at the bottom of the stairs. Then pick one check you will repeat next week, such as whether the laundry is still at the bottom step or whether the upstairs light is still being used. Name the person who does that check. If the list has more than two items on it, call the line on Local Help in St. Louis and ask who covers a stair check at the house.