En español | Caring for loved ones who have dementia at home comes with safety concerns. In addition to other health challenges, they may have visual-perceptual and physical coordination problems, as well as difficulty understanding instructions and accurately interpreting the world around them or making reasonable decisions. That means they need help to make their daily life safe.
Where to begin
The first step is to take an objective look at your loved one's abilities and how they might change in the future. Remember to consider the common safety concerns as we all age or deal with health problems, but with the added layer of cognitive impairment.
Evaluate the home, and determine what changes need to be made with the help of the individual's doctors, occupational therapists or physical therapists (talk with your loved one's doctor about orders for a consultation and if health insurance will cover the cost), geriatric care managers or aging life care experts, certified aging-in-place specialists or staff of the local Area Agency on Aging and Alzheimer's Association.
Things to consider in your loved one's daily routine:
1. The bedroom. How much assistance does he need to get in and out of bed? Are you able to manage that yourself, or do you need help? Consider equipment such as a hospital bed or bed assist bar, or a recliner/lift chair, as well as padded floor mats and a lower bed if you have concern that your loved one might fall out of bed. A floor-mat alarm, bed-pad alarm, audio monitor, motion-sensor alarm and/or video monitor will alert you if the patient gets out of bed.
2. The bathroom. This is a common place for falls and other injuries to happen. You may want to consult an occupational or physical therapist, who can best evaluate your loved one's needs and suggest placement of safety grab bars, a raised toilet seat and other equipment (talk with the patient's doctors about orders for a consultation and if health insurance will cover the cost). Consider a no-step shower entry, temperature-controlled water faucets to avoid scalding, a shower seat, nonslip flooring and other equipment.
Other bathroom issues:
- Wet floors pose a fall hazard, so keeping a portable urinal handy can be helpful if the person has a tendency to miss the toilet.
- Is it safe for your loved one to shave with a safety razor? You might consider switching to an electric razor (and may need to do the shaving yourself at some point).
- Ensure that outlets in the bathroom have GFI (ground fault interrupt) or are protected by a GFI circuit so they will shut off if they get wet.
- Check for toxic cleaning supplies in the bathroom that might be confused with cosmetics or medicines.
3. General mobility. Evaluate your loved one's balance; coordination; strength; and ability to walk, sit and stand by herself or with assistance. Is she able to get in and out of a chair unassisted, or would a lift chair help? Is it time to stop using chairs that swivel or have wheels? If you consider a small home elevator or a stair lift with a seat, determine whether your loved one can understand how to safely use them and if you can help. And if you make changes, remember that people who have dementia may take more time to adjust or may not be able to adjust.
4. Fall prevention. Check for all fall hazards, including loose rugs, poor lighting, stairs, clutter, no handrails, or uneven flooring or pavement. If you have animals, keep their food, water dishes, leashes and doggie doors away from areas where your loved one might walk and potentially trip.
5. Paint colors, flooring, lighting and mirrors. It's best to have solid-color walls painted in light hues to reflect more light and avoid confusing patterns on wallpaper. Consider color and texture contrasts between walls and floors to help with depth perception. Mark edges of steps with brightly colored or glow-in-the-dark tape. Adequate lighting is key to preventing falls, as poor lighting can create shadows that can be confusing and scary for people with dementia. So use strong, low-glare lighting and night-lights or motion-sensor lights.
6. Medications. Over time you will likely need to adjust medication management multiple times. You may start by filling a pill organizer for your loved one and storing the medication bottles in a safe place so they aren't mistaken for food or taken incorrectly. If your family member is unable to remember to take prescriptions, you might set up a notification or reminder system.
7. The kitchen and laundry. If your loved one is still cooking, consider installing an automatic stove-turnoff device in case he forgets to shut it off.
- Serve food that is not too hot, as the person may get burned easily if she forgets to check food temperature or has compromised sensitivity to temperature.
- Clean out the refrigerator periodically, so there's no risk of your relative eating spoiled, expired and moldy items.
- Ensure that food and cooking equipment are easily accessible, as your loved one may have difficulty judging what is safe in terms of climbing onto step stools or counters or reaching for items.
- Consider automatic temperature-controlled water faucets.
- Store cleaning and laundry supplies in areas where they won't be confused with food or medicines, and be especially careful with bleach.
- Check to make sure the family member cleans the lint trap in the dryer with every load to prevent a fire hazard.
8. Identity theft, scams and finances. Your loved one may be at higher risk for identity theft or scams. Consider placing a "No Solicitations" sign on the front door. Help sort mail, and monitor phone calls to try to prevent the individual from getting caught up in scams. In addition, register home and mobile phones with the Do Not Call Registry. Make sure your loved one isn't forgetting to pay utility bills. If he is able to use a computer, ensure that all computer security and safety precautions are in place and kept updated.
9. Storage of dangerous items. Depending on your loved one's current abilities, make sure that everything from cleaning supplies to medications to food, alcohol, car keys, smoking materials, matches and lighters, tools and scissors are stored in safe places. Be especially careful about removing or storing firearms, knives, or other weapons or dangerous materials in cabinets or closets with locks that are difficult or impossible to open.
10. Having others in the home. You may hire professionals to help care for your loved one, or volunteers may come in to spend time with her. Be sure you conduct background checks and obtain references for these people. Assess their skills, making sure they are well trained, so as to keep your loved one out of danger and free from the risk of worker theft.
11. Leaving the home unattended and getting lost. This is a top concern for people caring for a loved one with dementia. I address it extensively in "When Leaving the Home and Getting Lost Are Worries."
12. General safety. Would your loved one know what to do if alone or something happens to you in an emergency? If so, do you have emergency phone numbers prominently placed? If your loved one is still able to be left alone, be sure your contact information is displayed so emergency personnel will see it and contact you. Who, besides you, can be contacted?
- Make sure that smoke detectors and carbon monoxide detectors are in place and batteries are checked and replaced regularly. You should have fire extinguishers mounted on walls and easy to access.
- If you use a security system, inform the company that a person with dementia lives there, and also notify your local fire and police departments.
- Consider removing locks from bedroom and bathroom doors, since someone with dementia might accidentally lock himself in (or you out).
- Check appliances frequently to ensure they are in working order, or consider not using them if your loved one is confused about them or apt to use them unsafely. Ones to keep an eye on are garbage disposals, blenders, toasters, portable space heaters, power tools, vacuum cleaners, hair dryers, electric blankets and heating pads, vaporizers, aromatherapy diffusers and gas fireplaces.
You may not have to make all of these changes for your loved one — dementia develops uniquely for each person who has it. But it's critical that you evaluate all of these issues repeatedly as the disease progresses. Start by assessing your loved one's abilities while keeping an eye on the future.