Adapt the home for dementia patients

We can make dementia patients feel safe and comfortable by adapting our home so that they do not face problems while walking around, looking around, or doing things.

The changes we make have to be based on the patient’s current abilities. We can observe what the patient can do easily, and what he/ she seems to find difficult. Remember that the patient suffers from memory loss and can get confused about where he/ she is. Also, the patient’s coordination and spatial judgment is declining.

In early stages, the patient may seem confused because there are too many objects in the room. Or the patient may apparently forget where the bathroom is. Decluttering and adding signs may be helpful enough. When 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.

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.

• Tips for the home
• See also…

Tips for the home

For reality orientation: Patients are disoriented about time and space. Some minor changes in the house may help remind them 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.

Reminder lists: In early stage dementia, patients are able to read and use reminder lists.

• 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

• Leave pads and pencils near the phone, and at other places
• We can tie the pad and pencil to some fixed object so that the pad is not lost

Charts to do activities: In early stage dementia, patients are able to read and use charts on how to do activities, 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.

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
• 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.
• Consider night lights

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

For problems in handling things. Make it easier for the patient to hold and manipulate objects by making the handles bigger and more prominent. 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

For 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
• 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.

Special tips for the bathroom

• 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
• 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

General Safety

Patients sometimes close the door of the bathroom/ bedroom. Then they get agitated or fall down or do not open the door even when helpless family members keep knocking.
Consider replacing door bolts with simple latches and hooks that can be forced open from outside.

• Keep all medicines and poisonous liquids out of reach/ locked
• 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.
• 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 fire alarm and make sure it is working.
• 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

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See also….

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
• A Guide to Safe Guarding Your Home
• Do’s and Don’ts

Books and DVDs: The book,The Comfort of Home for Alzheimer’s Disease: A Guide for Caregivers contains several tips on adapting the home, along with illustrations.

Some relevant searches on this site: adapting the home, reality orientation

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