How to Alzheimer’s-Proof Your House

Part Five: Indoors and Outdoors

Five-Part Complete Guide to Alzheimer’s Proofing Your House

Part 1 | Part 2 | Part 3 | Part 4 | Part 5

Alzheimer’sProofing Indoors

Attics / Basements / Garages / Sheds / Storage Lockers

Attics, basements, garages, sheds, storage lockers are especially dangerous because, in general, they are repositories for chemicals, machinery, tools, and other items that often require special safe-handling protocols. If you permit your Alzheimer’s-afflicted loved one to enter these areas, it should be only under your careful supervision. Moreover, all of AlzheimersProof’s general safety tips are applicable. To be specific, you need to ensure that walking paths are clutter-free, the accessible areas are appropriately lit, and that dangerous items are beyond your loved one’s reach.

Attic fans. See Fans.

Bicycles. Bicycles should be secured – preferably out of sight. A stationary bike might be a good way for the Alzheimer’s-afflicted individual to exercise, but it must be used only under careful supervision. Regular bicycles are likely to prompt your loved one to leave the premises.

Fans. Fans should be secured. As mentioned for other items, I favor electrical-plug locks that prevent appliances from being plugged into outlets. However, if the fan is functional (or hardwired – as are attic, or whole-house, fans) then access to it must be restricted. At the least, the fan blades need to be inaccessible so that they cannot be touched or bumped into (whether accidentally or on purpose).

House fans. See Fans.

Lawnmowers. Lawnmowers and other lawncare equipment – such as edgers (“weed eaters”), hoes, pickaxes, post-hole diggers, rakes, shears, shovels, spades, etc. – should be placed out of reach. Additionally, mowers (and other machines with engines) should be properly stored. This might involve having to drain them of fuel (e.g., gasoline) and oil. When in doubt, call in a lawn-and-garden specialist or handyman.

Locks, garage. The garage needs to be locked. Actually, it should be secured in several ways. Firstly, if there is an access door from the house, this should be locked with a double-keyed deadbolt. Secondly, I recommend installing a Guardian latch high up on the door for additional security. Thirdly, the motorized garage door should be restricted. You may need to confiscate and control access to remote controls. Additionally, it may be necessary to recode or replace them if confiscation is not an option. Consider purchasing a “dummy” opener to give to your loved one, so that your loved one will not continue to look for the operational remote.

Paints. Enamels, latexes, and oil-based liquid paints should either be properly discarded or else locked securely in cabinets. The same goes for aerosol spray paints except, in this case, there is an additional and more pronounced danger of fire or explosion. Paints must be stored according to manufacturers’ warnings about temperature and pressure.

Sporting equipment. Keep sporting goods locked away. Baseballs and bats, gold clubs, and the like should be put away. In the first place, these items could be used – whether innocently or not – to cause damage indoors. In the second place, they can give rise to desires to “elope.” For instance, my dad would look at his golf clubs and then try to leave the house to get to a golf course. It’s good to give Alzheimer’s sufferers physical activities to do. However, these need to be carefully arranged and scheduled and should not involve pieces of equipment that might put the patient or others at risk.

Tools, garage. Restrict access to electrical tools and hand tools. Locking tool boxes and storage chests are available from hardware and home-improvement stores.

Weight equipment. This equipment needs to be gotten rid of or else kept well out of reach. Like other Sporting equipment, barbells, dumbbells, free weights, and other weight equipment can be dangerous for a person with dementia. Number one, safe-lifting practices may be neglected. Number two, the individual may no longer have any clear idea of his or her own strengths (or weaknesses).

Whole-house fans. See Fans.

RETURN TO PART ONE: THE MASTER LIST.

Bathrooms

SEE PART FOUR: KITCHENS AND BATHROOMS

RETURN TO PART ONE: THE MASTER LIST.

Bedrooms

Assist bars. Remember that one of the “Activities of Daily Living” is being able to transfer (e.g., in and out of bed) by oneself. If this is getting to be difficult, you can place “assist” bars or rails next to the bed. These devices provide the afflicted person with something to grab onto for greater leverage.

Baby monitors. This is highly effective for keeping track of a napping or sleeping dementia patient. It can also be used in other rooms of the house, and for other occasions.

Bed monitors. This pressure-sensitive device can be placed under the mattress. It will alert you whenever a person’s bodyweight is removed.

Bed rails. If your loved one frequently falls out of bed, install bed rails along the sides. Mats or pillows can also be placed on the floor. However, if left in place, these can create a tripping hazard.

Fans. Some people like fans to sleep. However, as electrical appliance, a fan is not without danger. For one thing, you need to make sure the cover is secure so that fingers and objects cannot come into contact with the blades. For another thing, you want to see that the fan is placed somewhere well clear or any water (especially if your loved one likes to sleep with a glass of water on the night table).

Furniture. Ensure that furniture is “anchored” so that it cannot be knocked or tipped over easily. Heavy furniture can cause severe injury or death if it falls on a person.

Lighting, bedroom. Install a low-light detecting nightlight.

Medicines. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Prescriptions. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Rugs, bedroom. As previously discussed, and just like in other applications, rugs should be removed from the bedroom floor, or tacked down. Properly installed carpeting is superior, since it is less likely to bunch up, slide, or otherwise contribute to a person tripping.

Space heaters. These are dangerous since they must be placed correctly, operated carefully, and switched off while not being monitored. A space heater constitutes a burn and fire hazard. Similar warnings extend to things like electric blankets and heating pads. Central heating and cooling – properly controlled – is a better option.

RETURN TO PART ONE: THE MASTER LIST.

Entrances & Miscellaneous

Chair lifts. Install as needed, if affordable. Also called “stair lifts,” these are basically chairs that run on motorized rails and can transport physically impaired individuals up and down staircases without their having to walk.

Mats. Nonslip mats can be placed in on hardwood or linoleum entry areas in order to minimize the danger of slipping. However, as with rugs, mats can slide. Ensure that mats are stable (e.g., glued, tacked, or otherwise secured affixed to the floor) before relying upon them.

Stair lifts. See Chair lifts.

RETURN TO PART ONE: THE MASTER LIST.

Kitchens

SEE PART FOUR: KITCHENS AND BATHROOMS

RETURN TO PART ONE: THE MASTER LIST.

Laundry Rooms

Bleach. Exposure to bleach (sodium hypochlorite) mainly causes irritation. This can occur in the eyes or skin through topical contact, in the eyes or lungs from inhalation of bleach fumes, or in the mouth or digestive system from ingestion. Keep bleach locked in a cabinet or otherwise secured.

Detergents. See Laundry Room: Laundry detergents.

Laundry detergents. As you did with Bleach, keep all detergents under lock and key. In June of 2017, in an article titled “Laundry Pods Can Be Fatal for Adults With Dementia,” NBC News reported that, “…according to the Consumer Product Safety Commission …six adults with cognitive impairment died over the past five years as a result of ingesting the pods.”[1]

Locks. Because of the many hazards, the laundry-room door should be kept locked. Note: If a forced-air furnace is located in the laundry area, then the door needs to be outfitted with a vent, to allow for the free movement of air into the room.

Clothes Dryers. See Laundry: Dryer, clothes.

Dryers, clothes. Secure the door with childproof latches. Place childproof knob covers over the controls.

Washing machines. Securely latch the door or lid with childproof locks. Use childproof knob covers to restrict access to the control dials.

RETURN TO PART ONE: THE MASTER LIST.

Living Rooms

Bookshelves. Be sure that shelving is anchored to the wall so that it cannot easily topple over if it is bumped, climbed on, pulled, or otherwise mishandled.

Decals. To prevent facial and other injuries, mark glass panes on doors and windows with decals or stickers.

Electrical cords. Ensure that electrical cords are not damaged or frayed and be sure that the plugs are securely plugged into outlets to prevent sparking. See also General Safety Items: Extension cords and Seniors: Trip Hazards.

Fireplaces. For obvious safety reasons, it’s probably best to close up and secure the fireplace. At the least, however, an Alzheimer’s-afflicted person should never be left unattended with fires, fire pokers, lighters, matches, or the like of those.

Rugs. Remove scatter rugs or throw rugs. Repair or replace torn carpet. See also General Safety Items: Tripping hazards and Bedroom: Rugs.

Shelving. See Bookshelves.

Televisions. Be sure that flat screens, tube television sets, etc. are firmly secured and are incapable of being pulled or knocked over. Falling TVs can cause severe injury or death. See also Bedroom: Furniture.

RETURN TO PART ONE: THE MASTER LIST.

Alzheimer’s-Proofing Outdoors

BBQ equipment. Barbecue grills (whether charcoal or gas), fire pits, smokers, and other backyard accessories pose obvious fire risks in the best of times. If one factors in cognitive impairments, things could go from bad to worse in a hurry. Be sure that briquets, fire starters, matches, and the like are under lock and key. Additionally, ensure that gas cans are inaccessible. My dad once tried to scour a floor using sugar granules because I had restricted the chemical cleansers. It’s not outside the realm of the imaginable that an Alzheimer’s-afflicted person might try to start a fire using liquid hydrocarbons like gasoline, kerosene, and so forth.

Fencing. It is important to have definite boundaries around the perimeter of the patient’s “safe space.” An outdoor area can be calming and therapeutic, but it must also be bounded so as not to invite “elopement” (i.e., your loved one’s disappearing from or leaving your home or care area).

Hot tubs. See Pools.

Lighting, exterior. Make sure outside lighting is adequate. Motion sensors can switch on lights when a something moves through their fields. Mercury-vapor or sodium lamps are capable of lighting larger areas. Be sure to avoid irritating neighbors with badly placed fixtures. Keep the steps sufficiently lit to avoid falling at night. Additionally, you might want to light the perimeter of the driveway or walkway, to help guide reentry into the house.

Locks, outdoors. As has been stated elsewhere, entry/exit points need to be carefully controlled. Backyards can lead to “elopement” (or unauthorized departure from the care area), especially if they are unfenced. See Fencing.

Pools. Remove hot tubs, home spas, and swimming pools – or at least restrict access to them using sturdy covers and locking gates. As always, there is no replacement for careful supervision.

Ramps. At some point, it may be necessary to replace traditional steps with a wheelchair-accessible ramp. This should be professionally done. Plywood haphazardly placed on top on two-by-fours might collapse under the weight of a wheelchair, or otherwise pose the risk of serious injury to anyone who ventures on top of it.

Signage. Displaying some sort of alarm system or security signage can deter would-be thieves who may try to prey on the elderly or infirm. To further reduce the danger of the senior being “scammed,” hang a “No Soliciting” sign in a visible place at the main entry.

Spas. See Pools.

Steps. Maintain staircases and steps to prevent concrete deterioration or anything that might cause the surfaces to become falling or tripping hazards. In inclement weather, be sure that surfaces are properly treated with de-icer or salt compounds to prevent slipping and injury

Walking surfaces. Get rid of any items that might present falling or tripping hazards. Eliminate uneven surfaces or walkways, hoses, and other objects that may cause a person to trip. This may mean having to repair cracked or “heaving” concrete.

RETURN TO PART ONE: THE MASTER LIST.

How to Pay for Care Home Modifications

I have discussed long-term care in a separate post. Titled “Alzheimer’s-Proof Your Retirement Savings With Long-Term Care Insurance,” the article chronicles my own family’s financial struggle to get my dad nursing-home assistance. In that article, I point out that there are really only three ways to pay for long-term care.

Three (3) Ways That Anyone Can Pay for Long-Term Care

1. Private pay
2. Out of your own assets
3. Out of your own income
4. Spend your assets down and qualify for Medicaid
5. File a claim with your long-term care insurance

Now, of course, in order to be able to file a claim with long-term care insurance, you have to actually have a long-term care insurance policy in force. Since you will never be approved for such a policy if you wait until you have Alzheimer’s Disease (or some other form of dementia), if you are interested in protecting your retirement (and other assets) for your family/spouse, then you need to apply for long-term care insurance before you have any signs of cognitive impairment.

When it comes to paying for home modifications, the options dwindle down to two. As the website Caring.com explains: “Like Medicare, Medicaid doesn’t cover physical modifications to the home.”[2]

Two (2) Ways That Anyone Can Pay for Home Modifications[3]

1. Private pay
2. Long-term care insurance

Most people will therefore have to pay for their own home modifications, regardless of who they have perform the work. However, for those who have the right sort of long-term care insurance, some money might be available to subsidize various house alterations.

You have to check your contract or contact your insurance agent to discover whether these benefits are available to you and what limitations or restrictions, if any, may be placed upon them. For instance, some contracts might limit you to obtaining modifications of certain types, or from certain contractors, etc. And there may be maximums to the dollar amounts that insurance companies are willing to pay for such work.

Generally speaking, you may need to seek preapproval for any prospective, home-modification project.

But, here are a few sorts of installations/modifications that you might expect to receive approval – for those policies that offer these types of benefits.

• Addition of “knee holes” (to accommodate wheelchairs) in bathrooms, kitchens, studies, and work areas
• Installation of chair/stair “lifts” to enable people to traverse house levels without having to walk up stairs
• Mounting of grab bars and handrails
• Placement of wheelchair ramps over entryway steps
• Replacement of conventional bathtubs/showers with walk-in varieties
• Widening of doorways for wheelchair access

For More Information

See the following articles.

“How Do You Alzheimer’s Proof a Car?”

What do we mean by “Alzheimer’s Proofing?” see HERE.

What’s the Difference between Alzheimer’s Proofing and Baby Proofing or Childproofing? See HERE.

RETURN TO PART ONE: THE MASTER LIST.

Notes:

[1] Ben Popken, “Laundry Pods Can Be Fatal for Adults With Dementia,” NBC News, Jun. 16, 2017, <https://www.nbcnews.com/business/consumer/laundry-pods-can-be-fatal-adults-dementia-n773366>.

[2] Joseph Matthews, “FAQ: What Kinds of Home Equipment and Modifications Are Covered by Medicare, Medicaid, or the VA?” Caring.com, Apr. 9, 2018, <>. The author adds, however: “However, some state Medicaid programs have special pilot programs that can help with home modifications. If you need home modification, check with the Medicaid worker who handles your file and ask if there might be special coverage that can help you,” ibid.

[3] Veterans have certain grants that they can apply for through the U.S. Department of Veterans Affairs (also known as the Veterans Administration), usually designated the “V.A.” See Matthews, loc. cit.

How to Alzheimer’s-Proof Your House:

Part Four: Kitchens & Bathrooms

Five-Part Complete Guide to Alzheimer’s Proofing Your House

Part 1 | Part 2 | Part 3 | Part 4 | Part 5

Kitchens

Kitchens are replete with dangers. In general, reduce countertop clutter (see also Specific Tips for Early-Stage Alzheimer’s: Clutter), secure blades and cutting instruments, control access to breakables like china and glassware, and ensure that electrical appliances are not near sources of water.

Appliances, electrical. Ensure that electrical appliances are not near sources of water in the kitchen and that their use does not lead to fire. Blenders, cellular phones and chargers, Microwaves, mixers, toasters, are among the potentially dangerous small kitchen appliances. Individual appliances can be secured with electric-plug locks. Appliances that cannot be locked, should be removed from sight, or removed from the house altogether.

Blenders. See Appliances, electrical.

Burners. See Stovetop.

Cabinets. Install “childproof” locks on any storage cabinets that you wish to make off limits. China, glassware, and so on should be secured in this way (if not removed). Additionally, appliances like blenders, mixers, and toasters should be removed from sight and locked away when not in (supervised) use.

Centerpieces. See Table centerpieces.

Cleaning products, kitchen. Household cleansers also need to be kept under lock and key. Glass cleaners often contain ammonia, and surface-cleaning products may utilize bleach. Chemicals like these pose huge risks for Alzheimer’s sufferers who are liable to mistakenly ingest or otherwise misuse these substances. Even if properly used, a dementia-afflicted person cannot be counted on to adequately wash up afterwards, increasing the likelihood that they might contaminate food or whatever they touch after cleaning. See also Cleaning products, bathroom.

Coffee pots. See Appliances, electrical. [Kitchens]

Disposals. See Garbage disposals.

Drains. Install a plastic, wire-mesh or other sort of disposal/drain strainer to stop objects from falling into the disposal or down into the drain.

Drawers, kitchen. Drawers can likewise be latched or locked. Cutlery should be so secured, along with miscellaneous items like candles, glues, lighters, matches, razor blades, scissors, and so forth. Special problems are raised with the so-called “junk drawer.” This drawer needs careful attention. It should be emptied, and the contents relocated, or else it should be securely locked. Batteries, chemicals, tools, utility knives, and so on all pose acute dangerous for the cognitively impaired. Even more common and seemingly innocuous items like pencils and pens can be dangerous if used incorrectly, or for inappropriate purposes. For example, my dad once tried to use the clip from a pen to try to unscrew the cover plate from a wall outlet. The metal clip could easily have slipped and enter the electrical socket, which was live.

Foods. See General Safety Items: Food stuffs.

Garbage disposals. Consider having the garbage disposal removed entirely, to eliminate the danger of fingers being placed into it. A handyman or plumber can replace the disposal with additional PVC piping. At the least, the disposal needs to have a cutoff switch that will ensure it cannot be operated when no one is around to supervise.

Lighting, kitchen. Make sure that kitchen lighting fixtures provide adequate illuminations and are in good working order. Install a nightlight that switches on when the light falls below a particular threshold.

Magnets. Magnets are extremely dangerous if they are ingested. It is probably best to clear the refrigerator.

Mats, kitchen. If nonskid mats are being used, they must be securely placed so as not to slip out of position when they are needed.

Medicines. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Microwaves. Access to microwaves should be curtailed and microwave usage ought to be carefully monitored. One option would be to remove the microwave altogether. This is not ideal, however, if it inconveniences the caretaker. Another possibility would be to put electric-plug locks on the microwave’s power cord. This is the route that I took with my dad. Some microwaves now come equipped with “childproofing” features. Usually, this means that the control panel can be “locked” (by a sequence of buttons acting as a passcode). So, a final suggestion would be to replace your microwave with one that has these capabilities. Then simply engage the microwave’s lock function to prevent unauthorized use.

Mixers. See Appliances, electrical.

Ovens. Dementia patients may forget how to properly use appliances. The over door can be latched shut to prevent the cooking chamber from being accessed. It is also (theoretically) possible to install “shut-off” switches on some appliances, to keep them from heating in the first place or from remaining switched on for extended periods of time. The fuse panel or circuit breaker could also be used to accomplish the same purpose. Even if they manage to use the appliance correctly, Alzheimer’s sufferers may forget to turn it off – creating an obvious fire danger. Again, there is seldom an alternative to vigilance. See also Stovetop.

Pharmaceuticals. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Prescriptions. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Refrigerator. Install a “childproof” latch to the door to restrict access. This is especially important if medications have to be refrigerated. (See also Specific Tips for Middle-Stage Alzheimer’s: Pharmaceuticals.) Ensure that perishable foods are not spoiled. (See also General Safety Items: Food stuffs.)

Stovetop. “Childproof” knobs can be used to frustrate attempts to operate the appliance. My dad shattered several glass bowls when he placed them atop burners. Circuit breaker switches can be used to disable electrical stoves. See also Microwave and Oven.

Table centerpieces. Flowers and other centerpieces can be cheery additions to the dining area or kitchen. However, if centerpieces include such things as plastic fruits, poisonous plants, or other things that could be mistaken for edibles, then they are best removed.

Toasters. See Appliances, electrical.

Vitamins. Pills of all sorts – whether prescription, nonprescription, or whatever – need to be stored securely out of reach. This includes vitamins, which can present choking and overdosing hazards, just like prescription medicines can.

Water temperature. See Specific Tips for middle-stage Alzheimer’s: Water temperature.

RETURN TO PART ONE: THE MASTER LIST.

Bathrooms

Bathrooms are filled with perils of many kinds. The New York Times reports that, according to the Centers for Disease Control and Prevention, “…every year about 235,000 people over age 15 visit emergency rooms because of injuries suffered in the bathroom… Injuries increase with age, peaking after 85…”.[1] Interestingly: “People over 85 suffer more than half of their injuries near the toilet.”[2]

Persons suffering from cognitive impairment should be treated as you would treat small children. Never leave an Alzheimer’s-afflicted person alone in the bathroom. This need not mean that you have to stand next to them as the use the toilet (although, depending upon their overall physical abilities, you may have to do exactly this). But it does mean that you should always be aware of the what the person is doing. Impaired persons, left unattended, could end up burning, electrocuting, or poisoning themselves, or else choking, drowning, slipping, or otherwise harming themselves in any of several other unfortunate ways. Be present and be alert!

Appliances, electrical. Ensure that electrical appliances are not near sources of water in the bathroom. Cellular phones and chargers, clothes irons, electric radios and TVs, electric razors, electric toothbrushes, hair-curling irons, hairdryers, space heaters, and tablets are among the potentially dangerous equipment that can find its way into the bathroom. Police the entry into the bathroom, particularly if water is going to be involved. Try to encourage afflicted persons to shave themselves and dry their hair (etc.) in locations far removed from sources of water. And, as usual, be sure to place childproof covers on exposed and unused outlets.

Cleaning products, bathroom. Get rid of, relocate, or otherwise secure any cleaning products that may be stored under the bathroom sink. See also Cleaning products, kitchen.

Cough medicine. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Curling irons. See Appliances, electrical.

Doors. Doors could be widened to accommodate wheelchairs or other equipment. See also Locks, bathroom.

Drain traps. Insert drain traps in sinks to catch small items that may be lost or flushed down the drain.

Electrical appliances. See Appliances, electrical.

Electric razors. See Appliances, electrical.

Faucets. If your loved one has a faucet with separate spouts for cold and hot water, consider replacing the assembly with a single-spout version. The reason is that with dual spouts, the hot water comes out at full strength, and touching the stream (intentionally or unintentionally) can result in burns. With a single-spout setup, by contrast, the hot and cold water mix before coming out, thus decreasing the chances of burns (if the cold-water faucet is properly turned on, of course). See also Water temperature. You might also consider replacing fixtures with ones that have clearly and colorfully labeled indicators for “Cold” and “Hot” water valves. See also Decals and Labels.

Flooring. For bathroom-flooring concerns, see Tile flooring.

Hair dryers. See Appliances, electrical.

Heat lamps. Heat lamps can be excellent alternatives to space heaters for bathrooms.

Grab bars. Grab bars can and should be added in numerous places in the bathroom. For instance, bars can be a helpful addition to the toilet seat or, at least, installed next to the toilet bowl. Grab bars or handrails should also be a fixture in the bathtub or shower basin. As with many of the contemplated home modifications, grab bars need to be installed correctly to be useful. Improperly anchored grab bars are a major hazard and can result in severe injury to the senior (or whomever) if they give way under pressure.

Lighting, bathroom. Use a night-light. It may even be worthwhile installing motion sensors that will automatically turn on lights without a person having to fumble for, or remember to turn on, switches.

Locks, bathroom. Many bathrooms are standardly outfitted with doors that can be locked from the inside. In order to prevent the dementia sufferer from locking him- or herself inside, it is probably best to remove this lock from the door. At the very least, hide a key outside – for example, on the molding ledge above the door – for ease of reentry if your loved one is locked inside. (Many bathroom locks can be opened with a small, flat-bladed screwdriver. Take time to examine your door so that you know ahead of time how to open it if an emergency arises.)

Medicines. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Prescriptions. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Shelving. Shelves need to be properly anchored to the walls. Because of the tightness of the space in the bathroom, shelving should perhaps be sturdy enough to double as Grab bars. Where that is impractical, shelving should probably be removed.

Shower benches. These are basically small, nonslip seats that permit a person to sit in the shower (without having to be on the floor), instead of having to stand. They should be used along with shower “wands,” or handheld showerheads.

Showerheads. For added versatility, not to mention increased safety, think about converting traditional, fixed showerheads into handheld versions. These replacements enable your loved one to thoroughly wash without having to stand.

Shower seats. See Shower benches.

Shower, walk-in. Cognitively impaired individuals, along with some seniors in general, may have difficulties entering conventional bathtubs and shower basins. One thing to consider would be to convert the existing bathing/showering facility into a “walk-in” that is more accessible to someone who is experiencing coordination or mobility problems.

Space heaters, bathroom. See Appliances, electrical. See also Bedrooms: Space heaters.

Spout covers. A safety faucet cover is another useful, do-it-yourself addition to the bathroom. Also called “soft” faucet covers, these protective shields are usually made of foam, rubber, or some equivalent material designed to cushion the shower hardware in the unhappy event that someone slips and strikes the exposed metal. These covers are often available wherever childproofing devices are sold.

Tile flooring. Most bathrooms of course have linoleum, vinyl, or other tile flooring. However, to reduce the risk of slipping, you could consider replacing this with specialized “bath” carpet or rubber tiling.

Toilets. To prevent slipping, place nonskid adhesives or safety mats around the toilet.

Tub mats. Secure nonslip mats or “stickers” in the bathtub or shower basin.

Toilet seat. Elevated toilet seats, also called toilet-seat “risers,” can be helpful for elderly people who experience decreased flexibility and mobility. The slightly raised seats provide an assist when transferring on and off the toilet.

Walk-in shower. See Shower, walk-in.

Water temperature. See Specific Tips for middle-stage Alzheimer’s: Water temperature.

RETURN TO PART ONE: THE MASTER LIST.

How to Pay for Care Home Modifications

I have discussed long-term care in a separate post. Titled “Alzheimer’s-Proof Your Retirement Savings With Long-Term Care Insurance,” the article chronicles my own family’s financial struggle to get my dad nursing-home assistance. In that article, I point out that there are really only three ways to pay for long-term care.

Three (3) Ways That Anyone Can Pay for Long-Term Care

1. Private pay
2. Out of your own assets
3. Out of your own income
4. Spend your assets down and qualify for Medicaid
5. File a claim with your long-term care insurance

Now, of course, in order to be able to file a claim with long-term care insurance, you have to actually have a long-term care insurance policy in force. Since you will never be approved for such a policy if you wait until you have Alzheimer’s Disease (or some other form of dementia), if you are interested in protecting your retirement (and other assets) for your family/spouse, then you need to apply for long-term care insurance before you have any signs of cognitive impairment.

When it comes to paying for home modifications, the options dwindle down to two. As the website Caring.com explains: “Like Medicare, Medicaid doesn’t cover physical modifications to the home.”[3]

Two (2) Ways That Anyone Can Pay for Home Modifications[4]

1. Private pay
2. Long-term care insurance

Most people will therefore have to pay for their own home modifications, regardless of who they have perform the work. However, for those who have the right sort of long-term care insurance, some money might be available to subsidize various house alterations.

You have to check your contract or contact your insurance agent to discover whether these benefits are available to you and what limitations or restrictions, if any, may be placed upon them. For instance, some contracts might limit you to obtaining modifications of certain types, or from certain contractors, etc. And there may be maximums to the dollar amounts that insurance companies are willing to pay for such work.

Generally speaking, you may need to seek preapproval for any prospective, home-modification project.

But, here are a few sorts of installations/modifications that you might expect to receive approval – for those policies that offer these types of benefits.

• Addition of “knee holes” (to accommodate wheelchairs) in bathrooms, kitchens, studies, and work areas
• Installation of chair/stair “lifts” to enable people to traverse house levels without having to walk up stairs
• Mounting of grab bars and handrails
• Placement of wheelchair ramps over entryway steps
• Replacement of conventional bathtubs/showers with walk-in varieties
• Widening of doorways for wheelchair access

For More Information

See the following articles.

“How Do You Alzheimer’s Proof a Car?”

What do we mean by “Alzheimer’s Proofing?” see HERE.

What’s the Difference between Alzheimer’s Proofing and Baby Proofing or Childproofing? See HERE.

RETURN TO PART ONE: THE MASTER LIST.

Notes:

[1] Nicholas Bakalaraug, “Watch Your Step While Washing Up,” New York Times, Aug. 15, 2011, <https://www.nytimes.com/2011/08/16/health/research/16stats.html>.

[2] Ibid.

[3] Joseph Matthews, “FAQ: What Kinds of Home Equipment and Modifications Are Covered by Medicare, Medicaid, or the VA?” Caring.com, Apr. 9, 2018, <>. The author adds, however: “However, some state Medicaid programs have special pilot programs that can help with home modifications. If you need home modification, check with the Medicaid worker who handles your file and ask if there might be special coverage that can help you,” ibid.

[4] Veterans have certain grants that they can apply for through the U.S. Department of Veterans Affairs (also known as the Veterans Administration), usually designated the “V.A.” See Matthews, loc. cit.

How to Alzheimer’s Proof Your House:

Part Three: Specific Alzheimer’s Tips

Five-Part Complete Guide to Alzheimer’s Proofing Your House

Part 1 | Part 2 | Part 3 | Part 4 | Part 5

Specific Tips for Early-Stage Alzheimer’s

Alzheimer’s, if it is anything, is a disease that affects a person’s cognition. An Alzheimer’s sufferer may not do well with changes to his or her living environment. This is a difficulty, since (in some cases) major changes may be necessary in order to care for and protect the patient.

It is always preferable to be proactive rather than reactive, since if you’re reacting, then something bad has already happened. Therefore, try to anticipate problems before they occur.

Perhaps the best piece of advice, therefore, is to start implementing changes as early as possible. I have mentioned this elsewhere. (See HERE.) In a nutshell, if you can get an Alzheimer’s-afflicted person to accept the needed changes, so much for the better. Hence, it is well to try to get them accustomed to, or conditioned/trained for, the changes before they are strictly necessary.

In a way, then, it might be best for all of us to partially arrange out living environments in such a way that it will not be traumatic for us if we are ever cognitively impaired.

Still, whenever you begin the modification process, the following are things to think about.

Clutter. Eliminate or reduce clutter, pick up loose objects, and be sure that electrical cords are well clear of walkways. Clutter is potentially hazardous for several reasons. Firstly, it is psychologically hazardous as it can give rise to anxiousness, Trigger unsafe behaviors, or worsen confusion. Secondly, it is physically hazardous, both personally, as it can increase dangers such as tripping, as well as structurally, as it can heighten the risks of fire, mold growth, pest infestation (bugs, rodents, etc.), etc. See also For Seniors: Tripping Hazards.

Gates. Installing gates at the top and bottom of staircases may be appropriate, if access to the stairs needs to be limited.

Keys. Spare keys can be strategically placed outside of the house, in case the person with Alzheimer’s disease becomes locked out of his or her house. Of course, this must be done with care, since hidden keys – if discovered – pose home-security problems. See also General Safety Items: Keys.

Labels. Persons with cognitive impairments may be meaningfully assisted by labels or signs that help them to navigate their living space. Labels and signs should be large-print or visually based and can assist Alzheimer’s sufferers in finding bathrooms, light switches, television remote controls, and so on. In effect, these function as positive Triggers (which entry see for the negative sort).

Plants. Plants like European Mistletoe (Viscum album), Heart of Jesus (Caladium bicolor), Mother-in-law’s Tongue (Sansevieria trifasciata), and Nerium (Nerium oleander), though often kept as decorative, are actually poisonous (to one degree or other) and should be kept out of reach or removed altogether.

Thermostat. Carefully regulate ambient temperature. Consider camouflaging or relocating the thermostat. Another option is to install a thermostat lock box. In the case of my dad, he frequently fiddled with the controls. For example, if he felt chilly, he might set the temperature on 90 degrees. However, once the furnace was engaged, he might become distracted and allow the house to heat to an uncomfortable (or even dangerous) extent. Leaving open access to the thermostat can also be a recipe for higher-than-necessary electric or natural-gas bills.

RETURN TO PART ONE: THE MASTER LIST.

Specific Tips for middle-stage Alzheimer’s

Alcohol. Similarly, alcohol (both ethyl and methyl) should be discarded or locked away and stored out of sight. In addition to the dangers that drinking poses normally, a cognitively impaired individual may be more susceptible to alcohol poisoning. Moreover, drinking may be contraindicated for some prescriptions. Furthermore, alcohol can exacerbate certain dementia symptoms – such as decreased coordination, mental confusion, poor decision-making, and so on.

Answering machines. Use an answering machine when you cannot answer phone calls on behalf of your loved one. Be sure to set the machine to turn on after the fewest number of rings possible and turn the telephone ringers down. A person with Alzheimer’s disease often may be unable to take messages or could become a victim of telephone exploitation. Turn ringers on low to avoid distraction and confusion. Put all portable and cell phones and equipment in a safe place so they will not be easily lost. See also General Safety Items: For Seniors: Telephones.

Camouflage. In some cases, Triggers can be controlled through camouflage. If your loved one frequently “elopes” (i.e., leaves without permission) you might try to camouflage the door to make it look like it is merely part of the surrounding wall. Or again, you might cover the door knobs with pieces of fabric that are the same color as the surrounding paint. Camouflage works (when it does work) because people with dementia often experience perceptual and visual-discrimination difficulties.

Cigarettes, cigars, etc. Relatedly, smokers need to be watched carefully, as cigarettes, cigars, lighters, matches, pipes, and the like are fire hazards.

Doorknob covers. Covers, similar or even identical to ones used in “childproofing” expeditions, can help to secure entryways and exits. Covers work because Alzheimer’s sufferers often experience marked reductions in manual dexterity, making it difficult or practically impossible for them to perform the motion sequences required to bypass the knob covers.

Electric tools. See Tools.

Firearms. See Specific Tips for middle-stage Alzheimer’s: Guns.

Gates. Safety gates – like ones available for childproofing – could be positioned at the tops and bottoms of stairs as well as across door openings that lead to restricted areas. Additionally, yard gates should be locked to help ensure that your loved one does not leave the yard unsupervised.

Guns. Remove or secure any firearms (handguns, pistols, rifles, and the like). Because of the high-level of danger presented by these instruments, it is advisable to have redundant measures in place. For example, you could attach trigger locks onto guns and then, additionally, place them into gun safes or locked cabinets. Hide ammunition as well as any accessories that might prompt the patient to think about locating the firearm. Your local police department may be able to assist your family. Don’t hesitate to reach out to them with questions.

Handguns. See Guns.

Hand tools. See Tools.

Knives. As you would with Guns, you should secure or get rid of knives and other sharp objects (e.g., boxcutters, razors, scissors, shears, etc.).

Locks. Install locks on all exits and windows. Personally, I had a lot of success with double-keyed deadbolts – that is, deadbolts that must be opened with keys on both sides of the door. Some online authorities have also suggested installing “hotel-style” swing-bar locks. I also recommend reinforcement locks, but I prefer those that can be installed higher up (and out of sight) on the door. One household “hack” that can save you a bit of money is to reverse the lock on your screen or storm door to prevent “elopement.” Solicitors might think that you’re a bit loopy when they see the thumb-turn mechanism facing them when they approach the entryway. But this may be an agreeable price for servicing the ambition of frustrating your loved one’s attempts to leave the home unsupervised.

Motion sensors. Install magnetic or motion-sensitive alarms so that the caretaker will be alerted if an off-limits door or window is opened. Motion sensors throughout the living space can also alert you to instances of “wandering.” You might also consider Trackers.

Outlet covers. Cover exposed electrical outlets with childproof plugs. [See article on Childproofing vs. Alzheimer’s-Proofing]

Pets. Pets can be calming for persons with Alzheimer’s. However, they do not come without challenges of their own. Birds, cats, dogs, fish, and other pets need attention and caring. A person with impaired memory and reasoning faculties could accidentally injure, neglect, overfeed, or poison a pet through inattention or mistake. Some pets – like fish, hamsters, and such – need enclosures that must be kept clean and regulated. Consider fish. Large, water-filled tanks in close proximity to electricity (for filtration systems) can be dangerous for those with dementia. As difficult as it may be, fish should probably be relocated off premises. If pets are part of your loved one’s care plan, then just ensure that a caretaker is well apprised of everything the pet requires and has time enough to spend attending to it.

Pharmaceuticals. Secure medications (whether over-the-counter or prescription) and vitamins, possibly in locked cabinets. Do not leave them on bathroom or kitchen countertops or on bedroom night tables. Risks included choking, overdosing, and poisoning. Childproof caps may be advisable. [See article on Childproofing vs. Alzheimer’s-Proofing] Ensure that your loved one’s caretaker understands the dosage amount and frequency for each prescribed, or otherwise necessary, medication. Periodically check expiration dates and discard or renew expired prescriptions or over-the-counter medications. See also General Safety Items: Prescriptions.

Pistols. See Guns.

Plastic bags. Just as you would do with a small child, keep plastic bags well out of reach. Cognitive impairment can increase risks such as suffocation.

Power tools. See Tools.

Rifles. See Guns.

Shotguns. See Guns.

Tools. Hand tools, ladders, power tools, and so forth need to be fully secured in basement utility rooms, garages, or workshops. Again, redundancy is advised. For example, I locked away tools in cases and kept them in a double-locked garage. I placed ladders in the rafters and literally tied them to the ceiling joists using bicycle locks. Although it was unlikely that my dad would have been able to get into the garage in the first place (to my knowledge, he never did), if he managed it, his tools would still have been inaccessible. Or again, I put socket locks on the electric cord for the table, but I also removed and secured the blade.

Trackers. Various companies manufacture devices that can help you to locate a loved one who has left his or her care setting without authorization. Among other options, there is something called Project Lifesaver; the Alzheimer’s Association also has its Safe-Return Program.

Triggers. Ideally, these need to be eliminated or minimized. In the context of Alzheimer’s Disease, a “trigger” is something that prompts a sufferer to embark on a course of action that is unsafe for him or her. (For more helpful and positive “triggers,” see Labels.) For instance, an Alzheimer’s-afflicted person who is no longer competent to drive may still wish and try to do so after seeing the car keys hanging by the door. Or again, an open door might trigger a dementia patient to “elope” (i.e., to leave the care area without supervision). See also Trackers.

Water temperature. Just as should parents with young children, dial down the temperature on your water heater. You will need to adjust the setting to a temperature that is appropriate for your loved one’s context. Generally, the safe range falls somewhere in between about 105°F and 125°F, with most people opting for something around 115°F. Consult with your family physician or other advisers to determine what would be right for your situation.

Weapons. See the separate entries on Guns and Knives.

RETURN TO PART ONE: THE MASTER LIST.

How to Pay for Care Home Modifications

I have discussed long-term care in a separate post. Titled “Alzheimer’s-Proof Your Retirement Savings With Long-Term Care Insurance,” the article chronicles my own family’s financial struggle to get my dad nursing-home assistance. In that article, I point out that there are really only three ways to pay for long-term care.

Three (3) Ways That Anyone Can Pay for Long-Term Care

1. Private pay
2. Out of your own assets
3. Out of your own income
4. Spend your assets down and qualify for Medicaid
5. File a claim with your long-term care insurance

Now, of course, in order to be able to file a claim with long-term care insurance, you have to actually have a long-term care insurance policy in force. Since you will never be approved for such a policy if you wait until you have Alzheimer’s Disease (or some other form of dementia), if you are interested in protecting your retirement (and other assets) for your family/spouse, then you need to apply for long-term care insurance before you have any signs of cognitive impairment.

When it comes to paying for home modifications, the options dwindle down to two. As the website Caring.com explains: “Like Medicare, Medicaid doesn’t cover physical modifications to the home.”[1]

Two (2) Ways That Anyone Can Pay for Home Modifications[2]

1. Private pay
2. Long-term care insurance

Most people will therefore have to pay for their own home modifications, regardless of who they have perform the work. However, for those who have the right sort of long-term care insurance, some money might be available to subsidize various house alterations.

You have to check your contract or contact your insurance agent to discover whether these benefits are available to you and what limitations or restrictions, if any, may be placed upon them. For instance, some contracts might limit you to obtaining modifications of certain types, or from certain contractors, etc. And there may be maximums to the dollar amounts that insurance companies are willing to pay for such work.

Generally speaking, you may need to seek preapproval for any prospective, home-modification project.

But, here are a few sorts of installations/modifications that you might expect to receive approval – for those policies that offer these types of benefits.

• Addition of “knee holes” (to accommodate wheelchairs) in bathrooms, kitchens, studies, and work areas
• Installation of chair/stair “lifts” to enable people to traverse house levels without having to walk up stairs
• Mounting of grab bars and handrails
• Placement of wheelchair ramps over entryway steps
• Replacement of conventional bathtubs/showers with walk-in varieties
• Widening of doorways for wheelchair access

For More Information

See the following articles.

“How Do You Alzheimer’s Proof a Car?”

What do we mean by “Alzheimer’s Proofing?” see HERE.

What’s the Difference between Alzheimer’s Proofing and Baby Proofing or Childproofing? See HERE.

RETURN TO PART ONE: THE MASTER LIST.

Notes:

[1] Joseph Matthews, “FAQ: What Kinds of Home Equipment and Modifications Are Covered by Medicare, Medicaid, or the VA?” Caring.com, Apr. 9, 2018, <>. The author adds, however: “However, some state Medicaid programs have special pilot programs that can help with home modifications. If you need home modification, check with the Medicaid worker who handles your file and ask if there might be special coverage that can help you,” ibid.

[2] Veterans have certain grants that they can apply for through the U.S. Department of Veterans Affairs (also known as the Veterans Administration), usually designated the “V.A.” See Matthews, loc. cit.

How to Alzheimer’s-Proof Your House

Part Two: General and Senior-Safety Tips

Five-Part Complete Guide to Alzheimer’s Proofing Your House

Part 1 | Part 2 | Part 3 | Part 4 | Part 5

General Safety Items

As I was preparing the Master List with Alzheimer’s in mind, it occurred to me that many commonsense suggestions could be more widely applicable. Some things are just good practices for anyone, regardless of whether or not they are dealing with (someone who has) dementia. Here are a few examples.

For Everyone

Batteries. Store and discard batteries correctly. Exposed battery terminals can pose a fire hazard. Nine-volt (9V) batteries are especially dangerous. To be safe, cover battery terminals with electrical tape being throwing them away.

Break-in Deterrence. Cutting back bushes, foliage, and shrubbery can deprive would-be thieves of hiding places or staging areas. Adequate lighting is an essential component of home security. Obviously, doors and windows need to be kept locked. Alarm systems and other more exotic products are secondary to these foundational elements.

Chemicals, flammable. Keep inflammable chemicals (especially, but not limited to, aerosol paints, gasoline, lighter fluids, turpentine, and so on) far clear of kitchens, utility rooms, and anywhere there are sparking appliances such as furnaces and water heaters. Be mindful that: (a.) sometimes electrical switches can arc or spark and ignite chemicals; and (b.) the vapor or gas of certain chemicals can be just as dangerous – if not more dangerous – than the liquid.

Detectors. Ensure that working carbon-monoxide, natural-gas, and traditional smoke detectors are installed throughout the living space. (Click HERE if you would like to read about ALZHEIMERSPROOF’s detector recommendations.) Bedrooms, garages, hallways, and kitchens are hotspots – sometimes literally. Since the detector is only effective if its batteries are good, you need to schedule periodic battery checks and battery replacements. One person reported to me that replacing batteries is part of her family’s New-Year’s ritual.

Extension cords. Extension cords can present many dangers in the home. Damaged or frayed cords, for instance, pose the risk of electric shock or electrocution. Cords that are incorrectly gauged can pose fire hazards. Short circuits can blow fuses or trip circuit breakers, leaving seniors in the dark. Cords carelessly or haphazardly strewn about may cause seniors to trip and fall. See also Living Room: Electrical cords.

Food stuffs. Food – both canned goods and refrigerated items – should be checked regularly for expiration or spoilage. This becomes important in the case of a person whose eyesight or reasoning abilities are dwindling, but it is a good practice for anybody.

Lighting. Besides decreasing the risk of tripping at night, adequate lighting (especially on the exterior of the home) can also deter robbers.

Prescriptions. Many people keep prescription medications in the bathroom “medicine cabinet.” However, the fluctuating-temperature and high-humidity environment is generally not ideal for the storage of prescriptions or vitamins. Check the prescription for care instructions. Many bottles will indicate where and in what manner they should be stored (e.g., a label might read: “store in a cool, dry place,” or “refrigerate after opening,” etc.).

Telephones. Clearly record the home number as well as any emergency phone numbers and important contacts (e.g., family members or caretakers). For example: Poison control (1-800-222-1222); Alzheimer’s Association (1-800-272-3900); etc.

RETURN TO PART ONE: THE MASTER LIST.

For Seniors

The two keys for seniors are functionality and simplicity.

For seniors, activities of daily living become increasingly challenging. “Functionality,” then, has to do with thinking of changes that can help make day-to-tasks more manageable.

On the flipside, however, homes can become excessively cluttered with assistance apparatuses and “time-saving” devices. The extra clutter can jam up walking paths and present Tripping hazards (on which, see elsewhere). Beyond that, though, collections of stuff – when they get out of control – can exacerbate claustrophobia and become mentally oppressive. For those with some form of dementia, clutter can lead to cognitive overstimulation, which in turn can manifest in negative or anxious behaviors.

Yes, we want useful aids, but we also want organization. So, find a happy medium that works for your family. Here are some suggestions.

Benches. Sometimes little modifications can go a long way. For example, seniors may have difficulty entering their apartments or homes while carrying groceries or shopping bags. However, strategically locating a bench or shelf can provide a resting place for the packages while the senior unlocks the door.

Computers. The computer presents several challenges. Number one, seniors can fall victim to predators via nefarious “spam” email-message tactics. In “phishing” or “spoofing” emails, sending misrepresent themselves as being from reputable companies (such as the senior’s bank) or the government (e.g., the Internal Revenue Service) and seek to scare or otherwise cajole seniors into divulging personal information. Possible measures you can implement include installing Internet-restriction software, personally monitoring your loved one’s screen time, or limiting access to the computer through password protection. Number two, on the other side of things, seniors could accidentally delete documents or information that ought to be saved. Ensure that caretakers (or interested family members, what have you) keep local backups (e.g., on removal media like compact discs, DVDs, external hard drives, flash drives, and so on) or save the files to the “cloud.” Number three, the computer desk itself can present dangers in terms of tangles and tripping hazards. Due to their plethora of accessories, personal-computers (PC) workstations often rely on power strips to accommodate all the electrical cabling needed to make the operation work. Take some time and ensure that the various pieces of equipment – as well as their connecting and power cords – are safely stowed in out-of-the-way places. I have made good use of nylon (“zip”) ties and other cable accessories, to keep the setup tidy and off the floor. If valuable documents or materials are stored on a home computer, protect the files with passwords and back up the files.

Handrails. See Staircases.

Keys. Spare keys can be hidden outside and used as backups in case of emergency or inadvertent lockout. Be forewarned, however, that having a key outdoors may leave you vulnerable to certain home-security risks, if a thief were to discover and exploit the hidden key. So, think about ways to disguise the hiding place so that it will be useful, but will not leave the house as open to break in. See also, Specific Tips for Early-Stage Alzheimer’s: Keys.

Lighting, interior. Check to be sure that all rooms and walkways are sufficiently lit – especially during the nighttime hours.

Light switches. Additionally, try to ensure that light switches are located at the top and the bottom of staircases.

Rails. See Staircases.

Staircases. Stairways can be dangerous. Minimally, handrails should be installed on both sides of the staircase. The rail should extend farther out than the stairs, so that seniors can get a firm grip before venturing up or down. Additionally, the handrail should be professionally installed – and properly anchored to the wall. Some handrails are more decorative than functional, and one doesn’t discover until it’s too late that they are unable to support a person’s full body weight. Moreover, stairs ought to have nonslip surfaces – whether appropriate carpeting or with friction strips.

Telephones. Install flashing light in lieu of ringer for the hearing impaired. Set up an answering machine or voice mailbox to intercept – and screen – calls. See also Answering Machines.

Tripping hazards. Be sure that electrical cords are not stretched across walkways. Seniors can also trip on bunched-up rugs. Ensure that rugs are removed or are at least carefully affixed to the floor. Consider having carpeting put in instead of relying upon rugs.

RETURN TO PART ONE: THE MASTER LIST.

For More Information

See the following articles.

“How Do You Alzheimer’s Proof a Car?”

What do we mean by “Alzheimer’s Proofing?” see HERE.

What’s the Difference between Alzheimer’s Proofing and Baby Proofing or Childproofing? See HERE.

RETURN TO PART ONE: THE MASTER LIST.

Ultimate Guide to Alzheimer’s-Proofing A Home

Part One: The Master List

Five-Part Complete Guide to Alzheimer’s Proofing Your House

Part 1 | Part 2 | Part 3 | Part 4 | Part 5

Introductory Comments

As readers of this blog may already know, it fell to me to care for my dad, Jim, when he developed Alzheimer’s dementia. (Read “Jim’s Story.”) Among all the many challenges that I had to face initially was that of trying to make the home environment safe for Jim’s care.

As I told numerous individuals, if you are going to care for your loved one at home – whether your home or theirs – then you must treat the living space as a care environment. For some families, this might mean that the residence begins to look more like a hospital, complete with hospital beds, oxygen equipment, intravenous fluid-delivery systems, and so on. For others, however, the house will take on characteristics more reminiscent of a retirement community or a nursing home.

Whatever the look or “feel” of the home, the main idea is that it is up to the caretaker to adjust, alter or otherwise modify the living environment to maximize the ability to care for the loved one and keep him or her safe. In a word, you have to AlzheimersProof your living space. (“What Do We Mean By ‘Alzheimer’s Proofing’?”) In some respects, it is similar to babyproofing or childproofing a home. But in other respects, it differs notably.

The following is a work in progress. But it constitutes a sort of “master list” for home modifications that may be necessary or suitable for those suffering from dementia. Your feedback and suggestions are welcomed. As with many of my other posts, simply put, this is the list that I wish I had had at my disposal when I had to undertake the challenge of AlzheimersProofing my dad’s house.

The Usual Disclaimers

I am neither a lawyer nor a doctor. And I am not a home-improvement specialist or contractor. My articles are based on my own personal experience and research and they are provided on an as-is basis for informational purposes only. Not all listed or suggested modifications may be necessary in every situation. Contrariwise, some modifications may be necessary for you that are not listed.

Every situation is different. Readers are invited to create their own, personalized lists gleaning ideas from the master list and mixing in observations of their own. It is advisable, then, that readers carefully survey their area and walk through their (or their loved one’s) home environment, looking for and noting those items that might be hazardous. If you have background childproofing a house, then you have a bit of a head start (as some modifications translate easily from one application to the other).

Additionally, I make no promises about the feasibility of performing the needed modifications. To put it differently, not everyone is capable of executing the contemplated modifications on a do-it-yourself basis. You may want to seek profession advice or professional installation. When in doubt, consult an expert near you.

Also, keep in mind that no amount of modifications can or should replace caretaker diligence. Never leave a cognitively impaired person alone. Obviously, this is more important the more severe the impairment. And, since dementias are progressive diseases, the expectation is that your oversight will have to increase as your loved one’s condition worsens.

Some areas of the home – for example, the bathroom, garage, and kitchen – are especially dangerous (see below for safety tips). But, in truth, every room has its own dangers and risks.

Try to AlzheimersProof in as thorough a way as you can, given your energy, money, time, and other resources. The idea is to make a good-faith effort to protect your loved one. Try to anticipate or foresee your loved one’s needs and to meet them proactively. For example, if you are trying to prevent dad’s or grandma’s late-night kitchen raid, you might consider putting a judiciously stocked minifridge in his or her bedroom.

As difficult as the prospect might, though, you should be ready to entertain the possibility that the home may be unsuitable for your loved one’s care. I cannot give personalized advice. This website is merely for informational purposes. However, you should consult with attorneys, doctors, family members, financial planners, and others who can help you make the best decisions possible and to plan well for your loved one’s care.

Be safe and good luck to you and your family!

Master List

How to Use the Master List

The master list is an alphabetized directory of things that may need attention in or around the home.

You might find that simply reading the name of the item sparks your own ideas about how to sufficiently modify, protect, remove, secure, or otherwise “deal with” the item in question.

If not, then you can locate the follow-up, companion articles (as they are written!) to obtain more details and tips for the relevant action steps or items.

Click the bracketed links for more details on the selected entry.

Alcohol. Remove or restrict access to. [Specific Tips for middle-stage Alzheimer’s]

Answering machines. Use for call-screening purposes. [Specific Tips for middle-stage Alzheimer’s]

Appliances, electrical. Keep away from water. [Kitchens and Bathrooms]

Assist bars. Add next to bed. [Indoors and Outdoors]

Attic fans. See Fans. [Indoors and Outdoors]

Baby monitors. Use for monitoring patients. [Indoors and Outdoors]

Batteries. Store and discard batteries correctly. [General- and Senior-Safety Tips]

BBQ equipment. Remove or restrict access to. [Indoors and Outdoors]

Bed monitors. Use to alert to falls or movement. [Indoors and Outdoors]

Bed rails. Use to prevent falls. [Indoors and Outdoors]

Benches. Place in entryway to help with carrying packages. [General- and Senior-Safety Tips]

Bicycles. Secure. [Indoors and Outdoors]

Bleach. Restrict access to. [Indoors and Outdoors]

Blenders. See Appliances, electrical. [Kitchens and Bathrooms]

Bookshelves. Anchor. [Indoors and Outdoors]

Break-in Deterrence. Cut back bushes, foliage, and shrubbery; install motion-sensing lighting. [General- and Senior-Safety Tips]

Burners. See Stovetop. [Kitchens and Bathrooms]

Cabinets. Install “childproof” locks on. [Kitchens and Bathrooms]

Camouflage. Use to distract from door knobs and danger areas. See also Triggers. [Specific Tips for middle-stage Alzheimer’s]

Centerpieces. See Table centerpieces. [Kitchens and Bathrooms]

Chair lifts. Install as needed, if affordable. [Indoors and Outdoors]

Chemicals, flammable. Store correctly; restrict access to. [General- and Senior-Safety Tips]

Cigarettes, cigars, etc. Remove; control; monitor. [Specific Tips for middle-stage Alzheimer’s]

Cleaning products, bathroom. Get rid of, relocate, or otherwise secure. See also Cleaning products, kitchen. [Kitchens and Bathrooms]

Cleaning products, kitchen. Restrict access to. See also Cleaning products, bathroom. [Kitchens and Bathrooms]

Clothes Dryers. See Laundry: Dryer, clothes. [Indoors and Outdoors]

Clutter. Eliminate or reduce clutter. See also For Seniors: Tripping Hazards. [Specific Tips for Early-Stage Alzheimer’s]

Coffee pots. See Appliances, electrical. [Kitchens and Bathrooms]

Computers. Keep work area tidy; monitor usage; restrict access to. [General- and Senior-Safety Tips]

Cough medicine. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals. [Kitchens and Bathrooms]

Curling irons. See Appliances, electrical. [Kitchens and Bathrooms]

Decals. Use on doors and windows. [Indoors and Outdoors]

Detectors. Install carbon-monoxide, natural-gas, and traditional smoke detectors. [General- and Senior-Safety Tips] (Click HERE for product recommendations for detectors.)

Detergents. See Laundry Room: Laundry detergents. [Indoors and Outdoors]

Disposals. See Garbage disposals. [Kitchens and Bathrooms]

Doorknob covers. Use like in “childproofing” scenarios to secure entryways and exits. [Specific Tips for middle-stage Alzheimer’s]

Doors. Widened (if needed); remove locks. See also Locks, bathroom. [Kitchens and Bathrooms]

Drains. Install strainers. [Kitchens and Bathrooms]

Drain traps. Insert in sinks to catch small items. [Kitchens and Bathrooms]

Drawers, kitchen. Latch or lock. [Kitchens and Bathrooms]

Dryers, clothes. Use “childproof” knob covers and latches. [Indoors and Outdoors]

Electrical appliances. See Appliances, electrical. [Kitchens and Bathrooms]

Electrical cords. Check for damage; keep out of walkways. See also General Safety Items: Extension cords and Seniors: Trip Hazards. [Indoors and Outdoors]

Electric razors. See Appliances, electrical. [Kitchens and Bathrooms]

Electric tools. See Tools. [Specific Tips for middle-stage Alzheimer’s]

Extension cords. Keep in working condition and out of walkways. See also Living Room: Electrical cords. [General]

Fans (Attic). Cover; secure. [Indoors and Outdoors]

Fans (Bedroom). Cover blades. [Indoors and Outdoors]

Faucets. Replace with single-spout; mark “cold” and “hot” clearly. See also Decals and Labels. See also Water temperature. [Kitchens and Bathrooms]

Fencing. Secure yard perimeter. [Indoors and Outdoors]

Firearms. See Specific Tips for middle-stage Alzheimer’s: Guns. [Specific Tips for middle-stage Alzheimer’s]

Fireplaces. Restrict access to. [Indoors and Outdoors]

Flooring. See Tile flooring. [Kitchens and Bathrooms]

Foods. See General Safety Items: Food stuffs. [Kitchens and Bathrooms]

Food stuffs. Checked for spoilage; store correctly. [General- and Senior-Safety Tips]

Furniture. Anchor. [Indoors and Outdoors]

Garbage disposals. Disable or remove. [Kitchens and Bathrooms]

Gates (Specific Tips for Early-Stage Alzheimer’s). Installing at the top and bottom of Staircases. [Specific Tips for Early-Stage Alzheimer’s]

Gates (Specific Tips for Middle-Stage Alzheimer’s). Control access to yards; keep gates locked. [Specific Tips for middle-stage Alzheimer’s]

Grab bars. Install (securely and correctly) to assist with mobility. [Kitchens and Bathrooms]

Guns. Remove or secure. [Specific Tips for middle-stage Alzheimer’s]

Hair dryers. See Appliances, electrical. [Kitchens and Bathrooms]

Handguns. See Guns. [Specific Tips for middle-stage Alzheimer’s]

Handrails. See Staircases.

Hand tools. See Tools. [Specific Tips for middle-stage Alzheimer’s]

Heat lamps. Install in lieu of space heaters. [Kitchens and Bathrooms]

Hot tubs. See Pools. [Indoors and Outdoors]

House fans. See Fans. [Indoors and Outdoors]

Keys (General Safety Items). Control access to; hide spare outside. [General- and Senior-Safety Tips]

Keys (Specific Tips for Early-Stage Alzheimer’s). Spare keys can be strategically placed outside of the house, in case the person with Alzheimer’s disease becomes locked out of his or her house. Of course, this must be done with care, since hidden keys – if discovered – pose home-security problems. [Specific Tips for Early-Stage Alzheimer’s]

Knives. Remove or secure. [Specific Tips for middle-stage Alzheimer’s]

Labels. Utilize labeling and signage. See also Triggers. [Specific Tips for Early-Stage Alzheimer’s]

Laundry detergents. Restrict access to. [Indoors and Outdoors]

Lawnmowers. Restrict access to; store correctly. [Indoors and Outdoors]

Lighting, bathroom. Use night-light or motion sensors. [Kitchens and Bathrooms]

Lighting, bedroom. Install a low-light detecting nightlight. [Indoors and Outdoors]

Lighting, exterior. Ensure adequacy. [Indoors and Outdoors]

Lighting, interior. Check for adequacy. [General- and Senior-Safety Tips]

Lighting, kitchen. Check for adequacy. [Kitchens and Bathrooms]

Lighting. Ensure adequacy for robbery-deterrence. [General- and Senior-Safety Tips]

Light switches. Check for accessibility and functionality. [General- and Senior-Safety Tips]

Locks (Laundry). Secure room. [Indoors and Outdoors]

Locks, bathroom. Remove locks or hide keys elsewhere in house. [Kitchens and Bathrooms]

Locks, garage. Use double-keyed deadbolt or reinforcement locks. [Indoors and Outdoors]

Locks, outdoors. Control entry/exit points. See Fencing. [Indoors and Outdoors]

Locks. Install locks on all exits and windows. [Specific Tips for middle-stage Alzheimer’s]

Magnets. Discard or remove. [Kitchens and Bathrooms]

Mats, kitchen. Use nonskid versions; secure to floor. [Kitchens and Bathrooms]

Mats. Add to entryways. [Indoors and Outdoors]

Medicines. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Microwaves. Disable or restrict access to. [Kitchens and Bathrooms]

Mixers. See Appliances, electrical. [Kitchens and Bathrooms]

Motion sensors. Use to control “elopement” and “wandering.” See also Trackers. [Specific Tips for middle-stage Alzheimer’s]

Outlet covers. Use covers to block access to live electrical outlets. [Specific Tips for middle-stage Alzheimer’s]

Ovens. Disable or lock. See also Stovetop. [Kitchens and Bathrooms]

Paints. Discard or restrict access to. [Indoors and Outdoors]

Pets. Add or remove as needed. [Specific Tips for middle-stage Alzheimer’s]

Pharmaceuticals. Secure medications; control dosages. See also General Safety Items: Prescriptions. [Specific Tips for middle-stage Alzheimer’s]

Pistols. See Guns. [Specific Tips for middle-stage Alzheimer’s]

Plants. Keep well-maintained; remove if poisonous. [Specific Tips for Early-Stage Alzheimer’s]

Plastic bags. Keep out of reach. [Specific Tips for middle-stage Alzheimer’s]

Pools. Remove or restrict access to; supervise use of. [Indoors and Outdoors]

Power tools. See Tools. [Specific Tips for middle-stage Alzheimer’s]

Prescriptions. See Specific Tips for middle-stage Alzheimer’s: Pharmaceuticals.

Prescriptions. Store correctly; restrict access to. [General- and Senior-Safety Tips]

Rails. See Staircases. [General- and Senior-Safety Tips]

Ramps. Install as needed. [Indoors and Outdoors]

Refrigerator. Install a “childproof” latch on. See also Specific Tips for Middle-Stage Alzheimer’s: Pharmaceuticals. See also General Safety Items: Food stuffs. [Kitchens and Bathrooms]

Rifles. See Guns. [Specific Tips for middle-stage Alzheimer’s]

Rugs, bedroom. Remove or secure to floor. [Indoors and Outdoors]

Rugs. Remove or secure to floor. See also General Safety Items: Tripping hazards and Bedroom: Rugs. [Indoors and Outdoors]

Shelving (Bathrooms). Ensure proper anchoring or remove. See also Grab bars. [Kitchens and Bathrooms]

Shelving (Living rooms). See Bookshelves. [Indoors and Outdoors]

Shotguns. See Guns. [Specific Tips for middle-stage Alzheimer’s]

Shower, walk-in. Replace conventional with walk-in varieties. [Kitchens and Bathrooms]

Shower benches. Insert to allow seated showering. [Kitchens and Bathrooms]

Showerheads. Replace conventional with hand-held wands. [Kitchens and Bathrooms]

Shower seats. See Shower benches. [Kitchens and Bathrooms]

Signage. Display to avoid scam artists and solicitors. [Indoors and Outdoors]

Space heaters, bathroom. See Appliances, electrical. See also Bedrooms: Space heaters. [Kitchens and Bathrooms]

Space heaters. Remove. [Indoors and Outdoors]

Spas. See Pools. [Indoors and Outdoors]

Sporting equipment. Keep sporting goods locked away. [Indoors and Outdoors]

Spout covers. Cover metal to prevent (further) injury during slips. [Kitchens and Bathrooms]

Staircases. Keep clear; install handrails and nonslip surfaces. [General- and Senior-Safety Tips]

Stair lifts. See Chair lifts. [Indoors and Outdoors]

Steps. Maintain de-ice (as needed), maintain, and mark clearly. [Indoors and Outdoors]

Stovetop. Install “childproof” knob covers on. See also Microwave and Oven. [Kitchens and Bathrooms]

Table centerpieces. Remove if poisonous or inedible. [Kitchens and Bathrooms]

Telephone (Seniors). Set up an answering machine or voice mailbox to intercept – and screen – calls. [General- and Senior-Safety Tips]

Telephones (General). Display emergency numbers. [General- and Senior-Safety Tips]

Televisions. Anchor. See also Bedroom: Furniture. [Indoors and Outdoors]

Thermostats. Carefully regulate; control access to. [Specific Tips for Early-Stage Alzheimer’s]

Tile flooring. Cover with nonslip mats; replace with bath carpeting. [Kitchens and Bathrooms]

Toasters. See Appliances, electrical. [Kitchens and Bathrooms]

Toilets. Surround with nonskid adhesives. [Kitchens and Bathrooms]

Toilet seat. Replace conventional with raised seats as a mobility aid for ease of transferring. [Kitchens and Bathrooms]

Tools, garage. Restrict access to electrical tools and hand tools. [Indoors and Outdoors]

Tools. Secure or remove. [Specific Tips for middle-stage Alzheimer’s]

Trackers. Use to monitor whereabouts off premises. [Specific Tips for middle-stage Alzheimer’s]

“Triggers.” Eliminated or minimize. See also Labels and Trackers. [Specific Tips for middle-stage Alzheimer’s]

Tripping hazards. Clear paths; remove Clutter; and tack down carpet/rugs. [General- and Senior-Safety Tips]

Tub mats. Use to prevent slipping. [Kitchens and Bathrooms]

Vitamins. Restrict access to; control dosages. [Kitchens and Bathrooms]

Walk-in shower. See Shower, walk-in. [Kitchens and Bathrooms]

Walking surfaces. Keep cleared and treated. [Indoors and Outdoors]

Washing machines. Use “childproof” knob covers and latches. [Indoors and Outdoors]

Water temperature. Keep between 105°F and 125°F. [Specific Tips for middle-stage Alzheimer’s]

Weapons. See the separate entries on Guns and Knives. [Specific Tips for middle-stage Alzheimer’s]

Weight equipment. Remove or restrict access to. See also Sporting equipment. [Indoors and Outdoors]

Whole-house fans. See Fans. [Indoors and Outdoors]

How to Pay for Care Home Modifications

I have discussed long-term care in a separate post. Titled “Alzheimer’s-Proof Your Retirement Savings With Long-Term Care Insurance,” the article chronicles my own family’s financial struggle to get my dad nursing-home assistance. In that article, I point out that there are really only three ways to pay for long-term care.

Three (3) Ways That Anyone Can Pay for Long-Term Care

1. Private pay…
   A. Out of your own assets
   B. Out of your own income
2. Spend your assets down and qualify for Medicaid
3. File a claim with your long-term care insurance

Now, of course, in order to be able to file a claim with long-term care insurance, you have to actually have a long-term care insurance policy in force. Since you will never be approved for such a policy if you wait until you have Alzheimer’s Disease (or some other form of dementia), if you are interested in protecting your retirement (and other assets) for your family/spouse, then you need to apply for long-term care insurance before you have any signs of cognitive impairment.

When it comes to paying for home modifications, the options dwindle down to two. As the website Caring.com explains: “Like Medicare, Medicaid doesn’t cover physical modifications to the home.”[1]

Two (2) Ways That Anyone Can Pay for Home Modifications[2]

1. Private pay
2. Long-term care insurance

Most people will therefore have to pay for their own home modifications, regardless of who they have perform the work. However, for those who have the right sort of long-term care insurance, some money might be available to subsidize various house alterations.

You have to check your contract or contact your insurance agent to discover whether these benefits are available to you and what limitations or restrictions, if any, may be placed upon them. For instance, some contracts might limit you to obtaining modifications of certain types, or from certain contractors, etc. And there may be maximums to the dollar amounts that insurance companies are willing to pay for such work.

Generally speaking, you may need to seek preapproval for any prospective, home-modification project.

But, here are a few sorts of installations/modifications that you might expect to receive approval – for those policies that offer these types of benefits.

• Addition of “knee holes” (to accommodate wheelchairs) in bathrooms, kitchens, studies, and work areas
• Installation of chair/stair “lifts” to enable people to traverse house levels without having to walk up stairs
• Mounting of grab bars and handrails
• Placement of wheelchair ramps over entryway steps
• Replacement of conventional bathtubs/showers with walk-in varieties
• Widening of doorways for wheelchair access

For More Information

See the following articles.

“How Do You Alzheimer’s Proof a Car?”

What do we mean by “Alzheimer’s Proofing?” see HERE.

What’s the Difference between Alzheimer’s Proofing and Baby Proofing or Childproofing? See HERE.

Notes:

[1] Joseph Matthews, “FAQ: What Kinds of Home Equipment and Modifications Are Covered by Medicare, Medicaid, or the VA?” Caring.com, Apr. 9, 2018, <>. The author adds, however: “However, some state Medicaid programs have special pilot programs that can help with home modifications. If you need home modification, check with the Medicaid worker who handles your file and ask if there might be special coverage that can help you,” ibid.

[2] Veterans have certain grants that they can apply for through the U.S. Department of Veterans Affairs (also known as the Veterans Administration), usually designated the “V.A.” See Matthews, loc. cit.

Alzheimer’s-Proof Your Retirement Savings With Long-Term Care Insurance

My dad, Jim, passed in 2016 at age 85 from Alzheimer’s-related complications. At the time, he had been in a nursing home for almost four years. (For more details, see “Jim’s Story.”)

Nursing-home costs vary by region. There are also price differences that depend upon offered amenities and services.  However, on average, it is not uncommon for nursing-home care to run in the ballpark of $75,000 to $150,000 annually.

At a middling $100,000/year level, a four-year stay (as my dad had) would come to $400,000. This could easily devastate your – or your surviving spouse’s – retirement plans. Additionally, once an estate is spent down, it can be difficult or impossible to leave a legacy to your children or grandchildren.

Sadly, my family discovered this all too well.

Jim’s Case

My dad retired from Sears (he always called it “Sears Roebuck”) after nearly forty-five years of service. At first, he worked in display. This was back when department-store displays were impressive and custom-assembled setups. Jim was trained in glass cutting and other skills that are now largely lost, in a time when what brick-and-mortar stores are left typically have pre-fabricated displays crated in from corporate headquarters.

Ultimately, he ended up in “maintenance.” A lot of the creativity was gone from the job that he had originally entered. Especially towards the end of his working life, he didn’t make much, salary-wise.

It’s probably safe to assume that he brought in around $20,000/year. At age 65, when he retired, Jim had around $300,000 from his Sears profit-sharing plan.

For illustration purposes, let’s think of this $300,000 as a well of money that can be drawn out a little at a time. There are ways of using the money (for example, to purchase an annuity) that do not consist in treating it as a pool. But we will put that to the side, presently.

Now, abstracting away from niceties like cost-of-living increases and supplemental incomes (like from Social Security), let’s consider three sample scenarios.

Three Hypothetical Situations

• Firstly, imagine No-Change Jim. No-Change Jim wants his retirement years to be the same as his working years – no change in lifestyle. A conservative assumption would be that Jim needed most (if not all) of his $20,000/year income to pay expenses. So, drawing $20,000 from our well of money every year, No-Change Jim would deplete his $300,000 in fifteen years.

As stated, and in fact, the real Jim retired at 65 and died at 85. But, for the moment, put aside the fact that the real Jim got Alzheimer’s Disease around the age of 75.

Drawing off $20,000 every year, No-Change Jim would have had fifteen years of money. That would have allowed him to live, with “no changes,” to age 80. If No-Change Jim had lived to age 85, as the real Jim had done, he would have run out of money five years too early. This is even on a “best-case” scenario where No-Change Jim never needed any extra money for emergencies (like needing a new roof or needing nursing-home care). No-Change Jim cannot really have “no change” after all. He has major problems by age 80. Additionally, No-Change Jim was “locked” into the spending habits he had when he was working. $20,000/year would have kept him where he was at, financially, but would not have provided any funds for any retirement-specific activities (like, say, traveling to Europe). So, No-Change Jim can keep going for a while in the lifestyle to which he had been accustomed. But he can’t keep going until the end of his life. What will No-Change Jim do at age 80?

• Let’s modify some of our assumptions. Think of a man that we’ll call “You-Only-Live-Once Jim.” YOLO Jim values enjoyment above being conservative. YOLO Jim wants to do some traveling with his new-found free time. To be sure, there are extreme versions of YOLO Jim where he takes the $300,000 in a lump sum, pays the taxes, and then blows the remainder on a few purchases. But let’s remain tethered to financial conservatism in some respects. Suppose that YOLO Jim simply wants to keep his overall lifestyle the same as it was while he was working, plus add on a $10,000 vacation each year (or build a “man cave” with a nice entertainment system, or whatever). To keep his pre-retirement lifestyle, we have seen that he requires $20,000/year. But to add on his desired vacation (or whatever), he needs an extra $10,000/year. That brings us to $30,000 each year. With $30,000 being drawn off every year, YOLO Jim’s $300,000 would have lasted him ten years. Again, holding fixed real Jim’s ages of retirement and death, YOLO Jim would have run out of money at age 75. YOLO Jim could have been “living large” for a while. But it catches up with him. How is YOLO Jim supposed to survive the last ten years of his life?
• Maybe there’s a version of Jim that thinks through possibilities 1 and 2 and wishes to avoid them. This hypothetical Jim does not want to outlive his money. Let’s call this man “Frugal Jim.” Frugal Jim faces head-on the fact that he cannot spend money on retirement trips (or man caves). Moreover, Frugal Jim realizes that – spending-wise – he cannot even keep leading the life that he was leading prior to retirement. $20,000/year is too much to spend. Therefore, Frugal Jim gives himself a pay cut.

Now there are two subtypes of Frugal Jim that I want to look at. One can see the future with his crystal ball, and the other cannot.

Crystal-Ball Jim can be frugal, but can also minimize his pay cut. Still leaving the Alzheimer’s aside, Crystal-Ball Jim knows that he will die at age 85. Since he retires at 65, Crystal-Ball Jim knows that he needs income for the next 20 years. By simple division, Crystal-Ball Jim takes his $300,000 and divides it by the 20 years he knows that he will live, and arrives at the figure of $15,000/year.  So, he gives himself a $5,000/year pay cut. Presumably, this will mean that Crystal-Ball Jim needs to cut expenses somehow. But, suppose it’s possible. With $300,000, Crystal-Ball Jim could live out his life on $15,000/year.

But, clearly, few people would claim to have the requisite knowledge of the future. So, let’s envision a version of Frugal Jim without a crystal ball. Unaware Jim doesn’t know that he will die at 85 (we’ll continue to assume). Unaware Jim only worries that he will outlive his money and that believes that he needs to scale down his expenses in order to protect himself against that outcome. As with YOLO Jim, there are extreme versions of Unaware Jim who scale back so radically that they practically (or actually) end up living on the streets. But, once again, we will commit ourselves to minimalism, change-wise. Since he doesn’t know that he will die at 85, our version of Unaware Jim decides to plan to live until 90. So, our version of Unware Jim wants to ensure that he has income to live on for the next 25 years. $300,000 divided by 25 gives us the amount that Unaware Jim has to be able to live on: $12,000/year. Supposing that Unaware Jim manages to eke out an existence on $12,000/year, he spends $240,000 over the next 20 years, dies at 85, and leaves $60,000 as a legacy (of which, a portion will be paid in taxes).

How Much Money Do You Need to Retire?

What’s the “moral” of these various hypothetical case studies?

The first thing that jumps out at me is this: My dad didn’t have enough money to retire! Financially, retirement had been inadvisable for him.

Of course, there are seldom one-size-fits-all answers. Things like your assets, lifestyle preferences, location, and so on, all figure in any satisfying response. Your retirement goals (including your idea of what retirement consists in) plan a role as well. If your idea of retirement is to travel around the world, then you’ll probably need more money than someone whose idea of retirement has them living in a log cabin in an isolated part of the country. For an individualized answer, you should really address retirement-related questions in consultation with one or more trusted financial advisors – people to whom you feel comfortable disclosing your personal financial information.

However, general statements can be made. Current estimates suggest that the average worker needs upwards of $2 million to retire. The financial website TheStreet published an article in 2016 outline reasons for thinking that $2 million is the “new amount needed for retirement.” Previously, the baseline number was thought to be $1 million.

Citing the considered opinions of various investment and wealth managers, TheStreet author Ellen Chang contended that the $2 million figure is a “good goal” to aim at.

One Jon Ulin stated that each million saved could issue in an estimated income stream of between $30,000 to $40,000 per year.

It’s easy to see the difference that $2 million, or even $1 million, would have made to my dad’s case studies. Still thinking of the $1 million as a pool of money to be drawn upon (and not as the single premium on an annuity or as the base amount in an investment portfolio), we see that my dad could have drawn $25,000 each year and not outlived his money even if he would have lived to 100. Indeed, Jim could have lived on over $30,000/year and had enough to survive until the age of 90 – assuming that he never got Alzheimer’s Disease.

What About the Cost of Alzheimer’s?

By this point, you should be saying (and hopefully not screaming): “But he did get Alzheimer’s!”

And this is part of the point of going through the case studies. It’s hard enough to plan for a “normal” retirement. But even a person who had budgeted enough for him- or herself to carry a current lifestyle forward into retirement may find that Alzheimer’s blows that budget to smithereens. All the figures just covered assume everyday expenses only. We have not factored in the cost of Alzheimer’s care.

Given that male residents may spend between one to three years in a nursing home, and that females may spend between three and five years, estimated costs can be calculated for husband-wife pairs.

We said earlier that yearly nursing-home expensive range from $75,000 to $150,000. On the low end, if the husband spends one year in a $75,000/year home, and the wife spends 3 years at the same facility (whether concurrently or successively), that comes to $300,000. On the other hand, if a husband and wife spend three and five years, respectively, in a $150,000/year home, the total expense would be $1,200,000 (that’s 1.2 million dollars).

Of course, there are scenarios in which the husbands and wives spend more or less time and the facilities cost more or less than the costs sketched above. But this carves out a general estimated range for projecting Alzheimer’s-care expenses.

On average, we could say that total, estimated nursing-home expenses for Alzheimer’s-related care for a married couple run between $300,000 and $1.2 million.

Alzheimer’s is not the only danger to retirement funds. Any condition that results in the loss of two out of six “activities of daily living” (ADLs) or results in severe cognitive impairment can trigger the need for what is termed “long-term care.”

[See also “75 Questions to Ask a Doctor About an Alzheimer’s Diagnosis.”]

It is arguable, if not obvious, that my dad didn’t have the financial resources for normal, retirement-related expenses, let alone resources enough to afford long-term care.

In fact, Jim’s long-term care did cost around $75,000/year. This means that his care actually cost $300,000 over the four years that he ended up spending in a nursing home. He would have blown through his entire profit-sharing fund even if he had saved it, at its full value, until he needed full-time care in a facility.

A husband-wife pair with $1 million in retirement assets could reasonably plan to spend between $300,000 to $600,000 on long-term care, if they resolved only to utilize facilities that are on the low end of expenses, around $75,000/year. (As we have seen, 8 years of combined care in a facility costing $150,000/year costs $1.2 million.) This is between 30% and 60% of their available assets.

It may be a bit clearer why many writers are advising people to have $2 million put away for retirement.

A husband and wife with $2 million for retirement between the both of them might have to spend 15%-60% (if facilities cost upwards of $150,000) of those assets on Alzheimer’s, or other long-term, care.

Just working with $100,000/year, a married couple should probably budget $400,000 to $800,000 for their combined long-term care costs.

If you have around $2 million in retirement assets, could you afford to pay $400,000 to $800,000 for long-term care? Perhaps, if you could afford to pay for your other, pre-long-term care expenses with the remaining $1.2 or $1.6 million that remains.

However, there is another alternative.

Retirement Insurance

One alternative is to (try to) acquire long-term care (or “retirement”) insurance. There are different varieties of long-term care (LTC) insurance available. Presently, I will simply sketch a few of the basic concepts.

Two Main Types of Long-Term Care Insurance

In the main, there are two sorts of LTC policies. Number one, there are policies that only cover expenses occurred by an individual in a nursing home. Predictably, these sorts of policies are often designated nursing home only.

Number two, there are policies that cover a broader range of expenses. To understand this second sort of policy, usually referred to as a comprehensive plan, you should be aware of the range of possible care options (and attendant expenses).

1. Adult Daycare – This is basically like a child day care. It is probably best described as a place offering custodial, recreational/social, and supervisory services to older adults who primary live at home, but are dropped off at the daycare center for limited periods of time. Not usually an option for people who require around-the-clock attention or are confined in some way, it may nevertheless be suitable for many families. For instance, if adult children take care of their aged moms or dads, but need a place to take them while going to work, then adult daycare may fit the bill.
2. Assisted Living – Assisted-living facilities are a combination of senior housing and limited care services. You might take grandpa or grandma to an assisted-living home if he or she need some help with daily activities, but do not (yet) require skilled-nursing or 24-hour care.
3. Home Health Care – As the name expresses, this option is for seniors who do not need institutional care because they are receiving help at their own (or someone else’s) home. The health plan may still include periodic visits from a skilled nurse who may perform various therapies and generally will be overseen by a physician.
4. Hospice Care – During that unhappy time when the end draws near for a terminally ill individual, hospice-care personnel focus upon the comfort of the patient and the emotional wellbeing of the family. Nurses do not administer curative or remedial care, but try to minimize the patient’s pain. Hospice teams typically offer bereavement and counseling services as well.
5. Nursing-Home Care – This is what may immediately come to mind when the subject of long-term care is broached. Nursing homes offer a mixture of custodial and skilled-nursing care. They are equipped to provide care 24 hours a day.

What Types of Care Do Long-Term Care Policies Cover?

The only type of care covered by long-term care insurance is custodial care. “Custodial care” refers to care administered in order to help people perform the activities of daily living or help people who suffer from debilitating cognitive problems (like severe memory and reasoning deficits). Custodial-care workers do not require medical training.

Skilled-nursing care, on the other hand, is only performed by a licensed nurse. The nurse will be depending upon an attending physician for the patient’s care plan. Usually, the phrase “skilled nursing” designates nursing care that is available around the clock, 24 hours a day, 7 days a week, 365 days a year. Long-term care policies do not cover skilled nursing care. It would be covered under health insurance, hospitalization policies, and Medicare.

On the other hand, neither healthcare plans nor Medicare cover custodial care! The only game in town for non-individual long-term care coverage is Medicaid. And Medicaid only covers people who are financially impoverished.

You might also run across the phrase “intermediate care.” This is also performed by a licensed nurse, under a doctor’s orders. However, this is less-than-24 care. It’s medical care, but it is not performed around the clock. Again, long-term care policies do not cover intermediate care. Health insurance, hospitalization policies, and Medicare cover intermediate care (which is often temporary, transitional, and ordered to support patient recovery).

Benefit Amount

Perhaps the most conspicuous consideration is the benefit amount. Generally, LTC benefits are paid on a dollar-per-day basis. So, your benefit amount might be $100/day, for example. Available benefit amounts typically range from $50 to $500 per day. Different companies will have different per-day maximums. Intuitively, the higher the per-day benefit, the higher the premium cost. All things being equal, the lower the per-day benefit, the lower the premium cost.

The average per-day cost for long-term care presently hovers around $200/day. At this rate, a $200/day benefit would cover 100% of expected costs, in today’s dollars, while a $100/day amount would could about half the anticipated costs. And so on. (Your own care experience may be very different. Again, this is for illustrative purposes only.)

Benefit Period

Another consideration is the benefit period. This is the period of time over which your benefit amount will be paid. Often, you can specify a benefit period something like 1, 3, 3, 5, or 10 years, etc. Similarly to what was said before, longer benefit periods translate into higher premium costs; shorter benefit periods generally mean lower premium costs.

Elimination Period

It was earlier briefly mentioned that long-term, or custodial, care has two “triggers”: one physical, one mental. Physically, LTC is triggered when an individual lacks the ability to perform two out of six activities of daily living. Mentally, LTC is trigged when an individual suffers cognitive impairment severe enough to require around-the-clock custodial supervision.

However, once one (or both) of these triggers is activated, the LTC benefit period does not begin until after the “elimination period” has been satisfied. An elimination period is sometimes characterized as a “time deductible.” It is the amount of time you must wait, after you are eligible for benefits, but before your benefit period begins.

Theoretically, the elimination period could be any arbitrary number of days.[1] It generally ranges from 30 days to 180 days. The shorter the elimination period, the higher the premium.

If your elimination period were 0 (zero) days, your premium payments would be extremely high. With a zero-day elimination period, your benefits would begin as soon as your need for long-term care is triggered.

If, to swing to the other extreme, your elimination period were 365 days (i.e., an entire year), your premium would be lower than it would be if you had selected a briefer elimination interval. However, your out-of-pocket costs would high. Essentially, a one-year elimination period means that you will be paying for your first year of nursing-home care out of your own assets or income. Since we already estimated one year of nursing-home care at between $75,000 and $150,000, these would be your expected out-of-pocket expenses before your long-term care benefit period begins.

Usually, people opt for something in the middle. 90 days is a commonly selected option. In this case, once you have triggered your need for long-term care, you would have to cover nursing-facility expenses out of your own pocket for three months and then your LTC insurance would begin paying your benefit amount.[2]

Three months of care at a $75,000/year facility would run $18,750. At a facility that costs double every year (or $150,000), your three-month cost would also double. In this case, that would be $37,500.

What Insurance Companies Offer Long-Term Care Insurance?

Here is a sample of companies that do, or did, offer long-term care insurance.[3]

• Genworth (Rated B by A.M. Best; B+ by Standard & Poor’s; and B2 by Moody’s)
• John Hancock (Rated A by A.M. Best; AA- by S&P; A1 by Moody’s; AA- by Fitch)
• Knights of Columbus (Rated A++ by A.M. Best; AA+ S&P)
• Life Secure (Rated D by Weiss)
• Lincoln Financial Group (Rated A+ by A.M. Best; AA- by S&P; A1 by Moody’s; A+ by Fitch)
• Mass Mutual (Rated A++ A.M. Best; AA+ by S&P; Aa2 by Moody’s; AA+ by Fitch)
• Mutual of Omaha (Rated A+ by A.M. Best; AA- by S&P; A1 by Moody’s)
• Nationwide (Rated A+ A.M. Best; Rated A1 by Moody’s)
• New York Life (Rated A++ by A.M. Best; AA+ by S&P; Aaa by Moody’s; AAA by Fitch)
• Northwestern Mutual (Rated A++ A.M. Best; AA+ S&P; Aaa Moody’s; AAA Fitch)
• One America (Rated A+ by A.M. Best; AA- by S&P)
• Pacific Life (Rated A+ by A.M. Best; AA- by S&P; A1 by Moody’s; A+ by Fitch)
• State Farm (Rated A++ by A.M. Best; AA by S&P)
• Thrivent Financial (Rated A++ by A.M. Best; AA+ by Fitch)
• Transamerica (Rated A+ by A.M. Best; AA- by S&P; A1 by Moody’s; A+ by Fitch)

Notes:

[1] There is also a finer-grained distinction between “calendar” and “service” days. When an elimination period is based on calendar days, the first day of a claim starts the clock and it runs continuously until the elimination period is complete. On the other hand, when an elimination period is based on service days, the clock begins when the claim is made and the individual actually receives care. If a given person only receives in-home care three days out of the week, then only three days per week will be counted toward the fulfillment of the elimination period.

[2] Note that you may still have out-of-pocket expenses even after the benefit period begins. In any case where your contractual per-day benefit amount is less than your actual per-day cost of care, you will have to pay the difference out of your own assets/income.

[3] I have done my best to report accurate financial-strength ratings (as of this writing). However, I offer this list for informational purposes only and make no guarantees or warranties. I encourage anyone who is considering the purchase of a long-term care policy to do his or her own research into a company’s financial strength and philosophy before making a purchase. Moreover, a would-be purchaser may find that Company A offers a better policy than Company B for your individual needs. In this case, it may make sense to favor A over B, even if B has a higher financial rating. You should seek professional advice.

Alzheimer’s-Proof Your Diet: Vitamin D and Other Nutrients

The prospect that I might end up like my dad frankly terrifies me. I watched helplessly as he slowly lost his faculties – both mental and physical. It’s no exaggeration to say that Alzheimer’s Disease appeared to strip him of his humanity. If I thought that making changes to what I eat would – or even could – result in improved odds for avoiding dementia in my old age, then I would happily alter my diet.

In fact, some recent scientific research provides an indication – not to say a hope – that such dietary changes might be possible. Amazingly, such modifications are arguably easily implemented.

Vitamin D

Vitamin D is among the candidate nutrients that figure prominently in such a nutritional-reform project. To be a bit technical, the term “vitamin D” actually refers to a group of compounds rather than one single thing.[1] It also turns out that the stuff we call vitamin D is perhaps better described as a hormone that helps to maintain healthy cells as opposed to a “vitamin” in a traditional sense.

However scientists classify it, though, vitamin D interests me because of what it might be able to do for me. In this vein, there is an impressive list of things that vitamin D is believed to help.

According to Medical News Today[2] vitamin D plays an important supporting role in promoting:

• favorable blood pressure readings
• balanced blood sugar
• strong bones
• optimal brain and nervous-system operation
• healthy breast tissue
• excellent calcium absorption (among other metabolic processes)
• robust immunity
• vigorous lung and cardiovascular function
• overall longevity
• uncomplicated pregnancies and deliveries
• normal vision and macular health

To this already extensive and impressive list, let me not forget (no pun!) to add vitamin D’s alleged capability of staving off dementia.

An article from the highly esteemed Mayo Clinic started my journey into finding more research on this possibility. The pertinent article concerned a study from 2014, which showed that people with vitamin-D deficiency were twice as likely to develop dementia in general, and Alzheimer’s in particular.

Predictably, the clinic’s doctors took a cautious stance. They said, circumspectly, that more research was needed before anything conclusive could be declared. For my part, I am not as interested in making causal claims – even true ones – as I am in stacking the deck in my favor, health-wise.

Since discovering the Mayo Clinic post, I have unearthed several other pieces of information outlining correlations between vitamin D and dementia. Sayer Ji’s website, GreenMedInfo, has been an outstanding resource in my investigations.

I have learned that one study, published in 2012 in the scientific journal Neurology, compared scores on a state exam and concluded that low cognitive abilities corresponded with low vitamin D levels. That same year, a study followed almost 500 women for seven years. Experimenters obtained similar findings. Women who were determined to be vitamin-D deficient as the program began, were adjudged more likely to develop Alzheimer’s.  A third study from 2012 professedly demonstrated that vitamin D helped to clear the sort of “amyloid plaques” that form in the brains of dementia patients.

Is vitamin D a panacea? When it comes to giving the proverbial “definitive answer,” we should probably agree with the Mayo Clinic’s physicians: more research is needed.

However, when it comes to deciding how to structure my diet, I cannot see much reason to neglect supplementing with vitamin D.

If you too are persuaded that vitamin D might be helpful for you or someone that you love, here are some ways to incorporate it into your life.

How to Get More Vitamin D

The most direct way of obtaining vitamin D is through exposure to sunlight. So, take a walk outside.

I hear you exclaiming: “But I heard that (excessive) sunlight was bad for you!”

First of all, bear in mind that there are 2 types of rays that penetrate the earth’s atmosphere: UVA and UVB. UVA is indisputably a harmful one. UVB, on the other hand, is our natural vitamin-D3 source. UVB rays are readily available during certain times of the year in different locations. Purportedly, the sun needs to be at 50 degrees at or above the horizon. It seems like the winter sun would not be as beneficial as the sun in spring through fall – not that you need a reason beside presumably frigid temperatures to stay inside.

For most of human history we worked and virtually lived our lives outside. You might say that we were, well …made to be in nature. So I am planning on spending lots of time outdoors.[3]

But for those who balk at the idea of getting more “rays,” or for those who are (for whatever reason) otherwise unable to do so, it should be said that vitamin D is also found in numerous foods. It’s available in caviar, egg yolks, fish (of various sorts, including mackerel, salmon, sardines, and tuna[4]), and milk (raw).

Still, even if you’re getting moderate sun exposure and eating fish, you might find it desirable to augment your diet with commercially available vitamin-D supplements.

From what I have read, you want to look for the word cholecaliferol on the label. This form of vitamin D – known as vitamin D3 – appears to be the “best” in terms of things like efficacy, potency, and absorption.[5]

My chosen brand in the past was NOW, which makes a whole assortment of vitamin D3 capsules.[6] One that I have purchased repeatedly is NOW’s 5,000IU offering. Recently, due to the slightly lower price, I have switched to Doctor’s Best, also in a 5,000IU amount.

How Much Should You Take?

I need to emphasize that I am neither a doctor nor a nutritionist. Presumably, the most accurate way to arrive at a dosage amount would be to have your levels of vitamin D tested, and then (on the assumption that you are not already where you need to be) to have a customized recommendation as to how to move that measured level into its ideal range. Obviously, I cannot administer such a test on anybody and I cannot make any sort of customized recommendation.

I can, however, report my research findings and disclose my own practices (which you may take or leave).

Let me begin with the former. Alternative medical “guru” Dr. Andrew Weil suggests that supplementing with 2,000 IU each day ought to suffice as a good supplementary starting point for most people.

For me, personally, 5,000 IU is my go-to amount during the winter months, when sunlight is on the decline and time outdoors is hard to come by. I am by no means a nutritionist, but I take 1 capsule daily as a maintenance dose. To put it another way, I take one 5,000 IU capsule every day in order to keep my vitamin D3 levels up. If I feel myself falling ill (for example, with a respiratory illness), I may double up the dosage or take a single dose more than once.

I do also keep other amounts of vitamin D3 on hand. Right now, I have 1,000IU and 400IU products from Finest Nutrition and Origin. My idea is to augment, when necessary, my vitamin D3 levels during times (perhaps during the summer), when I might feel under-the-weather or be otherwise stuck inside and unable to get my daily sun exposure.

Some sources indicate that vitamin D3 should be taken alongside vitamin K, in order to aid absorption. I have been a bit lax in terms of following this advice. But now that I am reminded of it, maybe it’s time to make a change.

Other Nutrients

Looking into supplements reported to help in preventing Alzheimer’s, you quickly find out that vitamin D is not the only substance to consider. Four other figure conspicuously in the pertinent literature.

Folic Acid is a water-soluble vitamin also known as Folate or B9. Folate occurs naturally in vegetables like asparagus, avocados, beans (dried), beets, broccoli, lentils, peas, and spinach. It also turns up in fruits – chiefly bananas – as well as in liver. Technically, folic acid is the synthetic form of folate, and it is contained in many fortified foods and available separately as a supplement.

Folic acid and folate aids in:

• maintaining brain and nerve function
• generating red blood cells
• and generally helping your cells to reproduce and combine DNA appropriately

(This latter responsibility of the cells, if done incorrectly, could contribute to the growth of cancers because it can lead to damaged or mutated DNA.)

Vitamin B12 is also a water-soluble vitamin. Called Cobalamin, B12 is found in beef liver, sardines, Atlantic Mackerel, lamb, wild-caught salmon, nutritional yeast, feta cheese, grass-fed beef, cottage cheese and eggs.

Available in chewable tablets, regular tablets, and liquid, is important in:

• making red blood cells
• maintaining brain and nerve function
• supporting energy levels
• protecting the cardiovascular system
• improving bone density and strength

A deficiency in B12 could block folate so that it can’t change into its active form. If folate can’t change into the active form, it can’t do the job of aiding the cell during DNA reproduction. This, in turn, can lead to DNA corruption.

Magnesium is a mineral that is found in spinach, chard, yogurt, almonds, cashews, pumpkin and sunflower seeds, avocados, bananas, black beans and dark chocolate.

Magnesium (in aspartate, carbonate, citrate, glycinate, L-threonate, orotate, oxide, malate, and taurate forms[7]) supports:

• calcium and potassium absorption[8]
• nerve and neurotransmitter function
• blood-sugar control
• blood-pressure regulation
• maintenance of energy levels

Fish oil comes, funnily enough, from “oily” fish – such as wild-caught salmon, herring, tuna and sardines. Fish oil is a wonderful source of omega-3 fatty acids.

Studies have shown that fish oil, and omega-3 fats, yields positive benefits in these areas:

• Alzheimer’s Disease
• anxiety
• arthritis
• cancer
• cardiovascular disease
• diabetes
• eye disorders
• immune function

Additional Supplements to Consider

Although the jury is still out, the following might also be worth your time and attention:

Vitamin E is a fat-soluble vitamin found in almonds, asparagus, broccoli, butternut squash, chard, olive and palm oils, spinach, sunflower seeds, sweet potatoes, trout, and wheat germ. It is an antioxidant that prevents damage to specific and important fats in your body.

Vitamin E benefits us in virtue of its abilities to:

• Assist our bodies’ regulation of cholesterol
• Support the repair of skin damage
• Promote balanced hormone levels and healthy muscles
• Improve vision (at least, in conjunction with vitamin C, beta carotene and zinc)
• Protect against heart disease
• And, crucially for the present discussion, slow the progression of Alzheimer’s Disease

Ginkgo (ginkgo biloba[9]) is considered an herb. The stuff comes from an ancient tree whose benefits have been known in Chinese medicine for thousands of years. It may be consumed as a tea (for example, as a hot infusion) or in capsule form. In general, ginkgo has become quite well known among herbalists as an anti-inflammatory as well as a brain-function and nervous-system enhancer. Given this folk reputation, it is not difficult to see why it may be beneficial to dementia sufferers – and to those who wish to avoid that description.

Alleged benefits of gingko include:

• Conservation of visual acuity (possibly along with beta carotene, eyebright, and lutein)
• Improved cognitive function (especially increased memory capacity and heightened concentration)
• Maintenance of energy levels
• Promotion of positive mood (perhaps similarly to St. John’s Wort and “SAMe,” S-Adenosyl methionine)
• And reduction of dementia risk

Turmeric is a powerhouse herbal whose potency – over a wide range of conditions – has been suggested to be superior to pharmaceutical-based medicine.[10] Turmeric shows up on too many lists to adequately summarize here. Suffice it to say that turmeric boasts benefits as a(n):

• Anticoagulant
• antidepressant
• anti-inflammatory
• cancer treatment
• cholesterol regulator
• pain reducer (particularly for arthritis)

It is also taken in supplement form. Black pepper (bioperine) should be added to assist the bioavailability of the curcumin – one of turmeric’s principal active ingredients. There are two option. One option is to get a turmeric-pepper combination product. The other is to acquire bioperine individually.

CoQ10 is an element that is naturally produced in our bodies. As we age, that production decreases. Fortunately, Coenzyme Q10 is found in many foods like grass-fed beef, cage-free eggs, free-range chickens, strawberries, herring, broccoli, cauliflower, beans, nuts, oranges and rainbow trout.

Many positive benefits are touted for CoQ10. It:

• boosts energy levels
• promotes healthy cardiovascular systems and lungs
• reduces muscle diseases
• stabilizes blood sugar
• and, of course, may help cognitive disorders like Alzheimer’s

_________________________________________________

Notes:

[1] Specifically, they are fat-soluble steroids.

[2] See, for example, here.

[3] There is some evidence that vitamin D production can be stimulated through light exposure to tanning lamps. For more information on that, in my view, back-up option, see here. Besides being pricey (see Sperti’s “Fiji Sun” model), artificial light just pales (okay, maybe that is a little pun) in comparison to the real McCoy.

[4] Of course, you should keep in mind the adage “all things in moderation.” Tuna, amongst other fish types, may contain disadvantageous things like mercury.

[5] Food that is labeled “fortified with vitamin D” often contains D2 (ergocalciferol), a form of D which your body cannot absorb as well as D3. This may be due, on part to the source of each form. Vitamin D2 is plant-based, while D3 is animal-based (fish usually). In any event, the superiority of D3 over D2 has led to some writers referring to D3 as the “real” form of vitamin D. I won’t take a position on that, here. I simply want readers to be aware of the terminology.

[6] Though, I have begun to consider giving preference to products with bases of pure safflower oil instead of soybean or coin oil. This is due to GMO worries – another can of worms entirely. Readers who share this concern might take a look at Bluebonnet, Nature’s Plus, and other companies that manufacture such safflower-based products.

[7] Oxide and carbonate are generally inexpensive, but are also (supposedly) poorly absorbed. I have been supplementing with citrate and malate forms – alternating in order to increase the bioavailability of each form. I have read good things about aspartate, orotate, and taurate in terms of heart health. However, for Alzheimer’s support – and possible prevention – my money is presently on glycinate, L-threonate, and malate, due to their association with cellular-energy and cognitive support.

[8] In fact, most magnesium is found in the bones.

[9] Note that “ginkgo” is alternately rendered “gingko.” While I disfavor this spelling for some perhaps veiled psychological reason, it does comport more closely with the way that I pronounce the word.

[10] Herbalists and naturopaths sometimes disparagingly refer to this sort of medicine as “allopathy.”