(Alzheimer’s Disease Canada) Living in a place that is safe, familiar and comfortable is important to everyone, including people with Alzheimer’s disease or other dementias.
A diagnosis of dementia does not automatically mean that a person is incapable of living alone. Some people may be able to live on their own for some time after the diagnosis. Others may be at too much risk to continue living alone.
It is often difficult to decide when a person is at too much risk to continue living alone. When people who live alone have Alzheimer’s disease or other dementias, diagnosis may occur later in the disease because their symptoms may go unrecognized.
A premature move from home should be avoided. Moving people with dementia away from home to live, for example, with a son or daughter, or in a long-term care setting, may feel like a loss of freedom. Being able to access support and safety services, however, may result in more independence.
Each person’s living situation should be monitored and assessed carefully, as the disease progresses.
Loss of independence: Some people with Alzheimer’s disease can tell when living alone is no longer safe or desirable. Others may want to stay in their own home for as long as possible, even if there are some safety concerns. They may be worried that a move away from home would mean a loss of self-reliance and control in their daily lives.
Premature move from home: The person with the disease may have a higher tolerance for risk than family members and caregivers and may feel pressured into moving out of the home earlier than necessary.
Living alone: Many people with Alzheimer’s disease continue to live successfully on their own for some time. Here are some ideas to help:
- Speak to your Alzheimer Society, local community support agency or doctor about help with housekeeping, meal preparation or transportation.
- Talk to your bank manager about bank-at-home services. Arrange for direct deposit of cheques.
- Sort out closets and dresser drawers to make it easy to choose what to wear. Have a family member help you if necessary.
- Leave a set of house keys with a trusted neighbour.
- Use electrical appliances that shut off on their own.
- Install a smoke detector and check the batteries regularly.
- Leave written reminders to yourself like “turn off the stove” or “unplug the iron.” Place them where you will see them.
- Label cupboards with words or pictures that describe what is inside, for example, dishes, knives and forks.
- Write telephone numbers in large print and post by the phone. Include people to contact in an emergency.
- Write your address down and post by the phone. Keep a map with you that shows where your home is.
- Accept help when it is offered.
- Ask for help when you need it.
- Take your time.
- If something is too difficult, take a break.
Determining when living alone is no longer safe or desirable:When people with dementia no longer understand their own safety and can’t look after themselves, family members and health-care professionals may need to weigh the risks of living alone against the benefits of supporting him to live at home. In many families, caregiving falls to one person. Hold a family meeting when he is at an early stage of the disease, so that you can plan what each family member can realistically do to help, now and in the future.
Barriers within the health-care, community care and legal systems: Family members and health-care professionals often face barriers when trying to determine if a move from home is needed or if additional support can be provided in the home. These barriers include the difficulty of sharing information under privacy and confidentiality regulations; the limited availability of services to support independent living; and the complexities of competency legislation (the laws that determine when a person is no longer able to make certain decisions).
Living environments that provide safety, quality of life and support
People with Alzheimer’s disease need to live in safe environments that support quality of life. The amount and type of support available are important factors in determining if a person can live alone. For example, a person with a large family, or someone who lives in a community with many services may be better able to live alone than someone with no family, living in a community with limited services.
Family members and health-care professionals can help reduce risks for people with dementia who want to live alone. For example, if he frequently leaves the stove on, consider disconnecting the stove and finding other ways to provide hot food, such as Meals on Wheels.
Wherever possible, the person with the disease should take part in discussions concerning their own future.
Some factors to consider:
- What is his quality of life at home?
- Is there a good balance of stimulation during the day?
- Could he benefit from the level of care and support provided by another environment, such as a son or daughter’s home, retirement home or long-term care home?
- Is there help from community support agencies?
- Is he able to take medication properly?
- If sick, would he be able to understand and take appropriate action, such as calling for help?
- Is he able to take care of personal hygiene, such as bathing and toileting?
- Are there current or past health problems that might put him at risk of harm?
- Is he able to maintain a proper weight?
- Is he able to eat nutritiously throughout the day?
- Is he able to store and prepare foods properly?
- Is he eating inappropriately (cat food)?
- Is she at risk of harm? If yes, is the amount of risk acceptable to her? To family members? To caregivers?
- Is it possible to find a level of risk with which everyone is comfortable? For example, the risk of falling on the stairs might be considered an acceptable risk if she has no problems with balance or walking.
- Does the she pose a risk to others? For example, does she live in an apartment and cause fires with the stove or cigarettes?
- Is she able to react and take appropriate action in an emergency, such as a fire?
- Is her home safe? For example, are stairs well lit? Are there handrails?
- Do individuals or organizations check in with her regularly and in the event of a blackout or other emergency situations?
- Can she handle day-to-day financial transactions, such as keeping track of bills and paying bills promptly?
- Is she at risk of exploitation or abuse regarding finances?
Can she handle day-to-day financial transactions, such as keeping track of bills and paying bills promptly?
The following day-to-day strategies may help support a person with Alzheimer’s disease who lives alone. Assess the abilities of the person before initiating any of these strategies.
|Safety||Leave a set of house keys with trusted neighbors.||Access to the home is available.Someone can enter if there is a problem.||Neighbors not always at home.|
|Arrange for someone to call or visit once a day.||Regular checks can reassure person as well as family.May be able to monitor areas of concern.||Only once a day. Problems may arise at other times.|
|Register with Safely Home™ — Alzheimer Wandering Registry (Canada) or Alzheimer’s Association (US).||Provides peace of mind for the person and family should the person wander away from home and become confused.|
|Appliance safety measures:Automatic shut off kettle.
Stove safety — remove fuses, put burners on timers, shut off gas.
Lower temperature of hot water heater.
|Minimizes the chance of accident.||Some people may find the changes confusing or frustrating.|
|Emergency call system.||Person has 24-hour access to help should a problem arise.||Person may not be able to understand concept or use of call button.|
|Daily Living||Get help with tasks, such as housekeeping and meal preparation.||Someone is in the home to supervise activity and provide companionship.Tasks get accomplished.||Person with disease may be reluctant or resistant to accepting help.|
|Sort closets and dresser drawers to make only the necessary clothes available.||Makes decisions about what to wear easier.||Does not help if person has trouble knowing when or how to dress.|
|Food||Meals on wheels.||Delivery of hot meal once a day.||No way to monitor if food has been eaten or stored properly.|
|Provide toaster oven or microwave for heating food.||Good alternatives to stove.Allows use of pre-prepared foods with little work.||Person may not know how to use or may not be able to read or follow instructions.Concern about use of metal in microwave.|
|Use prepared foods, non-perishable foods and foods that do not need to be stored in a refrigerator.||Preparation is easier.Less concern about spoilage.||Preparation may still be too complex.The person may not like the food.|
|Medication||Simplify medication routines. For example, use a pill dispenser. Have someone visit to give pills.||Allows only a small supply of pills at once.Helps person take the pills on the right day and time.||Possibility for confusion about day and time. May not prevent person from taking extra medication, if more than one day’s supply is available.|
|Finances||Bank-at-home services.||Person does not have to leave home.Personalized service.||Person may not be able to deal with finances.Does not protect from overpayment.
non payment of bills, or from scams.
Person may not be willing to use new methods or have someone help with finances.
|Make someone else, such as a substitute decision-maker, responsible for handling finances, such as writing cheques, paying bills, monitoring accounts.||Allows person to manage finances with some independence yet provides protection.|
|Direct deposit of cheques and direct payment of bills.||This hands-free approach to banking offers fewer chances for problems.|
Living in a place that is safe, familiar and comfortable is important to everyone, including people with Alzheimer’s disease. A diagnosis of Alzheimer’s disease does not automatically mean that a person is incapable of living alone. Some people may be capable of living on their own for some time after the diagnosis. Others may be at too much risk to continue living alone. It is often difficult to decide when a person living at home is at too much risk to continue living alone. However, a premature move from home should be avoided. Each person’s living situation should be monitored and assessed carefully, as the disease progresses.
Some of the barriers to making informed decisions about a person’s ability to live at home include privacy of information regulations, availability of community support programs and competency legislation. With growing numbers of people with Alzheimer’s disease living on their own, there is a need for more public discussion of these issues.
© 2015 Alzheimer Society of Canada. All rights reserved.