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Author: Karen L. Rice, M.A., LNHA, Gerontologist, Negotiator, Mediator
Guide Publishing, 1180 Bell Road, Chagrin Falls, OH 44022. Copyright 1989-2004

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Home Safety and Dementia

By Karen L. Rice, M.A., LNHA
Gerontologist, Negotiator, Mediator

If you are caring for an elder with Alzheimer's disease or another form of dementia, no doubt you have wondered if it is safe for you parent to continue living at home. Will Dad wander away from the house? Is Mom growing more confused? Does she recognize you when you come to the door?

The cognitive problems that a person with dementia experiences cause a variety of home safety concerns. This is an ongoing concern for family members, because as the individual's dementia progresses, so do the needs for care. You should continually evaluate the ability of your parent to live at home safely. Questions to regularly ask are:

  • Can the elder recognize a dangerous situation, like a fire?
  • Does the elder know how to use the telephone for getting help?
  • How content is he or she at home?
  • Are there signs of agitation, depression or withdrawl?
  • Does the elder wander?
  • Is his or her confusion increasing?

The more the answers to these questions spell risk, the more you should consider placement in a specialized long-term care facility to reduce the chance of danger.

Safety at home
When evaluating safety around the home, keep in mind that dementia behaviors are unpredictable. Prevention should be one of your primary concerns. Adapt the home so danger is minimized while still allowing the elder to be as independent as possible. This helps control agitation.

Wandering is a serious risk. As a senior with Alzheimer's wanders aimlessly, he or she may fail to sense temperature extremes, moving vehicles and other dangers. Not everyone with dementia wanders. It is unpredictable who will wander or when. It is our job as caregivers to put security in place so that a person with dementia may pursue the need to wander, if or when that happens.

Below are suggested home modifications to help wandering, confusion, agitation and aggressiveness. All of these are behaviors common to Alzheimer's disease.

Kitchen - Simple steps like unplugging appliances can eliminate a potential danger. Inserting plastic outlet covers makes it more difficult for the elder to plug the appliance back in. Faucets can be restricted with heavy rubber bands. Remove equipment like knives, can openers, matches, chemicals and decorative items like throw rugs. Install inside locks (e.g., child safety locks) on drawers and cabinets. Locks on outside doors will keep the elder safely inside the house.

Bathroom - Medicine, razors, soaps and chemicals should be stored and locked in one place. Color-code or label faucets "hot" and "cold." In the tub/shower area, grab bars, nonskid mats and shower chairs are helpful. Consider posting reminders in the bathroom (such as "FLUSH TOILET" or "EXIT") and elsewhere around the house.

Living and dining rooms - Simplify the layout of rooms by rearranging furniture. Remove light-weight furniture that a confused elder could move easily. Eliminate obstacles like cords, throw rugs and knickknacks so that the senior can move about freely. It is important to keep the environment (here and elsewhere in the house) uncluttered to reduce confusion and agitation.

Halls and stairways - Address a demented elder's impaired senses by installing smoke alarms in case he can not smell smoke himself. Nightlights can help guide the elder. Similarly, dark areas warn him where not to go. In some cases, darkness can "erase" a room or hallway in the mind of a demented person. Darkening areas is one way of detouring a wandering elder. Add color contrast at the edges of stairs to help the elder differentiate between steps.

These home modifications are just a start. More home safety tips for those with dementia are available from ADEAR (the Alzheimer's Disease Education and Referral Center), which is a service of the National Institute on Aging. On the web site, you will find a useful publication called "Home Safety for People with Alzheimer's disease." Also, A Perfect Cause is an organization devoted to long-term care reform which addresses, in particular, the phenomenon of "walking away," or wandering, that can occur in a facility.

When home isn't an option
At what point is it no longer safe to care for someone with Alzheimer's at home? You should seriously consider moving the elder to a specialized long-term care facility when he or she requires around-the-clock skilled care for such things as medication management or supervision of vitals or psychiatric conditions like hallucinations, illusions and delusions.

Wandering is another reason to consider moving your parent. When wandering is extreme, the walking paths within the home may be too limiting for the elder, causing extreme agitation. Today, many healthcare facilities are designed to facilitate safe wandering, including looping pathways and security systems that alert the staff of an elder's whereabouts.

It is possible to successfully care for an elder with dementia at home, as long as the necessary support and supervision are in place. At some point during the disease's progression, however, the intensity of these requirements exceeds the abilities of most families. One of your most important responsibilities as a caregiver is to identify the point at which your loved one is no longer safe at home.

Author Karen Rice is a gerontologist, mediator and licensed nursing home administrator in private practice in dementia care services