Keeping a loved one with dementia or another cognitive impairment safe can be a challenging task, especially in the beginning when there may not be a clear diagnosis of the cause.
Maybe your loved one is getting lost for hours on the road, or perhaps they went out for a walk and they have always done and could not get home. Simple tasks they used to do everyday become hazardous activities and as caretakers, we strive to make their home as safe as possible as the disease changes.
We call the act of making Dad’s space safe for him, “Daddy Proofing” or "Dementia Proofing". In a lot of ways it is very similar to when you child-proof a house when you have children. Although it’s trial and error, putting yourself in their shoes and creating a plan of action is going to help reduce stressful incidents.
TOPICS COVERED - QUICK LINKS:
#1. Driving & Dementia
Driving is often not safe and can be met with resistance if taken away since it represents their freedom of mobility and independence. In some cases, it may be illegal for them to still be driving. Ask their doctor whether it’s safe for your loved one to drive, and contact your DVM to assist if necessary. If safety is in question, use these tips to prevent him or her from getting behind the wheel:
- If unfit to drive and resistant to the change, ask an authority figure, such as a doctor or insurance agent, to tell your loved one not to drive.
- Ask the doctor about contacting the Department of Motor Vehicles. In many cases the DMV can require physician approval for driving for a person with dementia and can revoke a license if there is a danger.
- Contact the Department of Motor Vehicles to have your loved one's license revoked. Some states have special examinations and procedures for evaluating a dementia patient, check with your local DMV if they have a process to help with your loved ones needs. Here’s an example from the DMV in Califonia
- Out of sight, Out of mind - If the person is no longer driving, remove access to car keys. If the car becomes a stressor and large issue, find a way to get rid of the car - donate it, lend it to a family member, sell it!
- Another tactic is to disconnect the battery to the car or remove the battery all together so your loved one is unable to move the car. You can say that the car needs to be repaired, and if you loved one calls to have the car repaired, simply leave a note for the mechanic explaining your loved one's situation. They will understand and this may be a way to help get the car completely out of sight.
- If person is still able to drive, consider using a GPS system to help if they get lost. You may also use a tracking locator such as the TILE product, to know where your loved one is using your smartphone.
- Keep Calm: Remember that eventually they will forget about the car altogether and lose the ability to drive. After some time they will not even remember they had a car at all, so try to keep calm and know you’re not alone!
#2. Wandering & Dementia
- Reduce Wandering with Regular Exercise: Make sure the person gets enough exercise, which can reduce anxiety agitation and restlessness - reducing the frequency of the wandering. With Dad, we made sure he had an hour of exercise/walking incorporated into his schedule to help curb the need to wander and to assist with regular sleeping. If he did not exercise, he would not sleep well and therefore none of us would sleep well either!
- Avoid busy places that are confusing and can cause disorientation, such as shopping malls and parks.
- If they can still read, place a “Stop” sign on doors to the outside to remind them not to leave.
- Amazon: Stop Sign Sticker
- Place alarms on all doors and windows that will sound if the doors are opened. Invest in remote care technology so that you will be alerted if your loved one opens a door or window that could be dangerous. Here are some options and some tips to keep in mind when selecting a system:
- If the house already has an alarm system installed, speak to home security provider to see what remote monitoring/notifications solutions they provide. Many providers have fantastic solutions for this and you can manage the alarm system even when you’re not anywhere near the home on your phone or computer.
- Amazon: Door Alarms - Pros: Inexpensive, quick fix that notifies whoever is in the home whenever a door is open by beeping. Cons: No remote notification and only those in the house paying attention will hear the beep. Will make noise whenever anyone opens the doors.
- Quick Medical: Anti-Wandering Door Monitoring System - Pros: Wrist sensor trips alarm whenever individual walks outside. Cons: Fairly expensive, no remote notifications.
- Remote Door Alarm Solutions: The following provide "complete" solutions (potential to include cameras) with the ability to view notifications and modifications on smart phone, tablet or computer. We have not tested these systems ourselves yet so we cannot advocate for one over the other yet. If you have, let us know your experience with the systems!
- Samsung SmartThings: Compatible products include cameras, motion sensors, outlet controls.
- Use indoor and outdoor cameras that can be accessed remotely to monitor your loved one at home in the same way parents use baby monitors for a child. This is extremely useful if your loved one is experiencing issues at night. Many of these technologies can be accessed remotely and bring a great piece of mind when you are not home. It also allows several family members the ability to “check-in” simultaneously.
- D-Link Wifi Camera: We had two of these cameras in our house (one in the common area and another in dads room) for when he was having issues sleeping. The cameras are not perfect (issues with wi-fi connection) but were very useful.
- Nest Home Cameras: The Nest Products (Thermostat, Cameras, C02 Monitor) integrate together allowing flexibility you to monitor the AC/Heat and Cameras remotely. This is useful if your loved one accidentaly frequently changes thermostat. Several states, including Georgia are currently providing subsidies for Nest products, making it an extremely affordable solution.
- Lock or disguise hazardous areas or areas where you do not want your loved one venturing into like the kitchen or basement. This works great for Late Stage 2, Stage 3 individuals (What Stage are we In?). Here are some ideas for how to do this:
- Use curtains to segment areas of the house - Dark curtains that block out most of the light will work best. Walmart has great cheap curtains or you can also purchase them for a low cost on Amazon.
- Use children gates, “Dutch” doors, swinging doors or folding doors to hide entrances to the kitchen, stairwell, workroom and storage areas. We used children’s gates with dad to keep him from going into the kitchen at night. Here’s the gate we used with dad: Evenflo Walk Through Gate
- Cover doors and locks with a painted murals or cloth. Same as with curtains, this gives the illusion that there is nothing there. Out of sight, out of mind. For individuals with visual impairment caused by the disease (frequently a symptom of FTD) such as affected color/contrast distinction (you can tell they have this if they are uneasy walking on dark floors), cover door knobs and locks with dark cloth.
- Use knob and handle covers to prevent the individual from opening the doors. These can be found on our website, on Amazon, and in stores such as Home Depot and Target in the baby section.
- Our Recommendation - Safety 1st: Door Knob Cover
- Our Recommendation - Safety 1st: Door Lever Cover
- Remove traditional 2 way door knobs altogether and replace with locks that require key access or code entry to open the door. Removing the knob removes the ability and temptation to open the door. This is extremely handy in preventing rummaging through their clothing or other closets in the house. Here are some options for this:
- Place deadbolts either high or low on exterior doors if there are concerns about the person wandering at night. You can also use the Door Guardian to keep the door closed. It is AWESOME.
- Remove door locks. Consider removing locks from the bathroom doors to prevent your loved one from accidentally locking himself or herself in. For more info on bathroom safety, go to section #7. Bathroom, Showering & Dementia.
- Go with your loved one if he or she insists on leaving the house. Don’t argue or yell. Instead, use distraction or gentle hints to get him or her to return home.
- Always keep spare keys to the house and doors in the house outside and around the house - it is very common for an individual with dementia to lock themselves in a room or lock their loved ones out of the house.
When the person does wander, to prevent injury:
- Register your loved one with the Alzheimer’s Association’s Medic Alert and Safe Return Program.
- Speak with the neighbors and let them know about your loved one’s situation. Ask them to call you or to help them get home if this happens. We once had dad wander out of the house to the Papa John’s next door in his undies when his caretaker was in the bathroom. They were nice enough to return him home once they recognized him because we previously had notified them of his condition.
- Have the person wear an ID bracelet or necklace with their name, address, phone number, DOB and diagnosis on it. We used a Road ID wristband with dad - it is Waterproof and easy to take on and off.
- Fence and close off any areas that may be dangerous, such as a stairwell, deck, a hot tub, or a swimming pool.
- Consider giving the person a cell phone with a GPS locator (embedded in most smartphones) or tracker such as the TILE attached to it. You can attach the TILE directly to the phone or the wallet, or even make a special pocket it in your loved ones clothes. Be careful when washing the clothes to not have the tile still there.
- ANDROID - View this video to make sure the necessary features are turned ON to ensure tracking is working correctly:
- IPHONE: View this video to see how the tracking works and to make sure the correct features are turned on:
#3. Medication Management & Dementia
If the person with dementia is unable to administer their own medication safely, arrangements should be made for someone else to do this.
Remove vitamins, prescription drugs, sugar substitutes and seasoning from the kitchen table and counters. Medications should be kept in a locked drawer or cabinet at all times.
Safety 1st: Magnetic Cabinet Locks - Requires Minor Drilling (Strong hold)
Safety Baby: Magnetic Cabinet Locks - No Tools Necessary, Uses 3M Adhesive
Use child-restraint caps on medication containers.
To help ensure that medications are taken safely, use a pill box organizer (doseette box) or keep a daily list and check off each medication as it is taken. Pill boxes have separate tablet compartments for days of the week and/or times of day such as morning, afternoon and evening.
Amazon: Pill Boxes and Organizers
Use a compliance pack for medication (to avoid forgetting or taking tablets twice). There are services out there that do this for you - one of which is PillPack which is FREE (you only pay the copays). PillPack pre-packages the medication by day and time to be taken and delivers the medications to your home. With dad, the prepackaged pills were a life saver - it's great when the caretakers can't overdose the patient because of human mistake. Check out their video below:
#4. Kitchen Hazards & Dementia
Label cupboards and objects with pictures and words so that they can be identified.
Prevent access to potentially dangerous appliances. Install safety knobs on the stove to prevent your loved one from turning the stove on or off. Use knob covers or remove the knobs if not suing the appliance. Disconnect the garbage disposal.
Use appliances that have an auto shut-off and timed shut-off features. Unplug toasters and other appliances when not in use.
If you have a gas stove and your loved one is prone to turn it on and off, fit an isolation valve so that the cooker cannot be turned on and left on. Devices are also available for electric cookers.
Store knives and sharp cooking utensils in a locked drawer or a cabinet out of reach. Install childproof latches on cabinets and drawers to limit access to potentially dangerous items. Dad would grab kitchen knifes and put them in his pocket!!
Safety 1st: Magnetic Cabinet Locks - Requires Minor Drilling (Strong hold)
Safety Baby: Magnetic Cabinet Locks - No Tools Necessary, Uses 3M Adhesive
Store cleaning products (bleach, soaps..), alcohol, matches, knives, sharp cooking utensils and scissors in a locked place and keep them out of sight. Dad would accidentally drink the dish soap thinking it was water.
Shut off water valves for sinks in the kitchen and in the bathroom if your loved one is prone to leaving them running. For more info on bathroom safety, go to section #7. Bathroom, Showering & Dementia.
Check food for spoilage. Your loved one may not know when food has gone bad.
- Hide the garbage can to reduce rummaging when unattended.
#5. Falling or Tripping & Dementia
Falls are a common and potentially serious problem affecting dementia patients. There can be several reasons for this:
- Diagnosis: People who have been diagnosed with Vascular Dementia, Parkinson's, or Lewy Body Dementia are at a higher risk of falling since the disease affects their motors skills drastically.
- Medications can have side effects, including dizziness, which could increase the risk of a fall. Changes to medication or dosage, as well as taking multiple medicines, can increase a person's risk of falling.
Impaired Eye Sight: Dementia can cause damage to the visual system (the eyes and the parts of the nervous system that process visual information), and this can lead to difficulties. The type of difficulty will depends on the type of dementia. Problems may include:
- Decreased sensitivity to differences in contrast (including color contrast such as black and white, and contrast between objects and background)
- Reduced ability to detect movement
- Reduced ability to detect different colors (for example, a person may have problems telling the difference between blue and purple)
- Changes to the visual field (how much someone can see around the edge of their vision while looking straight ahead)
- Double vision
Here are some strategies to prevent falls in the home:
- Check the home for potential hazards such as rugs, loose carpets, furniture or objects lying on the floor. Keep floors and surfaces clutter-free. Avoid dark rugs and carpets as they may appear to be a hole to dementia patients with visual impairments, use matte colors instead.
- Address slippery surfaces: Add textured stickers to slippery surfaces. Apply adhesives to keep throw rugs and carpeting in place or remove rugs completely.
- Amazon: Anti-Slip Mats
- Stairs: Place light switches at the top and bottom of the stairs. Make sure stairs have at least one handrail that extends beyond the first and last steps. Cover stairs in carpet or apply nonskid strips. If your loved one has balance problems, install safety gates in front of stairs. See Section: #2. Wandering & Dementia for more info.
- Mark glass doors, windows and furniture: Place a decal on glass doors, picture windows and furniture with large glass panels at your loved one's eye level to help him or her see glass panes.
- Limit Confusion: Leave furniture arranged in the same way for as long as possible so as to not cause confusion.
- Use light to guide the patient:
- Changes in light can be disorienting. Create an even level of lighting by adding extra lights to entries, doorways, stairways, outside landing, and areas between rooms, and bathrooms.
- At night time safety, use night lights or motion censored lights in hallways, bedrooms, and bathrooms to prevent accidents at night. You can also get outlet controls which allow you to turn lights on and off using your smartphone. We use light to guide dad to the toilet by placing a spot light on the toilet and leaving it on 24/7.
- In the Bathroom:
- Install walk-in showers
- Add grab bars to the shower or tub and at the edge of the vanity to allow for independent, safe movement.
- Place nonskid strips or a mat in the bath tub and shower. Unless the bathroom is carpeted, place nonskid strips on the floor near the bath tub, shower, toilet and sink, too.
- For more info on bathroom safety, go to section #7. Bathroom, Showering & Dementia.
#6. Eating & Dementia
- Hide all food that is not meant to be eaten or items that can be mistaken for food. Dad would eat everything he saw out, especially when he wandered at night.
Check the temperature of water and food. Avoid serving food and beverages that are too hot as the person with dementia may not remember to check the temperature.
Discard toxic substances or decorative pieces that may be mistaken for real food and make sure to check expiration dates on the food. Dad confused marbles and candle sticks for food!! How fun that was!!
#7. Bathroom, Showering & Dementia
Watch the temperature of the water to prevent scalding. Lower the temperature of the hot water tank to 120 degrees or less. Monitor the hot water temperature in the shower or bath. Consider installing an automatic thermometer. This video below outlines how to do this:
Install a shower chair, plastic shower stool and grab bars. A handheld shower head is extremely useful for assisting them in the shower.
Install anti-slip mats in the shower: Amazon: Anti-Slip Mats
Use a faucet cover in the bath tub. A foam rubber faucet cover can help prevent serious injury if your loved one falls in the bath tub.
Amazon: Rubber Faucet Cover
Inset drain traps in sinks to catch small items that may be lost or flushed down the drain.
Amazon: Drain Traps
- Use a lot of light in the bathroom to guide the patient into the shower - individuals with visual impairments can resist entering the shower because they think it's a black hole, or the reflections confuse them.
Other suggestions for the bathroom: Store hair dryers, razors, and curling irons in a secure area. Remove poisons, such as drain cleaner and nail polish remover.
#8. Bedroom, Sleeping & Dementia
Dementia patients are extremely sensitive to temperature changes - always keep them warm with enough blankets and warm clothing. This will also help them sleep better at night and keep them from waking up.
Install a monitoring device in the bedroom: A baby monitor or cameras (Details on monitors and cameras in section: #2. Wandering & Dementia) will help you hear if your loved one needs help.
Take caution when using heating devices in the bedroom: Don't use portable space heaters and if your loved one uses an electric blanket or heating pad, keep the controls out of his or her reach.
If you use portable fans, be sure that objects cannot be placed in the blades.
Make a clear path to the bathroom using night lights as guides for more info on this go to section: #5. Falling or Tripping & Dementia.
#9. Tobacco and Alcohol Use & Dementia
Substance use can have harmful side effects and may interact dangerously with some medications, however dementia patients can be stubborn and old habits die hard. Dad was a cigarette smoker all of his life, eventually he forgot how to smoke or that he had a desire to smoke. Here are some tips for dealing with substance use:
- Always supervise them when smoking as they may forget a burning cigarette and start a fire. Remove matches, lighters, ashtrays, cigarettes and other means of smoking from view.
Keep all alcohol in a locked cabinet or out of reach of the person with dementia. Drinking alcohol can increase confusion.
#10. Firearm Safety
- Get rid of them and reduce the headache altogether.
- Exercise full control and supervision.
- Keep firearms in a locked cabinet, firearm vault, safe or storage case, or remove them from the living space.
- Lock ammunition in a separate place.
- Keep firearms unloaded when not in use.
#11. Being Outdoors:
- Always use sunscreen and bugs spray for protection.
- Keep outdoor area well lit with motion sensor lights (See #5. Falling or Tripping & Dementia) , so that if a person is outside and daylight is fading they are still able to see adequately.
- Put a rail on any stairs to help the person get up and down them. It can also help to highlight the edges of each step with bright floor safety tape.
- Avoid trip hazards such as loose paving slabs, unravelled hosepipes or uneven surfaces. Keep steps sturdy and textured to prevent falls in wet or icy weather. Avoid clutter by keeping hoses, foliage and other debris off the walkways.
- Have seating areas so that the person can take a rest or enjoy being outside if they are unsteady on their feet.
- Use shelter to protect people from the elements if they want to spend a long time outside - eg a gazebo or a parasol over a table and chairs.
- Restrict access to the pool or hot tub, surround it with a fence. Install a gate with a lock. Cover the pool or hot tub when it's not in use.
- Safely store fuel sources - remove fuel sources for your grill or other equipment when not in use.
- If your loved one uses a walker or wheelchair, make sure he or she will be able to get in and out of your home. Consider widening doorways or adding ramps.
Other Safety Concerns
Have Emergency Contacts Ready to go: Display emergency numbers and your home address near all telephones. These might include the numbers for:
Carers, friends or family members
The physician and hospital
Social worker and Home care agency
Gas, water and electricity providers (especially in an emergency)
Tell anyone who might need this information where to find the list along with the following:
Where to find the gas and electricity meters, the fuse box
Where to find the point to turn off the main gas supply
Location of the first aid box.
Put smoke detectors, carbon monoxide alarms, and fire extinguishers on each floor, and test them to be sure they work. Place them in or near the kitchen and all sleeping areas. Check them regularly to make sure they work. If your loved one has vision or hearing problems, install a smoke alarm with a vibrating pad or flashing light. You might need to change the batteries every few months.
Nest provides a solution that integrates with the cameras and thermostat - see #2. Wandering & Dementia for more info.
Cover electrical outlets you’re not using, and take care of any wiring problems. Keep lamps and other appliances near outlets so you’re less likely to trip on the cords. You can also use tape to secure them to the floor.
Prevent Fraud: Persons with dementia may be easy prey for dishonest salespeople or money scams. Try placing a “No Solicitations” sign on your loved one’s front door. Add his or her phone number to the Federal Trade Commission’s “Do Not Call” list (888-382-1222). You should also limit access to credit cards and cash.
- Hide a spare house key outside in case the person with dementia locks you out of the house.
- Alzheimer’s Association: Steps to take for a person with dementia
- Alzheimer's Association: Dementia Care Practice Recommendations for Professionals Working in a Home Setting
- Moore, HD, Algase DL, Powell-Cope G, Appelgarth S, Beattie ER. A framework for managing wandering and preventing elopement