Turning a home into one that is dementia-friendly can help minimize accidents and maximize well-being. It can also give peace of mind and reduce stress for at-home and long-distance caregivers.
Act before a crisis. In safeproofing surroundings, it is best to take preventative steps, rather than scramble around to solve an immediate crisis. This way, options can be more carefully weighed. The challenge is to balance a desire to keep individuals with dementia as functional as possible against the hazards posed by their cognitive decline, which may include poor judgment, difficulty with spatial perception and inability to react appropriately. Observing an individual's patterns and how they navigate their environment, looking for red flags, and pinpointing causes and effects are all very telling.
Professionals or family caregivers themselves should survey a home three times, progressing in security at each inspection. Look for safe, safer and safest.
- Safe involves detecting basic dangers and fixing or removing those items, such as movable furniture that people wrongly rely on for support, chairs that blend in with the walls behind them, and loose extension cords and telephone wires;
- Safer means locating ways to minimize injury in the event of accidents, like replacing glass tables with furniture that has blunt edges, and locating a soft rubber mat by the bed in case of a fall; and
- Safest is maximizing access to help in an emergency, such as installing a monitoring device.
Look at critical areas. Since people with dementia need a quiet, orderly environment, it is critical to address factors such as noise, color and lighting. Modifying kitchens and bathrooms, and taking steps to deter wandering are primary concerns. The key is to pay special attention to lighting, furnishings, textures, changes in elevation, handrails, and types of flooring, and to remove hazardous clutter from floors, stairways, etc. Often, small changes can make big differences. For example, reducing the level of light during meals may prompt better eating habits; camouflaging an exit door with a curtain may prevent wandering; and removing clutter and unnecessary furniture may reduce confusion.
Be creative. Products do not have to be taken at face value; rather, consider a person's specific condition and further adapt products for an even greater sense of security. And always keep in mind that, with this progressive disease, what works one day may not the next.
Consider redundant strategies for life-threatening situations. For example, to help prevent wandering, install multiple locks on a door, each at varying heights out of direct sight and requiring different skill sets to open, and supplement them with an alarm. Or when buying a personal response system that uses pendants with a call button to alert a central monitoring station, spring for extras. Use one as a pendant, and cut off the strings from the others and use double-sided tape to install the help buttons to base moldings in key spots. This way, if the individual falls while not wearing the pendant, he could crawl to an emergency button in, say, the foyer or shower.
Walk gently. While many changes sound easy enough, convincing the at-home caregiver and/or their loved one to alter their environment can be the hard part. Often, their reluctance boils down to a sense of shame or the feeling that many assistive devices are unattractive.
Look for designs and assistive devices that give people independent functioning while maintaining privacy and dignity. One example of a perfect solution: grab bars so individuals can get on and off the toilet by themselves. Manufacturers are increasingly designing products without a medical-type appearance, addressing the "shame" issue for both caregivers and those with dementia. Products are nicer looking, boasting decorative colors and style.
In presenting home safety features to individuals with dementia, be delicate. Since most people do not welcome change, caregivers may need to broach the subject on several occasions and make gentle suggestions. Also, try to include the person with dementia in the decision-making process. And use language that empowers the person to agree to the safety features for someone else's sake, such as, "It's not for you; it's for me so I don't worry so much." Another effective strategy is to call solutions by another name—gifts.