Guest Columnist
Making the Home Safe and Comfortable for Dementia Patients
Oct 25, 2010 - 12:18:58 PM

Tips from a Professional Dementia Caregiver with Partners in Care,an affiliate of The Visiting Nurse Service of New York

( - Dementia is the loss of brain function from different diseases that normally occurs later in life. Some of the different diseases include; Alzheimer’s, and TIA (Transient Ischemic Attacks). Affecting 5-8% of people over the age of 65, and 25-50% of people over the age of 85, many families are living with a relatives suffering from dementia. When living with someone suffering from dementia, a family has to factor in the safety of their loved one.

Creating a Dementia-Friendly Environment

The following are five key areas that will be affected as the disease progresses:

• Judgment: For example, forgetting how to use household appliances.

• Sense of time and place: Getting lost on one’s own street or being unable to recognize or find areas in the home.

• Behavior: Becoming easily confused, suspicious, or fearful.

• Physical ability: Experiencing difficulty with balance or depending on a walker or wheelchair to get around.

• Senses: For example, experiencing changes in vision, hearing, sensitivity to temperature, or depth perception.

Partners in Care know these changes may occur over a long period of time or they may occur all at once. There is no timeline for such transformations, making the challenge of adapting the home all the more difficult. Regardless of calculations and preparations, dementia patients’ needs are going to change.

Partners in Care has created five steps for a dementia-friendly home:

• Assess the home: What objects could cause injury? Identify areas of possible danger. Is it easy to get outside or to other dangerous areas such as the kitchen, garage, or basement?

• Focus on adapting rather than teaching: Rather than trying to re-teach an elder about safety, identify possible risks and take preventive precautions.

• Simplify the activities: Most accidents, especially in the area of personal care, occur when an elder is rushed. Break up activities into simple, step-by-step tasks, allowing the individual plenty of time to complete them.

• Support the individual’s needs: The home should encourage independence, social interaction, and meaningful activities.

• Be realistic about limitations: It’s impossible to prevent every problem. Rely on common sense while paying close attention to objects or activities that could be dangerous.

Designing a Successful Personalized Action Plan

As environmental, emotional, and other unexpected barriers present themselves, these principles become crucial. Building a home requires careful planning and craftsmanship; creating the home to adapt to an elder’s ever-changing needs is the same.

Developing a personalized plan is very important for the safety of dementia patients. When developing this plan consider what the individual’s triggers may be before anything happens and then seek a way to make the environment conducive to prevention. Knowing the trigger can prevent the consequences of the behavior before a problem actually occurs.

If the elder is prone to wandering, alarms on doors provide one possible solution. A creative approach would involve covering doors that lead outside with a mural that looks like a bookcase. Being flexible when considering each individuals needs is the best way to find a solution.

There are four key elements that Partners in Care uses that supports a personalized action plan and encourage its success:

1. Create a clutter-free environment, removing misleading stimuli and minimizing background noise, put items away when not in use.

2. Communicate effectively: Caregivers’ reactions and approaches—verbal and nonverbal—can change everything.

3. Simplify tasks: For example, if an elder is having problems brushing his or her teeth, you may just need to model the action first or prepare the toothbrush with water and toothpaste before handing it to him or her.

4. Engage elders to prevent boredom, depression, and agitation.

Moving Beyond the Physical Environment: Activities

Meaningful, purposeful activities allow persons with dementia to stay home and be successful. Dementia patients should remain involved in regular activities they can handle around the home, such as setting the table for dinner or helping with laundry. Such tasks affirm that the elder is still contributing as an active member of the family.

From my experience at Partners in Care I believe that maintaining the brain is a crucial part of creating a dementia-friendly home. One of our clients, a 95-year-old woman still living at home, just finished a major task: sorting a massive collection of nuts and bolts. The project took months, but she enjoyed it and it gave her purpose.

Look to the individual’s life history for cues on activities. Tasks such as snapping peas or husking corn may be comforting and familiar to a woman who grew up on a farm or prepared meals from scratch for her large family. Tailor the activity to the person and remember that the diagnosis does not erase personhood. As long as the activity holds meaning and purpose for the individual, it doesn’t matter whether the caregiver really needs the nuts and bolts sorted or the peas snapped.

Keeping a Safe Home

Creating a list is extremely helpful for bringing all of the pieces together in the home. Here is an excellent tool that Partner in Care recommends that helps breaks it down room by room:

In the Kitchen
Lock up cleaning supplies. Turn off electricity to the garbage disposal. Hide knives and other utensils. Store small appliances such as the toaster and blender. Unplug larger appliances such as the microwave. Remove knobs from the stove. Keep a fire extinguisher nearby. Clean out the refrigerator regularly.

In the Bathroom
Set the water temperature at 120˚F or lower. Install grab bars. Add textured stickers to slippery surfaces. Supervise the use of hair dryers, curling irons, and electric and hand razors. Remove locks from the bathroom door. Remove dangerous items from medicine chests.

In the Bedroom
Monitor the use of heating pads. Install night-lights between the bedroom and bathroom.

In the Garage
Lock up hand and power tools such as drills, axes, saws, and picks. Limit access to large equipment, such as the lawn mower, weed trimmer, and snow blower. Lock up poisonous chemicals such as paints and fertilizers.

Throughout the Home
Disguise outdoor locks or install dead bolts. Remove or tape down throw rugs and carpeting. Apply colored stickers to large windows and sliding glass doors. Create an even level of lighting near doorways, stairways, and between rooms. Remove objects that block walking paths. Remove and disable guns or other weapons.

Disconnect gas hookups from grills. Lock fence gates. Supervise elders. Put away car keys.

Focus on Caregivers

It’s important to recognize the crucial need for caregiver respite. If caregivers are unaware of their own needs or push those needs aside, both the caregiver and the elder will be at risk. Caregiver burnout is an unseen but all-too-common hazard; it won’t matter how many nonskid rugs are placed or how many door alarms are installed if caregivers are unable to meet elders’ needs.

Making certain adjustments for dementia patients can make other residents’ lives easier, too. Partners in Care believe that all the members of a household can participate in the process. Children, grandchildren, or other inhabitants can offer valuable insights that may otherwise go unnoticed. Such input also ensures that when their help is needed, all household members have been included in the decision-making process and are part of the action plan.

It’s essential to have grab bars in many places—in the garage going into the house and just inside the entry, as well as in various areas in the bathroom. The use of adaptive equipment helps maintain some degree of independence, and promotes safety. The goal is to encourage independence for your loved one.

Partners in Care know that the goal of independence for the older adult and reduced stress on the caregiver is paramount. The elder may live at home for five years or 15.

The challenge of caring for and keeping safe an elder with Alzheimer’s or related dementias is one that must be taken seriously. As providing care at home for as long as possible continues to be a preferred option due to high health care costs and family emotions and dynamics, being flexible while maintaining an elder’s independence is a challenge facing many 21st-century families.

For more information about Partners In Care and the services they provide, visit

RENATA GELMAN is an RN, BSN and clinical manager for Partners in Care, the nation’s largest not-for-profit provider of private personal and medical home health care services, and an affiliate of the Visiting Nurse Service of New York. The Visiting Nurse Service is the oldest in New York, having been founded in 1893 by Lillan Wald and Mary Brewster. With over 8,147 home health aides (HHA) employed at Partners In Care, the agency is proud of their affiliation and position as one of the most well-respected and loved agencies in the New York area.

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