(Alzheimer’s Foundation of America) Turning a home into one that is dementia-friendly can help minimize accidents and maximize well-being. It can also give peace of mind and reduce stress for at-home and long-distance caregivers.
Act Before a Crisis
In safeproofing surroundings, it is best to take preventative steps, rather than scramble around to solve an immediate crisis. This way, options can be more carefully weighed. The challenge is to balance a desire to keep individuals with dementia as functional as possible against the hazards posed by their cognitive decline, which may include poor judgment, difficulty with spatial perception and inability to react appropriately. Observing an individual’s patterns and how they navigate their environment, looking for red flags, and pinpointing causes and effects are all very telling.
Professionals or family caregivers themselves should survey a home three times, progressing in security at each inspection. Look for safe, safer and safest.
- Safe involves detecting basic dangers and fixing or removing those items, such as movable furniture that people wrongly rely on for support, chairs that blend in with the walls behind them, and loose extension cords and telephone wires;
- Safer means locating ways to minimize injury in the event of accidents, like replacing glass tables with furniture that has blunt edges, and locating a soft rubber mat by the bed in case of a fall; and
- Safest is maximizing access to help in an emergency, such as installing a monitoring device.
Look at critical areas. Since people with dementia need a quiet, orderly environment, it is critical to address factors such as noise, color and lighting. Modifying kitchens and bathrooms, and taking steps to deter wandering are primary concerns. The key is to pay special attention to lighting, furnishings, textures, changes in elevation, handrails, and types of flooring, and to remove hazardous clutter from floors, stairways, etc. Often, small changes can make big differences. For example, reducing the level of light during meals may prompt better eating habits; camouflaging an exit door with a curtain may prevent wandering; and removing clutter and unnecessary furniture may reduce confusion.
Be creative. Products do not have to be taken at face value; rather, consider a person’s specific condition and further adapt products for an even greater sense of security. And always keep in mind that, with this progressive disease, what works one day may not the next.
Consider redundant strategies for life-threatening situations. For example, to help prevent wandering, install multiple locks on a door, each at varying heights out of direct sight and requiring different skill sets to open, and supplement them with an alarm. Or when buying a personal response system that uses pendants with a call button to alert a central monitoring station, spring for extras. Use one as a pendant, and cut off the strings from the others and use double-sided tape to install the help buttons to base moldings in key spots. This way, if the individual falls while not wearing the pendant, he could crawl to an emergency button in, say, the foyer or shower.
Walk gently. While many changes sound easy enough, convincing the at-home caregiver and/or their loved one to alter their environment can be the hard part. Often, their reluctance boils down to a sense of shame or the feeling that many assistive devices are unattractive.
Look for designs and assistive devices that give people independent functioning while maintaining privacy and dignity. One example of a perfect solution: grab bars so individuals can get on and off the toilet by themselves. Manufacturers are increasingly designing products without a medical-type appearance, addressing the “shame” issue for both caregivers and those with dementia. Products are nicer looking, boasting decorative colors and style.
In presenting home safety features to individuals with dementia, be delicate. Since most people do not welcome change, caregivers may need to broach the subject on several occasions and make gentle suggestions. Also, try to include the person with dementia in the decision-making process. And use language that empowers the person to agree to the safety features for someone else’s sake, such as, “It’s not for you; it’s for me so I don’t worry so much.” Another effective strategy is to call solutions by another name—gifts.
- Clear all passageways.
- Remove unnecessary furniture, knickknacks, clutter and items that may cause confusion.
- Fix loose or uneven steps, and loose or broken handrails.
- Put gates at the top of stairways.
- Install safety latches on cabinets that store dangerous items, such as knives, firearms, medications and cleaning products.
- Place guards around radiators and other heaters.
- Install secure locks that are higher or lower than eye level on outside doors and windows.
- Eliminate poisonous houseplants.
- Keep small objects that may be swallowed out of sight.
- Make sure electrical wires and phone cords are secured and cannot be tripped over, and that lamps cannot fall over.
- Remove or fasten down scatter rugs to prevent slipping.
- Put nightlights in bathrooms, hallways and bedrooms.
- Make sure light fixtures are easy to turn on, such as switches near doorways and glow-switches.
- Use maximum wattage allowed by fixtures.
- Reduce glare with frosted bulbs.
- Ensure adequate lighting by stairways and passageways.
- Remove stove and oven knobs when not in use.
- Install an automatic shut-off switch on the stove.
- Put away kitchen appliances such as blenders and toasters.
- Use non-slip decals or mats in the tub and shower.
- Install grab bars around the tub, shower and toilet.
- Try a bathtub bench or a hand-held shower.
- Keep the temperature gauge on the hot water heater at 120 degrees or lower to prevent scalding.
- Remove locks on bathroom doors.
- Outfit the individual with an ID bracelet or some other form of identification.
- Obtain a wristband transmitter or other tracking device to locate wanderers.
- Post emergency telephone numbers in large print near phones.
- Prepare and practice an emergency exit plan.
Note: Don’t leave someone home alone—even for a few minutes—if they cannot respond to an emergency situation.
Both fear of falling and a fall itself are real concerns for older Americans. The domino effects can be enormous, often resulting in injuries, an emergency department visit, hospitalization and even death. And, individuals who have Alzheimer’s disease may face a greater risk of falling. There are some simple strategies to help reduce risk of a fall:
- Clear out the clutter. Excess clutter increases the likelihood that someone will trip. Get in the habit of putting things away immediately and keep pathways clear.
- Light the way. Place night lights or motion-sensitive lights strategically throughout the living space.
- Bump-proof the bathroom. Use a slip-resistant rubber mat or textured adhesive on tub and shower falls to help reduce slips. Install grab bars and/or a durable seat in the tub or shower to ease access.
- Keep it within reach. In the kitchen, keep dishes, pots, utensils and food within reach to reduce the likelihood of stepping on a stool, chair or countertop to grab something.
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A person’s right to dignity and need for independence complicate the decisions surrounding home safety and supervision. Individuals with Alzheimer’s disease and other dementias are likely to be convinced that it is safe to be alone long after it has clearly become unsafe-even after several accidents or injuries have occurred. Always ask yourself: Is it still harmless for my loved one to be alone? If it is, these steps can help:
- Provide reassurance before you leave the house, since being alone can cause anxiety and fear for those with dementia.
- Explain that you are only running out for a minute, and remind your loved one that he can call you or another family member if he feels concerned.
- Put important telephone numbers and step-by-step instructions at each phone.
- Make some simple activities, like a favorite movie or puzzle, readily available to provide distraction.
- Ask a friend or another family member to call to chat while you are out, and to reorient your loved one and provide reassurances.
- Leave large, simple notes around the home, such as “Joan is at the store and will be home soon” or “Joan will be home when this clock says 4:30.”
- To ward off wandering, put up visual cues on the exits, like “Stop” or “Do Not Leave.”
- Make sure that your loved one has some type of identification bracelet, such as those available from local Alzheimer’s agencies.
- Consider enrolling in Project Lifesaver, which uses state-of-the-art radio technology to quickly locate wanderers.
Heightened anxiety can indicate that it is no longer okay for your loved one to be home alone. Then, consider making other arrangements, such as:
- Ask a neighbor or family friend to visit in your absence.
- Invite a friend to accompany you and your loved one outdoors, running errands together as a group.
- Hire a trustworthy individual from the community—a high school student or member of your congregation, for example—to come in for a few hours.
- Bring in trained dementia care professionals.
As a caregiver, you must assess when to change routines to assure adequate supervision. The last thing that a well-intended caregiver needs is a crisis situation that could have been prevented. These crises can also be construed as neglectful, possibly leading to a Protective Services investigation. It is the caregiver’s legal and ethical responsibility to intervene when supervision is needed.
Survival Guide to Hospitalization
A hospital stay can be frightening, confusing and risky for anyone. But for people with Alzheimer’s disease or a related dementia, it can be downright dangerous—and even deadly. It is critical to take steps that can help prevent conditions that would land a person in a hospital, or should an admission be unavoidable, help keep the person safe while there.
- Check symptoms, such as coughs and congestion, immediately with a phone call or visit to a physician to reduce the likelihood they will progress into something more dangerous, like pneumonia.
- Urinary tract infections are another common culprit for hospitalizations. Encourage the person to drink six to eight eight-ounce glasses of water or other non-caffeinated fluid per day
- Strive to ensure a smooth transition between care settings, (i.e., between home or skilled nursing facility and the hospital).
- Supply hospital personnel with a list of the individual’s current medications and dosages, over-the-counter medications, supplements and allergies—and make sure this is included on the patient’s chart.
- Get to know the attending nurses and doctors. Try to be present during doctors’ rounds to have face-to-face interactions with the patient’s medical professionals.
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For more information, connect with the Alzheimer’s Foundation of America’s licensed social workers. Click here or call 866.232.8484. Real People. Real Care.
©2015 Alzheimer’s Foundation of America. All rights reserved.