The physical environment around the dementia patient can make a great difference to the way patients manage their daily activities and how they behave and socialize. Suitable home adaptations can improve patient orientation, make them safer and more comfortable, make tasks simpler for them, and encourage them to do things that will make them feel better.
Typically, though patient abilities deteriorate over time, the environment around them remains relatively unchanged. For the patient, this unchanging environment becomes increasingly challenging to cope with, adding to their difficulties. Family members can improve things for the patient if they keep modifying the home to take into account the patient’s current abilities. We can observe what the patients can do easily, and what they seem to find difficult. It is useful to remember that patients may be confused about their location, may have problems recognizing objects or deciding how to use them, may have declining coordination and spatial judgment, and other cognitive problems. What seems simple to us may be very difficult for them.
The person with dementia finds it difficult to understand where he/ she is, or walk around the home
What caregivers can do: Make changes in the home to keep the environment safe for the patient. See if home adjustments can make it easier for patients to do their own work independently, or with very little support. Keep adjusting the home as the patient’s abilities deteriorate.
The state of the patient changes over time, and so the adaptation has to progressively simplify the physical environment around the patient. For example, in early stages, the patient may seem confused because there are too many objects in the room, or apparently forget where the bathroom is, and decluttering and adding signs may be helpful enough. Later, as the patient starts facing problems in walking, we can add grab rails. If the patient finds it difficult to get up from a chair without arms, we may need to replace it with a chair that has arms.
Patients may be emotionally attached to some objects. A decoration piece or trophy we consider unnecessary could mean a lot to the patient. We should not ignore the patient’s emotional well-being while adjusting the home. If there is a risk of the patient tripping over a curio he/ she is fond of, place it so that it can be seen but does not pose any danger.
Adapting homes according to the patient’s abilities and needs is part of the generalized changes that improve the quality of life of the patient, empower them, and reduce chances of their withdrawing or feeling agitated, etc. The tips below are generic and indicative; creativity is key while making our homes safe, stress-free, and emotionally fulfilling for patients. Support groups are very useful for practical tips, and also for knowing where special materials may be available.
On this page
- Approaches while considering home adaptations
- Possible ways to improve reality orientation
- Aides for performing tasks more easily
- Encourage/ discourage actions by adjusting the environment
- Ensure safety at home
- Special concern areas
- Assistive devices
- See also…
The process of evaluating the home for possible adaptations is an ongoing one. As the patient deteriorates, the type of adaptations to consider keep changing. While each person with dementia is different, the initial mild confusion and disorientation keeps worsening with time. Physical coordination reduces, as does the ability to communicate needs. There is a reduced ability to recognize or use familiar daily objects, inability to read or remember instructions, problems physically handling objects. Vision and hearing changes add to the problems, such as reduced ability to perceive depth. An observation caregiver may notice or suspect problems and be able to think of home adjustments to make the home safe and easy to use even as the dementia worsens.
Broadly speaking, we can look at home adaptations in terms of aspects we are trying to address through them, such as reality orientation, simplifying normal daily tasks and easing navigation, increasing safety, using cues to encourage some behaviors and discourage harmful behaviors, etc.
Reality orientation: Patients are often confused about where they are of what time/ date it is. Reality orientation changes aim at helping patients know where they are. These changes may include things like adding prominent clocks and calendars, having windows that allow them to see the sunlight, etc. The changes may also include removing clutter and simplifying the room and the ways around the house, so that, for example, the patient can recognize which room to eat in, which to sleep in, etc. Lighting and signs (words or pictures or both) can also help.
Simplifying daily tasks: Patients may start having difficulties locating objects in cluttered rooms. Or they may not recognize an object or may forget how to use it. Or objects may be too difficult for them to handle/ manipulate. Or, if there are too many objects, they may have problems selecting which one they want. They may also have problems navigating through a room. It is possible to make changes in the home to reduce the difficulties patients face in daily tasks, and thereby make them more independent.
Encouraging some behaviors and discouraging others: Home adaptations can change what is visible/ prominent and what is not, and thus be used to encourage patients to engage in some activities, and discourage them from others. So it is possible to keep them safer and happier, and also more active by arranging the room suitably.
Ensuring safety: Given the multiple problems patients face, it is important to consider how home adaptations can make home a safer place for them even if they are confused and have poor coordination.
Most home adaptations involve removing objects, adding objects, and re-arranging objects. So a prominent, easy to read clock may be added to improve reality orientation, as may signs and night lights. Rooms may be simplified by removing clutter and hiding objects that are unnecessary. Shelves and wardrobes may be re-arranged to make more useful objects prominent and put away objects that are not used often.
Before trying to make changes, do consider how easy or difficult the patient may find adjusting to the change. For example, replacing a complicated phone with a sleek, modern model with just a few simple buttons may seem a good idea, but the patient may find the new phone tough to use because she is used to the old phone. A digital clock may seem an easy way to convey date and time, but may be difficult to read and feel odd to patients used to reading clocks with hands. Changing a room layout or re-arranging the kitchen may make the patient unsure about how to cook as everything seems different. The adjustment needed by the patient (and any uncertainty they may feel) is a major consideration while making adaptations.
While making home adaptations, it is important to keep in mind the sort of cognitive problems that patients may be facing. For example, one important aspect is that dementia often affects the way patients see and interpret things. Objects that seem perfectly commonplace to us may seem odd and even frightening to them.
Teepa Snow, dementia care and training expert, has explained in a video how the area that dementia patients can see clearly reduces, and how they have problems figuring out the depth of objects they see, or even knowing what is “real” and what is not. This understanding is very useful for adapting the home for dementia patients. To view the video at youtube, click here.)
Another problem is that, even if their sight is alright, as their dementia progresses, many of them start having problems reading things, as they are not able to make sense of the letters and words. They may have gait problems. They may have problems holding and manipulating objects. They may withdraw or get frustrated, and not realize that some small changes can make things easier for them, but family members can remain alert on the problems they are facing, and how these change over time, and they can keep adjusting the home accordingly.
Some minor changes in the house may help remind patients where they are and what the time is:
- Place large clocks prominently, clocks with the numbers clearly written, preferably in back on a plain white background, and with the clock hands clearly visible from a distance. Digital clocks may not be readable by the patient
- Place a large calendar, or a date display, so that the patient can see the date, day, and month/ year
If the patient is still able to read and understand, it is helpful to use large clocks and calendars, have pads and pencils conveniently located, and use labels and notes.
For helping patients understand which part of the house they are in and what the room is meant for, the following may help:
- Remove unnecessary objects (declutter) from shelves, floor, tables, etc.
- Use good lighting, including night lights for the passage to the bathroom.
- If the patient can understand them, use some signs (pictures, words, or a combination)
[Also see the discussion on Helping with Activities of Daily Living]
Reminders: In early stage dementia, patients are able to read and use various types of reminders:
- Prominently placed stickies or whiteboards can help. Place the reminders close to where the patient will need them
- Messages about the food can be stuck to the fridge using a fridge magnet
- Important phone numbers, such as emergency numbers, can be displayed near the phone
- Make it easy for the patient to make notes by leaving pads and pencils near the phone, and at other places. Tie the pad and pencil to some fixed object so that the pad is not lost
Charts on how to do activities: In early stage dementia, patients are able to read and use charts and instructions for tasks such as making tea.
- Place the charts prominently near the place where the activity will be performed
- Make activities easier by labeling objects, such as placing labels on containers for tea and sugar, labeling drawers to indicate whether they have files or stationery or tools. Consider using labels with both words and pictures.
Make things easier to locate: Simplify rooms to make things easier to locate
- Declutter rooms (remove unnecessary objects and furniture). Note that clutter is often a trigger for agitation for many patients, so decluttering is very useful
- In shelves/ wardrobes/ bathroom cabinets that patients use, keep only objects that are used every day. Do not keep too many clothes/ shoes/ cosmetics as that may make it difficult to locate things or select between them.
- Use contrasting colors to make important objects visible.
- Avoid complicated patterns and stick to simple colors and shapes, preferably soothing colors so that objects are visible and colors are not “loud” (loud colors may agitate the patient).
- Reduce the overall noise levels, as noise adds to confusion
Make objects easier to use: Make it easier for patients to hold and manipulate objects. For example,
- Have large, prominent handles on doors
- Use bigger spoons, and plates with edges (thalis)
- Use mugs with large handles, and if possible, mugs with two handles
Make it easy to move around for familiar tasks: Make it easier for patients to walk around to do activities they normally do. /p>
- Identify the various activities for which the patient moves around, and for each, ensure the required objects are accessible easily
- For the path the patient usually walks down (such as to the toilet, to the TV switch, from bed to the favorite chair) make sure the path is clear and well-lit. (This is also sometimes called “clearing pathways of travel)
Make it easier for them to ask for help/ contact persons:
- Keep a list of useful numbers visible and accessible to the patient. That way, they may be able to call people without needing to remember phone numbers or ask you. Code in these in a mobile phone if the patient is comfortable using a mobile phone.
- Add a bell near the bed/ chair, and also near any place where they may want help, especially the toilet (this may not be useful if the patient is in a state where they keep ringing the bell without realizing what it is)
- Keep your contact numbers and details prominently displayed (patients may forget your name or phone number, or even the fact that they can call if they need help). A displayed list may be useful even to someone else who notices the patient needs help but doesn’t know how to call you.
- Keep a list of important contact numbers and details prominently displayed (like the doctor, ambulance, and others who may be needed in an emergency). Again,a displayed list may be useful even to someone helping the patient.
Note that many of these will not work once patients start calling up people so often that it is problematic for the other party. At that stage, instead of keeping all numbers accessible, you may have to keep only one or two very important numbers accessible, like your number
Reduce need to move when confused:
In addition to the above, remember that patients may not remember to call out for help. At night, especially, when they are sleepy and confused, they are more likely to try and walk to the bathroom and then fall down. If they are able to use it, place a bedside commode at nighttime for their use. Note, however, that not all patients feel comfortable using a bedside commode.
Adaptations to help patients cope with problems in getting up and in walking Here are some possibilities:
- Use furniture that is heavy and stable, so that it does not fall over the patient
- Use chairs with arms
- You may need higher beds and chairs to make it easy to sit down and get up from (you can raise existing beds and chairs by using wooden blocks, but these should not jut out, otherwise the patient will trip over them)
- Make sure there are no sharp edges (tie cushions over them, or stick foam, if you need to)
- Make sure there are no unstable or breakable objects along the path that the patient walks, because the patient may suddenly lean and catch them for support
- Make sure there is nothing the patient can trip over (e.g., wires, uneven floor/ tiles, carpets/ frayed rugs)
- Install grab rails along the walls
- Rearrange way of living so that patient does not need to climb stairs. If the house has stairs, consider putting a safety gate blocking access to the stairs.
- Consider removing thresholds at doors, as the patient is unlikely to notice them, and may trip (clothing may also need to be modified to reduce chances of tripping)
- Over time, you may need walking sticks and walkers (consult the doctor for advice on what would suit the patient) and wheelchairs.
Adaptations to make things easier for the caregiver Here are some possibilities:
Most discussions on home adaptations center on making life easier and safer for the patient, but home adaptations must also be considered to make it easier and more comfortable for the caregivers, too.
- Think of changes in the room so that you can be physically comfortable while helping the patient with various activities.
- Adjust the room so that you can stand, sit or lie down comfortably if he/ she has to be with the patient for a long stretch of time.
- Have ways you can entertain yourself without disturbing the patient
- Consider ways you can add some physical exercise and exposure to fresh air to your day even if home-bound because of caregiving responsibilities.
- Add physical aids/ furniture/ gadgets that make it easier for you to assist the patient, especially for activities that involve helping the patient walk, bathe, toilet, etc.
- As the patient becomes more dependent and less mobile, add suitable assistive devices so that you don’t strain or injure yourself. For example, when the patient becomes bedridden, consider a hospital bed where the patient can be brought to a sitting position by using a lever or a button, and not need to be physically moved to a sitting position.
Use colors and placement to make some objects prominent and hide some objects:
- Use contrasting colors to make objects more visible
- Use similar colors to hide objects/ make them less prominent
- If you want the patient to notice something, place it near them or in front of them. (Keep objects behind them/ hidden if you think the object is not normally useful to them)
- Place the objects that the patient often needs near their usual sitting place, so that they can find them easily and are not dependent on others
Encourage patients to engage in activities (to the extent suitable for the patient)
- Place interesting/ stimulating games near the patient (only to the extent the patient may enjoy
- Place reminiscence objects like albums, photographs, and posters within sight
- Arrange the daily routine such that the patient can walk around safely for at least some time. For this, create a space that is safe to walk in.
- Arrange the daily routine such that at least part of the day is spent by the patient at a place where he/ she feels socially connected to others (such as, watching kids play, or watching neighbourhood activities, or feeling part of the family’s evening get-together)
Reduce chances of tripping/ hurting
- Have fewer objects on the floor and remove superfluous furniture
- Remove sharp objects like knives (keep them locked)
- Remove objects that could break and hurt the patient, such as crystal vases, glass, and porcelain plates. Keep them locked and take out only when using.
- Remove furniture with sharp edges.
- Remove any rugs or carpets that can cause tripping
- Make sure there are no wires on the floor that can cause tripping
- Make sure the floor is not slippery
- Make sure the floor/ tiles on the floor are not uneven
- If the house has steps, make sure the steps are not slippery, and that the end of the steps is clearly marked
- Ensure all electric connections are safe and that there are no exposed wires
Reduce chances of confused interpretation of objects/ reduce things that frighten the patient
- The person may assume a reflection in a mirror is another person, and may get frightened. If the patient shows this problem, remove mirrors or keep them covered
- Some decoration pieces can frighten the patient, such as deer-heads and masks, or vivid pictures that are depressing/ dark
- Sometimes, some designs of tapestry or printed bedsheets could be confusing or frightening to patients
- Contrasting colors can confuse the patient. For example, light and dark stripes on the floor can make the patient feel there is a hole where the color is dark, and the patient may refuse to walk
Lighting: A dark place can be frightening to the patient, but a very bright light can also be confusing.
- Consider using frosted lights instead of bare bulbs. Be sure there is no “glare” from any lighting.
- Consider night lights
- Have emergency lights that go on if there is a power cut
Reduce chances of wandering by making minor changes to the room
- Make the door less visible by painting it the same color as the wall, or covering it with a curtain
- Hang a mirror on the door. The patient, on seeing it, may assume someone is standing there, and turn back
- Put a large stop sign on the door. The patient may instinctively obey it and turn back
Wandering is a very common behavior observed in dementia, and puts the patient at risk. A more complete discussion on wandering–why patients may wander and what can be done to reduce their chances of wandering–can be seen at this link (which includes video explanations): Special Tips: Wandering
Grab rails in a corridor and in a toilet
(Photographs taken at Nightingales Centre for Ageing and Alzheimer’s, Bangalore)
Special tips for the bathroom
The bathroom is one of the most common areas for accidents like falls and burning. Some tips:
- Make sure the floor is not slippery or wet
- Have a higher commode
- Place grab rails near the commode, and near the bath area
- If possible, use a raised toilet seat with handrails
- Use taps that are easy to grip and open
- Make sure the geyser setting is such that the patient does not get scalded inadvertently (patients may not be able to judge water temperature correctly)
- Consider using a stable bath stool that the patient can sit on while having a bath
- Make sure the bucket does not tip over and spill water all over the floor
Consider replacing door bolts with simple latches and hooks that can be forced open from outside.
- Lock away or dispose all hazardous/ poisonous material (such as pesticides, kerosene, rat poison, etc.)
- Lock all medications away
- Keep all sharp objects locked/ out of reach
- Keep all electric outlets covered, and check that there is no place where the patient may, out of confusion or curiosity, pull at a extension cord or touch a naked wire.
- Make sure all switches are safe.
- Make sure that tap water in various taps is never hot enough to burn
- Keep the kitchen locked so that the patient cannot use it when alone.
- If that is not possible, switch off the gas regulator when not cooking, and position the gas such that the patient cannot reach the regulator. Keep the matches and lighter away. Install a smoke detector/ fire alarm and make sure it is working.
- If the person is a smoker, consider having smoke detectors in the toilets and bedrooms also, because in spite of the best of efforts, smokers sometimes manage to smuggle in cigarettes but may not be alert enough to extinguish them.
- There should be no match boxes or lighters visible in the house
- Install locks on all doors and windows leading outside.
- If you have a self-locking door, always make sure you carry the key in case the patient wanders out and locks the door
- If there are expensive items, such as laptops, keep them at places where the patient does not damage them inadvertently, like dropping them
Some activities that the patient was able to perform safely may become problematic when the patient’s ability to detect mistakes/ understand danger goes down. Special caution needs to be taken for these, and families need to be alert about when to start getting more cautious about them.
- Smoking: Patients who smoke may be at danger because they may not be cautious enough about lighted cigarettes and may set the place on fire. Smoking, unfortunately, is addictive, and smokers often are pretty ingenious in how they manage to procure cigarettes and smoke. Special care needs to be taken to keep them safe and to prevent their harming themselves. De-addiction may not always be possible, though it can be attempted, so controlling access to cigarettes and matches/ lighters and ensuring that any lighted cigarettes are properly extinguished is very important.
- Missed/ double dose of medication: Often, the patient may be handling their own medicine intake for quite a while, but families need to be alert about when the patients start getting confused about their medication. It is common for patients to forget they need some medicine, or refuse to believe it is needed. They may start hiding pills or throwing them away or spitting them out. Or they may get confused on whether they have taken their medicine for the day or not, and may double-dose or even triple-dose. This is even more likely with sedation medication, when a drowsy patient may take the medication multiple times. While pill-dispensing boxes may work well in early stage, once they reach the stage when they make mistakes in medication, the family will need to take an active role in administering and storing medicines as the dementia worsens.
- Missing meals/ poor hydration and nutrition: Some patients forget to have their meals, even if the meals are prepared and kept ready for them. Some adjustments like reminders on the fridge may help in early stages, but the type and prominence of reminders may need to be adjusted as the patients get more confused and forgetful. Patients may also forget to drink enough fluids. To some degree, placement of objects and reminders can act as timely reminders, but as dementia progresses, caregivers will need to be alert and ensure proper hydration and nutrition by more direct intervention and monitoring.
- Use of appliances: As dementia worsens, the patient’s ability to operate common appliances deteriorates. Again, families need to be observant about this and remove access to any appliances that the person can no longer use properly, or that could be dangerous if used wrongly.
- Driving: Patients who are used to driving may start making mistakes because they are confused/ disoriented about directions, or overwhelmed by traffic, etc. Unsafe driving is a danger for the patient (may get lost/ mayget hurt in an accident) as well as for others (may hurt others in an accident/ may drive so erratically that others have an accident trying to avoid the car). The decision to stop the patient from driving is a tough one, and implementing it is also difficult. Once the family sees that the patient is not a safe driver any more, they need to ensure the patient does not have access to the car, as the patient may not remember they are not supposed to drive and may start off in the car as a matter of habit. But they also need to ensure that the patient can still go where they need to go by being driven by others, etc.
- Financial transactions/ scams: Most persons with dementia start losing their ability to understand the value of money or to transact financially, and this makes them vulnerable to cheats and fraudsters. Frauds like making patients invest in dubious schemes, sign off property, gift off jewelry, etc., are common. Online scams and scams over mobile phones are also common. Confused patients may even tear up or throw away important papers by mistake. Families need to find ways to guard against such problems without curbing reasonable independence. Again, this is very tricky to achieve. Removing material that can attract fraudsters can help, such as putting away important house and investment papers and jewelry in lockers, and keeping bank passbooks and check books in a safe place.
- Alertness for crises: As dementia progresses, patients are unable to recognize a crisis situation or call for timely and appropriate help, whether for themselves or persons with them. This is because they may not be able to realize something odd has happened, and also because their decision-making abilities are not functioning well enough. They may not notice a fire in the house, or may not smell cooking gas leaks. They may let in a strange and not realize the stranger is a burglar. They may fall and not recognize they are hurt. If they are alone at home with a caregiver and the caregiver gets injured or has a heart attack, they may not recognize that they need to call for help. The home needs to be set up so that persons can realize something is wrong and intervene. If the patient is alone for some time, having video cameras installed may help, or asking a neighbor to check in periodically or use some available neighborhood watch program. Relatives/ friends can be alerted about the possibility of such problems so that if they find their calls remain unanswered, they alert someone appropriate. Neighbors should have emergency contact numbers.
Assistive devices are available that can be used in home adaptations or that can be used by persons with dementia (or their caregivers) to make some daily tasks easier. One site that discusses such devices is the Govt. of India’s Old Age Solutions portal; see their section: Assistive devices. This section includes various types of devices, such as devices suitable for mobility, self-care, dressing, drug management, safety, housework, and many other topics.
Some organizations are now producing assistive devices in India. Some searching/ asking around may provide leads, or stalls may be set up in various fairs/ events designed for the elderly, etc., or coverage may be seen in various newspapers. Here is one example of an organization in Bangalore set up by two ladies: Devised Care India (see newsreport here and an article on the Silver Talkies portal here: Devising Ways to Help the Elderly)
Note that even if a product is not available in India, looking at the product description may give you some ideas on how to achieve the same function or how to get similar products made. Of course, whether you buy a product or whether you get it made yourself, be very careful of its safety and sturdiness, and its suitability for the person who will be using it.
Some relevant interviews on this site:
- A nurse shares tips to adapt the home: Keeping persons with dementia peaceful and improving their quality of life .
- Tips from a caregiver’s husband: Mistakes made, lessons learnt, tips shared .
The full list of interviews is here: Voices: Interviews with dementia caregivers, volunteers, and experts
Caregiver resources in India and Other dementia/ caregiving resources: Many of these resources have tips on how the home can be adapted to provide patients a safe environment in which they can function.The following are particularly helpful:
- Home Safety for People with Alzheimer’s Disease
- Safety Center
- Staying safe: steps to take for a person with dementia
- Home Safety for People with Alzheimer’s Disease
- A Guide to Safe Guarding Your Home
- Do’s and Don’ts
And here is a general discussion on the principles for adapting the environment around the patient to make it more enabling: Dementia Enabling Environment Principles.
Here are some books with tips and illustrations on how the home can be made safe and empowering for persons with dementia. The suggestions may need to be adapted for your context depending on the availability of materials. Check out the suggestions below, or surf Amazon.com or Amazon.in for your specific needs.
This book is also available as a Kindle eBook, which means you can buy it online and start reading it within minutes on your laptop/ tablet/ Kindle! Read a sample/ read reviews/ buy it from: Amazon.com or Amazon.in.
(You can also see our full books/ DVD suggestions at: Books and DVDs
[This page was last updated in April 2015]