What caregivers can do: Make changes in the home to keep it safe for persons with dementia. Look for changes that can make it easier for them to do their tasks independently, or with very little support. Help them feel more capable and happier by suitable changes at home. Keep adjusting the home as their abilities get worse.
The surroundings affect how persons with dementia do their daily activities and how they feel and respond to situations. But though their abilities get worse over time, the home and objects around them do not change much. This makes it even more difficult for them to do their tasks. Home adaptations help to make them safer, happier, and more independent. This reduces chances of their withdrawing or feeling agitated, and also reduces the overall stress for other family members.
- Approaches while considering home adaptations.
- Possible ways to improve reality orientation.
- Possible ways to make it easier to perform tasks.
- Encourage/ discourage actions by adjusting the environment.
- Ensure safety at home.
- Special concern areas.
- Assistive devices.
- See also….
Changes have to be selected based on the current abilities of the person with dementia. These abilities change over time, and so the home may need to be changed again and again accordingly. For example, in early stages, the person may seem confused because there are too many objects in the room, or apparently forget where the bathroom is. Removing unnecessary objects and adding signs may help. Later, when the person starts facing problems in walking, you can add grab rails. If the person finds it difficult to get up from a chair, you can use a chair that has arms.
An important part of home adaptations is observing the person’s problems to see which home adaptations can be useful. You have to select what suits the person as well as and the rest of the family. Changes require effort and money. Remember that you may need to keep making more changes. Be creative and look for practical ideas and materials. In addition to the suggestions and resources listed on this page, talk to friends and get ideas. Visit online or in-person support groups; other caregivers may have faced similar problems and may have good, practical tips. They may also know where you can buy special equipment and materials.
While looking at which adaptations can help the person, be clear of your reason. Some possible reasons to make changes:
Make it easier for the person to know the place and time (Reality orientation): People with dementia are often confused about where they are or what the time or date is. Reality orientation is the term for trying to help them know where they are. Changes may include adding prominent clocks and calendars, having windows that allow them to see the sunlight, etc. Clearing the room of clutter and simplifying the layout can help, because then they can recognize the purpose of the room more clearly–is it a bedroom? a dining room? etc. Consider using better lighting. You can also add signs (words or pictures or both), especially for the bathroom.
Simplify daily tasks: People with dementia may start having difficulties finding what they need if the room has too many things. Or they may not recognize an object. They may have forgotten how to use it. Some objects may require a lot of physical control to use and they may not have that much hand control any more. If there are too many objects in a cupboard, they may have problems selecting which one they want. They may also have problems walking around in a room. Look at changes that can reduce such difficulties so that they can do their tasks more easily, and be more independent.
Encourage some behaviors and discourage others: Use changes in the home to make some things more visible and make some other things less visible. This can be used to remind persons with dementia to do some things, and discourage them from doing other things.
Ensure safety: Given the several problems that persons with dementia face, think how the home can be made safer even if they are confused and have poor coordination.
Most home adaptations involve removing things, adding things, and re-arranging things. 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 or hiding unnecessary objects. Contents of shelves and wardrobes can be re-arranged so that useful objects are more visible and things that are not required are removed.
Before making changes, consider how the someone with dementia will adjust to the change. You may think that it is a good thing to replace a complicated phone with a modern model that has only a few buttons. But the person may be used to the old phone. The new phone may be too difficult to learn. Similarly, you may think that a digital clock is an easy way to know the date and time. But the person may be used to clocks with hands, and may not be able to read a digital clock. Similarly, re-arranging the kitchen may make the person unsure about how to cook because everything seems different. It is important to think of the person’s difficulties in adjusting before you make changes to something the person is used to.
Teepa Snow, dementia care and training expert, has explained in a video how the area that persons with dementia can see clearly reduces. They 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 people with dementia. View video “Aging vision and Alzheimer’s” on Youtube .)
Another problem is that, even if their sight is alright, many persons with dementia start having problems reading things. They are not able to make sense of the letters and words. They may have balance and walking 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. You can remain alert on the problems they are facing, and how these change over time, and can keep adjusting the home accordingly.
While making home adaptations, remember the cognitive problems that persons with dementia may be facing. For example, dementia often affects the way they see and interpret things. Objects that seem perfectly commonplace to you may seem odd and even frightening to them.
Some minor changes in the house may help remind persons with dementtia 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 person
- Place a large calendar, or a date display, so that the person can see the date, day, and month/ year
If the person is still able to read and understand, it may help to use large clocks and calendars, have pads and pencils conveniently located, and use labels and notes.
For helping them 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 person can understand them, use some signs (pictures, words, or a combination)
[Also see the discussion on Helping with Activities of Daily Living]
Reminders: In the earlier stages, persons with dementia are able to read and use various types of reminders:
- Prominently placed stickies or whiteboards can help. Place the reminders close to where the person 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 person 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 the earlier stages, persons with dementia 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 persons with dementia, so decluttering is very useful
- In shelves/ wardrobes/ bathroom cabinets that they 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 them).
- Reduce the overall noise levels, as noise adds to confusion
Make objects easier to use: Make it easier for the person 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 the person to walk around for normal activities. /p>
- Identify the activities for which the person moves around. For each, make sure the person can easily get what is needed.
- For the path the person 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 person. 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 person 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 person keeps ringing the bell without realizing what it is.
- Display your contact numbers and details prominently. This is because the person may forget your name or phone number. A displayed list is also a reminder for the person to call if help is needed. . A displayed list can also be used by someone else who thinks the person needs help and needs to call you.
- Keep important medical contact numbers and details prominently displayed. This includes doctor, ambulance, and others who may be needed in an emergency.
Many of these tips will not work if the person with dementia start calling up people so often that it is a problem for others. If that happens, you may have to keep only one or two very important numbers accessible, like your number.
Reduce need to move when confused:
Also remember that persons with dementia may not remember to call out for help. At night, when they are sleepy and confused, they may try to walk to the bathroom without putting on the light, and may fall down. Place a bedside commode at nighttime for their use if they are able to use it. Note that not all persons feel comfortable using a bedside commode.
Adaptations to help persons with dementia cope with problems in getting up and in walking Here are some possibilities:
- Use heavy and stable furniture so that it does not fall over the person
- Use chairs with arms
- Think of using higher beds and chairs which could 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 person could trip.
- Make sure there are no sharp edges. Tie cushions over them, or stick foam on sharp edges, if necessary.
- Make sure there are no unstable or breakable objects where the person walks, because the person may lean on them or catch them for support.
- Remove anything the person could trip over, for example wires, uneven tiles, carpets, frayed rugs.
- Install grab rails along the walls
- Rearrange the way of living so that person 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 person may not 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 is suitable) and wheelchairs.
Adaptations to make things easier for providing care:
Most discussions on home adaptations look at ways to make life easier and safer for the person with dementia. But home adaptations must also be considered to make it easier and more comfortable for you.
- Think of changes in the room so that you can be physically comfortable while helping the person with various activities.
- Adjust the room so that you can stand, sit or lie down comfortably if you have to be with the person for a long stretch of time.
- Have ways you can entertain yourself without disturbing the person
- Consider ways to get physical exercise and exposure to fresh air even if you are home-bound because of care work.
- Add physical aids, furniture, and gadgets that make it easier for you to assist the person, especially for activities that involve helping the person walk, bathe, toilet, etc.
- As the person becomes more dependent and less mobile, add suitable assistive devices so that you don’t strain or injure yourself. For example, when the person becomes bedridden, get a hospital bed so that the person can be brought to a sitting position by using a lever or a button.
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 person 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 person often needs near their usual sitting place, so that they can find them easily and are not dependent on others
Encourage persons with dementia to engage in activities (to the extent suitable for the person)
- Place interesting, stimulating games near the person (only to the extent the person may enjoy)
- Place reminiscence objects like albums, photographs, and posters within sight
- Arrange the daily routine such that the person 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 the person spends at least part of the day feeling socially connected to others. For example, seat the person where they can watch kids play, or watch neighboring activities, or be 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 person, 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 person
- The person may think a reflection in a mirror is another person. This could frighten them. if so, remove mirrors or keep them covered
- Some decoration pieces can frighten the person, 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 persons with dementia
- Contrasting colors can confuse. For example, light and dark stripes on the floor can make the person feel there is a hole where the color is dark, and the person may refuse to walk
Lighting: A dark place can be frightening to the person with dementia, 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 person may see the reflection and assume someone is standing there, and turn back
- Put a large stop sign on the door. The person may instinctively obey it and turn back
Wandering is a very common behavior observed in dementia, and puts the person at risk. A more complete discussion on wandering–why persons with dementia 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 persons does not get burned inadvertently; persons with dementia may not be able to judge water temperature correctly.
- Consider using a stable bath stool that the person 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 you can force 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 person 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 person cannot use it when alone.
- Switch off the gas regulator when not cooking, and place the cylinder such that the person 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, think about putting smoke detectors in the toilets and bedrooms. In spite of the best efforts by family members, smokers sometimes smuggle in cigarettes. They may then forget to put them out and set the place on fire.
- 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 person wanders out and locks the door
- Keep expensive items, such as laptops, at places where the person does not damage them by mistake or drop them.
Some activities of the person with dementia become problematic when the person is no longer able to notice mistakes or understand the danger. Take special caution for these, and remain alert about when to reduce the need for the person to do these activities.
- Smoking: Persons with dementia who smoke may not be cautious enough about lighted cigarettes. They may set the place on fire. Smoking, unfortunately, is addictive. Smokers often somehow manage to procure cigarettes and smoke.Making them stop smoking is not easy, though it can be tried. It is very important to control the availability of cigarettes and matches/ lighters, and to make sure any lighted cigarette is extinguished properly.
- Missed or double dose of medicine: Be alert about when the person with dementia starts getting confused about medication. It is common for dementia persons to forget they need some medicine, or to think they don’t need medicines. They may start hiding pills or throwing them away or spitting them out. Or they get confused on whether they have taken their medicine and may double-dose or even triple-dose. This often happens with sleep medication, because a sleepy person may take the medicine many times. Pill-dispensing boxes may work in early stage, but once they start making mistakes in medication, you need to take on the job of storing and giving medicines.
- Missing meals/ poor hydration and nutrition: Some persons with dementia forget to have their meals, even if the meals are prepared and kept ready for them. In early stages, you can use reminders, like notes on the fridge. The type and prominence of reminders has to be adjusted as the persons become more confused and forgetful. They may also forget to drink enough fluids. Use placement of food and water to act as timely reminders. As dementia progresses, you will need to take more direct steps so that they eat and drink well. Proper hydration and nutrition are a must.
- Use of appliances: As dementia worsens, the person’s ability to operate common appliances reduces. Be careful about this. Remove appliances that the person can no longer use properly and which are dangerous if used wrongly.
- Driving: Persons with dementia who are used to driving may start making mistakes. They may be confused about directions or overwhelmed by traffic or slow to respond to things around them. Unsafe driving is a danger for the person, who may get lost or get hurt in an accident. It is also a danger for others. They may crash into someone else, or others may have an accident trying to avoid their car. You may have to stop the person from driving once the person is not a safe driver. This includes making sure that the person cannot get the keys to the car. Just being told not to drive is not good enough because they may not remember they are not supposed to drive. They may drive off the car as a matter of habit. But you will also need to ensure that they 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 handle financial transactions. They can be cheated easily. It is common to see frauds like making persons with dementia invest in dubious schemes, sign off property, gift off jewelry, etc. Online scams and scams over mobile phones are also common. Confused persons may throw away or give away important papers by mistake. Find ways to guard against such problems without letting the person feel bad. This is often very tricky to achieve. Remove material that can attract fraudsters can help. Put important house and investment papers and jewelry in lockers. Keep bank passbooks and check books in a safe place. Keep passwords and PINs safe.
- Alertness for crises: As dementia progresses, persons are not able to know when they need to call for help for themselves or others around them. This is because they may not realize something odd has happened. They are not able to make decisions well and fast. They may not notice a fire in the house. They may not smell cooking gas leaks. They may let in a stranger and not realize the stranger is robbing the house. They may fall and not recognize they are hurt. If alone at home with another family member, they may not notice if this other person gets injured or has a heart attack. They may not think there is a problem or call for help. This is a common problem when an elderly couple is staying alone and one has dementia and the other is the caregiver.
Set up your home so that others around the person can notice if something is wrong and can do something about it. Video cameras may help. Ask neighbors to check in periodically or use a neighborhood watch program. Tell relatives and friends about the type of problems that can happen. Ask them to remain alert in case their calls remain unanswered or if they notice something odd. Make sure your neighbors have the emergency contact numbers.
Assistive devices can be used by persons with dementia (or caregivers) to make some daily tasks easier. Devices are available for mobility, self-care, dressing, drug management, safety, housework, and many other aspects of daily living. Examples of devices are bedroom accessories, bathroom accessories, daily living aids, hearing, visual, mobility aids, adjustable Indian commode, economy commode, toilet safety railings, adjustable back rests, wheelchairs, bed raisers, bent forks, and many other such products.
Some organizations are now making such devices in India and have agents in various cities. Information on available devices is also often visible in stalls in fairs and events aimed at seniors. Products may also be available from online stores. Shops that sell orthopedic supplies may also have such products or know vendors/ agents who have them.
Even if a product is not available in India, you may be able to look at the product description and think of how to get similar products made. Of course, whether you buy a product or whether you get it made yourself, please be very careful of its safety and sturdiness, and its suitability for the person who will be using it.
For devices not available in India yet, some families order them from suppliers outside India, or ask friends and relatives to get them when coming for a trip to India.
Some specific data on sources of assistive devices is given in the resources section below (See Also…)
Resources/ references from Dementia Care Notes and related sites
Two resource listings are available on the site, at: Caregiver resources in India and Other dementia/ caregiving resources. Both of these list various organizations and online resources, and many of these have tips on how to adapt the home for patients.
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
Assistive living devices in India
The Govt. of India’s Old Age Solutions portal has a section: Assistive devices . This discusses various types of devices.
Pedder Johnson : They manufacture and market several products for dignified living of elders and disabled persons. Their site contains pictures that make it easy for visitors to decide whether the product would be useful.
Information on such products and agents who sell them may also be seen in newspaper articles. For example, for Bangalore, two possible organizations where information was available online are shared here. Please satisfy yourself about their suitability and reliability before ordering anything.
Devised Care India is an organization set up by two ladies: (articles on it at newsreport on Devised Care in Hindu and on the Silver Talkies portal: Devising Ways to Help the Elderly ) Contact details (as of November 29015): Phones: +91-9886393874, +919972817654, Email: firstname.lastname@example.org
Geriose: An online retail outlet offering products for the geriatric community in India. Contact and website: www.geriose.com, www.facebook.com/geriose, and email: email@example.com
External links with discussions/ suggestions on home adaptation
- Home Safety for People with Alzheimer’s Disease
- Safety Center
- Staying safe: steps to take for a person with dementia (PDF file)
- Home Safety for People with Alzheimer’s Disease (PDF file)
- A Guide to Safe Guarding Your Home
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.
The Comfort of Home for Alzheimer's Disease: A Guide for Caregivers (The Comfort of Home) (Maria M Myers, Paula Derr): This book has many tips on how to adapt the home for safety and comfort of care receivers. It describes various equipments to help patients stay mobile. For the paperback version, see Amazon.com, or, if you are in India, see Amazon.in or Flipkart or any other vendor.
(You can also see our full books/ DVD suggestions at: Books and DVDs
Page/ post last updated on: September 26, 2016