What caregivers can do: Make changes in the home to keep it safe for the patient. Look for changes that can make it easier for patients to do their tasks independently, or with very little support. Help patients feel more capable and happier by suitable changes at home. Keep adjusting the home as the patient’s abilities get worse.
The surroundings of the dementia patient affect how patients do their daily activities and how they behave. But though patient 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 patients safer, happier, and more independent. This reduces chances of the patient withdrawing or feeling agitated, and the overall stress for the entire family.
- 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 patient’s current abilities. The state of the patient changes over time, and so the home may need to be changed again and again to suit 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. Removing unnecessary objects and adding signs may help. Later, when the patient starts facing problems in walking, you may need to add grab rails. If the patient finds it difficult to get up from a chair, you may need to use a chair that has arms.
An important part of home adaptations is observing the patient’s problems and remaining alert about possible home changes. You have to select what suits the patient 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 patient, be clear of your reason. Some possible reasons to make changes:
Make it easier for patients to know the place and time (Reality orientation): Patients are often confused about where they are or what the time or date is. Reality orientation is the term for trying to help patients know where they are. Changes for this may include adding prominent clocks and calendars, having windows that allow patients to see the sunlight, etc. Clearing the room of clutter and simplifying the layout can help, because then the patient 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: Patients 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 patients to do some things, and discourage them from doing other things.
Ensure safety: Given the several problems patients face, think how the home can be made safer even if patients 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 patient 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 patient 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 patient 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 patient unsure about how to cook because everything seems different. It is important to think of the patient’s difficulties in adjusting before you make changes to something the patient is used to.
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. View video “Aging vision and Alzheimer’s” on Youtube.)
Another problem is that, even if their sight is alright, many patients 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, 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.
While making home adaptations, keep in mind the cognitive problems that patients may be facing. For example, dementia often affects the way patients 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 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 their normal activities. /p>
- Identify the activities for which the patient moves around. For each, make sure the patient can easily get what is needed.
- 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.
- Display your contact numbers and details prominently. This is because patients may forget your name or phone number, or even that they can call if they need help. A displayed list can also be used by someone else who thinks the patient 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 patients 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 patients 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 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 heavy and stable furniture so that it does not fall over the patient
- 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 patient 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 patient walks, because the patient may lean on them or catch them for support.
- Remove anything the patient could trip over, for example wires, uneven 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:
Most discussions on home adaptations look at ways to make life easier and safer for the patient. 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 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 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 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, get a hospital bed so that the patient 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 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 the patient spends at least part of the day feeling socially connected to others. For example, seat the patient 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 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 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 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 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 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.
- Switch off the gas regulator when not cooking, and place the cylinder 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, 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 patient wanders out and locks the door
- Keep expensive items, such as laptops, at places where the patient does not damage them by mistake or drop them.
Some activities of the patient become problematic when the patient 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 patient to do these activities.
- Smoking: Patients 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: Often, the patient handle their medicine for quite a while. You 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 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 patient may take the medicine many times. Pill-dispensing boxes may work in early stage, but once patients start making mistakes in medication, you need to take on the job of storing and giving medicines.
- Missing meals/ poor hydration and nutrition: Some patients 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 patients become more confused and forgetful. Patients 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 the patient eats and drinks well. Proper hydration and nutrition are a must.
- Use of appliances: As dementia worsens, the patient’s ability to operate common appliances reduces. Be observant about this. Remove appliances that the patient can no longer use properly and which are dangerous if used wrongly.
- Driving: Patients who are used to driving may start making mistakes because they are confused about directions or overwhelmed by traffic or slow to respond to things around them. Unsafe driving is a danger for the patient, who may get lost or get hurt in an accident. It is also a danger for others. When patients drive badly, they may crash into someone else, or others may have an accident trying to avoid the patient’s car. You may need to take the decision to stop the patient from driving once the patient is not a safe driver. This includes making sure that the patient cannot get the keys to the car. Just being told not to drive is not good enough because patients may not remember they are not supposed to drive and may drive off the car as a matter of habit. But you will 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 handle financial transactions. They can be cheated easily. It is common to see frauds like making patients invest in dubious schemes, sign off property, gift off jewelry, etc.. Online scams and scams over mobile phones are also common. Confused patients may throw away or give away important papers by mistake. Find ways to guard against such problems without letting the patient 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, patients 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, and 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 a caregiver and the caregiver gets injured or has a heart attack, they may not think there is a problem or call for help.
Set up your home so that others around the patient 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 so that they are also alert in case their calls remain unanswered or 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. 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 making such devices in India. Look around, and visit fairs and events designed for the elderly, etc. Newspapers also carry articles on such things. Here is one example of an organization in Bangalore set up by two ladies: Devised Care India (see newsreport on Devised Care in Hindu and an article on the Silver Talkies portal: Devising Ways to Help the Elderly)
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, 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
- 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
[This page was last updated in June 2015]