There's No Place Like Home: Creating Safe Environments for People With Late Stage Dementia

As any poll on the living preferences of older adults will tell you, the majority want to age in place in their current home—and that includes people with dementia and/or intellectual and developmental disabilities (IDD). This preference remains strong whether or not the person will be living alone; in fact, around one third of people with dementia live on their own. Though there are challenges posed by not living in a specialized setting, it's also true that change can be very stressful for those with dementia and IDD, and that familiar environments provide a great amount of comfort and stability. The famous The Wizard of Oz quote says it best: "There's no place like home."

That said, the home may not always be the safest or most convenient place for people with dementia and IDD to live. Effective and sustainable aging in place requires more than just wanting to do it: it involves planning, anticipating problems, devising solutions and modifying the home to a loved one's needs. As a caregiver, you can play a part in helping your loved one continue to live safely in familiar surroundings by assessing their home.

Home Checkups

Conducting a home check up is a great place to start in determining how well a loved one's home does or doesn't suit their current needs. To start, take a tour of the house and make a list of any repairs or renovations that will make it safe, comfortable, convenient and secure.

Give special attention to these potentially dangerous areas of the house:

1. Stairs

Going up or down stairs can be treacherous for people with memory loss— especially if they also have poor vision, difficulty walking or balance problems. Ask yourself the following questions:

• Are the handrails able to support my loved one in walking up and down the stairs? Are there handrails on both sides of the stairs?
• Are the stairs well-lit at the top, bottom and middle?
• Would my loved one benefit from a chair lift and be able to safely operate it?
• Is the carpeting worn or torn in any places? Are there loose or protruding nails or boards?
• Do the stairs have treads?
• Are the stairs kept free of clutter? Do visitors to the house know not to leave items on or by the stairs?

For more tips on stair safety, check out our article on managing stairs for older adults.

2. Bathrooms

Bathrooms can also be hazardous places. They are used frequently, so they must be as safe and convenient as possible for people with memory problems, IDD and/or mobility issues.  Here are some questions to ask yourself during your checkup:

• Is there anything safe and sturdy to grab onto in the tub/shower, or by the toilet?
• Are the faucet handles and shower controls easy for my loved one to use?
• Is my loved one able to keep water temperature at 120 degrees or lower to avoid burning themselves?
• Are there adequate ways to light the bathroom at night?
• Is there anything on the floor to lower the risk of my loved one falling?

If a loved one has trouble finding the bathroom,  tape a picture of a toilet to the bathroom door to remind them where it is and what it’s for. For additional tips, take a look at our article on bathroom safety.

3. Living Room

Living rooms present a variety of obstacles that can cause falls or other mishaps. Ask yourself these questions:

• Are there any rugs that my loved one could trip or slip on? Is there anything under the rugs, such as vents or cords, that could make them uneven to walk across?
• Are cords for electronics out in the open and possible tripping hazards?
• Are rugs and carpeting worn or torn? Are there any loose floorboards?
• Are electrical outlets protected when not in use?

4. Kitchen

Even if your loved one no longer cooks, they may enjoy spending time in the kitchen and helping you with certain tasks. However, kitchens can be especially dangerous due to fire hazards and the presence of sharp objects such as knives. When assessing the kitchen, consider these questions:

• Can my loved one easily get a hold of knives, scissors or other sharp objects? What about matches? Are there any dangerous chemicals like bleach or drain cleaner under the kitchen sink?
• Is there anything in place to stop my loved one from using the stove without supervision?
• Are electrical outlets protected when not in use?
• Is there a fire detector in the kitchen, and are its batteries regularly changed?

Strategies for safe wandering

According to the Alzheimer’s Association, 60 percent of individuals with dementia wander away or get lost at some time during their illness. This can be a frightening and dangerous experience for the family and their loved one. The Alzheimer’s Association suggests ways families can manage wandering behaviors and ensure their loved one’s safety. Try:

• Taking frequent walks with a loved one to reduce anxiety and restlessness
• Exercising during the day so that a loved one sleeps better at night
• Involving a loved one in household chores like sorting laundry, setting the table or pulling weeds to keep them active and occupied
• Creating indoor and outdoor wandering trails in a fenced-in backyard or around the house.
• Hiding doors with curtains, paint or wallpaper that matches the wall. Consider installing sliding bolt locks on outside or basement doors that are high enough so a loved one can't reach them.
• Explaining to neighbors that you have a loved one with a memory problem and ask them to let youknow right away if they see this loved one outside alone.
• Hiding the car keys where a loved one can’t find them or disabling the ignition so the car won’t start.

Sign up for “Safe Return”

Even if you follow these tips, there is a chance your loved one may still find a way to wander away from home. This can be an incredibly dangerous situation for a loved one to be in. If wanderers are not found within the first 24 hours after their disappearance, they are likely to be seriously injured or dead. Wanderers can also suffer from falls or other injuries. 

The MedicAlert® + Alzheimer's Association Safe Return® program has created a nationwide information and photo database of individuals with memory disorders. This database is available to law enforcement agencies across the country to help them return people with Alzheimer’s who have wandered away and gotten lost to their families.

For a registration fee of $55, individuals enrolled in Safe Return® receive identification clothing labels, bracelets or necklaces with the toll free 800 Safe Return phone number. When someone with Alzheimer’s who is enrolled in the program is found, an individual or law enforcement officer calls the toll-free 24-hour Safe Return phone number and the individual's family or caregivers are notified.

This article was written for the Expansion of Dementia-Capable Communities within Urban and Rural Settings in Ohio using Evidence-Based and Informed Programming project, a grant funded by the Administration for Community Living (ACL). Learn more here.