Which Home Modifications Should You Make First When Dealing With Alzheimer’s Dementia? Tips to Get You Started
In the wake of an Alzheimer’s diagnosis, families can feel like they are adrift at sea in a damaged boat – without help in sight. When my dad, Jim, was diagnosed, one of the first things that become obvious to us was that we needed to make changes to the home environment in order to make his care more manageable and to keep him safer. (Read Jim’s story, HERE.) This is to be expected since most households are organized around the lives of people with normal cognitive functioning. They are not especially well suited to home-health or memory-related care. But by making a few tweaks here and there, caretakers and families can make the home more conducive to dementia care.
These changes can come in several categories. On the one hand, there will be access-control modifications. These will be additions to the home – like gates, latches, locks, and the like – that will help caretakers restrict their charge in terms of where he or she can go throughout the living space. Common restrictions will apply to appliances, attics, cars and other vehicles, bathrooms, entryways and exits, fireplaces, garages, kitchens, and yards. Other modifications will pertain to improving mobility and minimizing falls and tripping. These may include the installation of grab bars, handrails, extra lighting, ramps, walk-in bathtubs, widened doorways, and so on.[1] Still other household changes – setting up “baby monitors,” cameras, intercoms, mirrors, etc. – will be geared toward more effective patient monitoring.
You’ll Need to Survey Your Own Living Space
I didn’t have much guidance when it fell to me to prep the household for my dad’s care. The following resource, then, is basically one of several that I wish I had had available to me after my dad’s Alzheimer’s diagnosis. It’s really part of my overall “Alzheimer’s-Proofing” project – and part of a series of articles on Alzheimer’s-proofing the home. Interested readers can examine other articles in the series, links to which are provided at right about the end notes.
Not every tip will apply to every reader. Moreover, given the specifics of your situation, you may need to perform modifications that I do not cover on this page. For more suggestions that may spark your own imagination, consult the “Additional Reading” section, below.
But to get you going and to help you start thinking through the modifications that may be necessary in your own home, here is my top ten list for recommended changes. This list is based on my own dealings with my dad, Jim. (If you would like more of the personal details, I invite you to read “Jim’s Story.” For a bit more information about how Jim actually died, there is a follow-up post HERE.)
Just a word about the structure of the list. The first five items are those modifications that can be made well in advance of someone’s actually getting diagnosed with Alzheimer’s or a related condition. The last five are those that, in many circumstances, should be made as soon as you know that your family is facing the prospect of living with someone with dementia.[2]
Top Ten Modifications to Begin Alzheimer’s-Proofing Your Home
- Lighting! This item has easy aspects – and “less easy” ones. On the simple side, just ensure that all the home’s light fixtures and switches are in good working order and have appropriately sized (and functional!) light bulbs. You want to simultaneously provide adequate luminance in the home, while minimizing the danger of bulbs overheating and becoming fire hazards. (On other home-related hazards – and how to rectify them – see HERE.)
On the less easy side, you might need to add light fixtures to dimly lit areas, or even swap out existing (possibly low-luminance or “mood”-type) lights with brighter ones that help to increase visibility. This could be as easy as adding a lamp (out of the way, of course). Or it may need to be as involved as hiring a handyman or electrician to install lights, switches, and wiring.
A less common, but still possible, problem that you may encounter is lighting that is too bright. In my dad’s case, this one mainly applied to the flood lamp on our garage. The motion-sensing fixture would turn on when we pulled a vehicle or walked into the driveway. On at least one occasion, my dad lost his balance because the bright light disoriented him. For us, the fix was to reposition the lamps so that they were differently aimed. However, in related cases it may be advisable to replace the entire lighting assembly with a different one, or to try to obtain suitable bulbs that have lower wattages.[3]
- Baby monitor – that’s also an intercom. Remember that there are certain modifications that will be helpful once they become necessary. But there are some items – like monitors – that also tend to be obtrusive if they are installed only after a cognitive impairment surfaces.
When it became obvious that we needed to monitor my dad (Jim), it took me weeks to find an appropriate hiding spot for the camera/transmitter. I ended up having to camouflage it because he would locate the thing and either move or remove it.[4] And this might also happen to you.
But it occurred to me that if you introduce the device early enough – say, before the dementia presents itself – your loved one might become acclimated or “used” to its presence. This is especially the case if the item has multiple uses.
So, you might try getting a baby monitor to use as an intercom system. When and if it becomes necessary to use it as a monitor – the idea is – your loved one will not be perturbed by it.[5] At least, this is what I would try if I had it to do over again.
- Microwave – with “childproofing” features. I feel like this is another good thing to have in your Alzheimer’s-proofing repertoire. Like other cooking devices (such as conventional ovens, stoves, and so on), microwaves pose various risks – from the risk or burns and fires to the risk of eating underprepared food (because your loved one didn’t observe proper procedures) and more.
The basic idea is that some microwave ovens have the capability of being “locked” (usually with a 3- or 4-digit code) in such a way that prevents them from being operated without “authorization” or apart from careful supervision. My dad, Jim, had a habit of trying to use kitchen appliances well past the time when he could remember how to safely prepare meals. As it was, we had to remove the microwave from the kitchen. Having a lock-able model would have been far better. I’d tell you: get one – if you don’t have one already.[6]
- GPS tracker – that doubles as a watch. Eventually, Jim got to be a real handful. Even though his mental faculties were on the decline, he remained physically fit – at least initially. This meant that even when he couldn’t remember simple things (like how to wash his hands correctly, or where to put dirty dishes), he was still able to open doors and jump fences. (Believe it or not!)
In caretaking circles, Alzheimer’s patients aren’t said to “escape” from their safe areas; this sounds too prison-like. Rather, when they leave their care facilities or homes, Alzheimer’s sufferers are said to elope.
And believe me, Jim eloped frequently enough to alarm us. He always wore a watch, however. So, another gadget that could really have benefited my family would have been a watch with built-in GPS location-tracking features. It’s not a substitute for careful supervision or thorough safeguarding. But it can be a kind of failsafe.[7]
- Handrails. This is a simple one. Even before there is any cognitive impairment arises, a case can be made that it is worthwhile to “beef up” the house’s mobility aids.
Many homes don’t have adequate railings for staircases. So, to my way of thinking, this is a fairly obvious first step (no stairway pun intended).
This may not be as critical if you (or your loved one) aren’t suffering from any physical disabilities. But even able-bodied people may need slight “assists” from time to time. For example, after my dad’s surgeries (triple bypass and colectomy), he had major difficulties getting around. If the truth be told, I’ve had injuries (sprains, etc.) and illnesses that have hampered my own ability to get up and down.
The moral? Handrails can benefit everyone in the house (and even visitors). And they may get you thinking about adding additional mobility aids. For more on the possibilities, see HERE.
- Guardian door lock. Every time I think about home Alzheimer’s Proofing, this little thing pops into my head. It’s an absolute gem. Its primary function is as a door brace to guard against forced entry. But caretakers are impelled to become experts on non-traditional uses for things.
And, in reality, this one doesn’t require much imagination. You install it the same way for theft deterrence or for this secondary purpose: namely, providing an additional layer of protection against “elopement.”
I positioned one high up on the door going into our garage. Even when my dad unlocked the door, he was less likely to be able to get into the garage – which was, as might be expected, fraught with peril (at least for a cognitively impaired person).
To my knowledge, my dad never defeated it. For one thing, I think that this was because he had a hard time seeing it. For another, he would have had a difficult time reaching it. And finally, to disengage it requires a particular motion that would have been challenging for him. And it’s around $15. Honestly, I think it’s close to a no-brainer.
- Electric plug locks. On my list of suggested modifications, this is only second to the Guardian – and this is probably because I love my Guardians so much. In terms of versatility, these small locks can be lifesavers.
Have a coffeepot or toaster that you want to leave out, but don’t want your loved one operating? No problem. Plug the power cord into a plug lock and mom or grandad won’t be able to plug in the toaster. The lock accommodates two- or three-prong electrical plugs and can be unlocked with a key.
A bit inconvenient for the caretaker who might want coffee or toast? Sure. But what you lose in convenience you gain in peace of mind that your loved one won’t hurt him- or herself – or burn the house down.
And the locks work equally well on other appliances. Among other things, and besides the aforementioned coffee pot and toasted, I locked our blender, can opener, electric drill, and table saw. Your investment will be under $20 per lock.
- Cabinet and drawer locks. These are going to be practically essential. It almost a sure bet that your cabinets and drawers contain at least some objects that would be dangerous in the hands of a cognitively impaired individual. This really leaves you with only two alternatives: get rid of the offending materials or lock them up.
I can’t tell you which option is best for your situation. But I can say that in our case removal wasn’t always feasible. For instance, insofar as people will be living and doing meal preparation inside the home, there will be various items (like knives and kitchen appliances) that are necessary to have on hand.
Even if you could swap glassware for plasticware, and remove things like firearms, you may not be able to rid the household of everything that poses a danger. And, frankly, it’s probably not worth thinking too hard about when cabinet and drawer locks are readily available.
You can often find these in the “childproofing” sections of many stores – or online. (For more on the similarities between baby/childproofing and Alzheimer’s-proofing, see HERE.)
- Alcohol, guns, and other ‘specialty’ hazards. Since many people keep alcohol and guns in cabinets (though, hopefully, not the same cabinet!), in a way, this is just an extension of the previous recommendation. Nevertheless, I feel like I should call out these items for special attention, since the risks they pose are especially great.
Because these concerns are significant, I may as well mention here one of the strategies that I use. I am a big believer in redundancy, that is, the use of several “layers” of security that are put in place so that if a primary layer fails, secondary (tertiary, etc.) layers can serve as a kind of backstop.
So, in the case of a firearm, an extreme example of redundancy might be the placement of locked gun, inside of a biometric safe, inside of a locked cabinet that is itself located inside of a locked room. Is all this redundancy strictly necessary? I can’t answer that. But the various layers of security allow that even if the impaired person enters the room or gains access to the cabinet, he or she will be unlikely to defeat all layers and actually get to the firearm.
- Thermostat cover. Once again, I am just drawing on the experience that I had with my dad. But one of the things that happened in his case was that he constantly fiddled with the temperature controls. And since, by that time, he had questionable perceptual and reasoning abilities, he would simply crank the thing up or down more or less willy-nilly.
Sometimes this would lead to conditions where, for example, the house temperature would end up around 90 degrees. Not only is this an annoyance, but it can also pose hazardous to a person’s health in terms of things like overheating or hyperthermia.[8]
For us, believe it or not, we actually had the functional thermostat moved to the lower level and we left the main-level thermostat in place, but inoperable. Because it’s so convoluted of a solution, I wouldn’t recommend this, particularly.
Instead, I would tell you to try getting a locking thermostat cover – the kind that you see in public areas like libraries, offices, etc. If this causes your loved one to become agitated, you can explore additional options like camouflaging it. But at least the temperatures will remain at reasonable and safe levels.
Concluding Remarks
Bear in mind that these recommendations only scratch the surface of what you could do and, unfortunately, of what you might be forced to do to properly care for your loved one.
For a more complete list of suggestions, see my free web resource titled “Ultimate Guide to Alzheimer’s-Proofing A Home: Master List.” You can think of it as a list of possible action items. Peruse it to get some ideas as to how you might effectively alter your own living environment to better care for your afflicted family member.
Looking for Product Recommendations?
Unsure what to buy? I recommend select products HERE.
Additional Reading
Background Information on Alzheimer’s Itself:
General Alzheimer’s-Proofing Information:
Five-Part Complete Guide to Alzheimer’s Proofing Your House:
- “Part One: The Master List.”
- “Part Two: General and Senior-Safety Tips.”
- “Part Three: Specific Alzheimer’s Tips.”
- “Part Four: Kitchens & Bathrooms.”
- “Part Five: Indoors and Outdoors.”
- “Recommended Products”
Alzheimer’s-Proofing a Vehicle:
Notes:
[1] Another aspect of this will simply be decluttering and decontaminating the living space, where applicable. I cover these is other articles.
[2] There are the usual provisos. For one thing, every situation is different. Since Alzheimer’s is a brain-degenerating condition, it may – and is liable to – affect people in various ways. Additionally, because cognitive impairments often impact seniors, there may be physical impairments to contend with as well. These might be byproducts of the dementia, or they might be unrelated (i.e., “comorbid”). Thus, care for some patients may require a heavier emphasis on mobility-aid improvements. While care for other Alzheimer’s sufferers might demand a focus upon access-control and restriction. Let your loved one’s specific case and needs dictate your direction.
[3] Generally, you can put lower wattage bulbs into a light fixture without danger. Of course, you need to make sure that the bulbs are designed for use in fixtures similar to yours. Also, be aware that lower-wattage bulbs will be dimmer. You just never want to exceed the recommended wattage, or you could have a fire hazard on your hands.
[4] He sometimes also obstructed it. Sometimes this may have been intentional; other times, it probably wasn’t.
[5] Of course, I have to include a major caveat. Alzheimer’s ravages memories. So, it is possible that your loved one won’t remember being “used to” the monitor when he or she is suffering from dementia. It’s also possible that your loved one will “remember” the object and fiddle with it in ways that obstruct its use as a monitor. But I still think that this item is valuable enough to be worth that risk. Having a monitor on my dad freed me up to be able to do other tasks around the house – or even do business-related work in the home – without worry that Jim was “getting into” or doing something that he shouldn’t.
[6] Before spending money, you might want to determine whether your current model is lockable in the relevant way. Try to locate the printed copy of your microwave’s owner’s manual – or find it online.
[7] IF, that is, your loved one would wear it. Although my dad wore a watch, it was a wristwatch with a traditional clockface and moving hands. It wasn’t digital. So, it’s not a sure bet that he would have accepted a GPS-tracking watch as a substitute for what he was used to wearing. However, after he disappeared several times, I would have been inclined to give it a try.
[8] Of course, it’s also possible that the house temperature could drop dangerously low and present equal but opposite risks. However, personally, I never ran into this with my dad.
