Home Safety for the Person with Alzheimer's Disease

/Home/Caregiving and Alzheimer's/Safety and Alzheimer's

HOME SAFETY

When caring for someone with Alzheimer's at home you are providing a chance for that person to remain in a familiar, comfortable environment where he can use his strengths and be encouraged to be as independent as possible for as long as possible. A safe, comfortable home can help a person with Alzheimer's feel more relaxed and less overwhelmed. Try to look at the world through the eyes of a person with AD and above all focus on preventing accidents, wandering away from home, and emotional upset. Ask a friend or relative to look at it with you to make sure you have not overlooked any hazards.

Safety

For the safest home, follow as many of these steps as possible:

* Remove any furniture that is not needed.
* Place the remaining furniture so that there is enough space for a walker or wheelchair. This will avoid the need for an elderly or disabled person to move around coffee tables and other barriers. Move any low tables that are in the way.
* Once the person in your care has gotten used to where the furniture is, do not change it.
* Make sure furniture will not move if it is leaned on.
* Make sure the armrests of a favorite chair are long enough to help the person get up and down.
* Add cushioning to sharp corners on furniture, cabinets, and vanities.
* Keep a telephone and flashlight where they are easily available.
* Keep power tools and other dangerous equipment where they are not accessible to the person with AD.
* Remove clutter.
* Remove scatter rugs, which can cause trips and falls.
* Place protective screens in front of fireplaces.
* Cover exposed hot-water pipes.
* Have a carpenter install railings in places where a person might need extra support. (Using a carpenter can ensure that railings can bear a person's full weight and will not give way.) It is worthwhile to consult with an expert, such as a physical or occupational therapist, for help in placing grab bars and safety rails. If they are not in the right position or securely attached they will not lend the support they are intended to provide. The screws MUST go into the wall studs.
* Plan for extra outdoor lighting for good nighttime visibility, especially on stairs and walkways.
* If the person with dementia is incontinent, use fabric pads that blend with the upholstery. These are available in many colors and are machine washable. These may not cause the embarrassment that regular pads can.
* Make chair seats 20" high. (Wood blocks or a wooden platform can be placed under large, heavy furniture to raise it to this level.)
* Place masking or colored tape on glass doors and picture windows.
* Use automatic night-lights in the rooms used by the person in your care.
* Clear fire-escape routes.
* Provide smoke alarms on every floor and outside every bedroom.
* Place a fire extinguisher in the kitchen.
* Think about using monitors and intercoms.
* Place nonskid tape on the edges of stairs (and consider painting the edge of the first and last step a different color from the floor to help with depth perception).
* Install a sturdy gate with a lock on any dangerous stairs. Gate must be higher than the person with AD's waist. Baby gates are dangerous as people may try to climb over them.
* It is easier to walk on thin-pile carpet than on thick pile. Avoid busy patterns.
* Be sure stairs have even surfaces with no metal strips or rubber mats to cause tripping.
* Remove all hazards that might lead to tripping.
* Adjust or remove rapidly closing doors.
* Cover exposed hot-water pipes.
* Provide enough no-glare lighting--indirect is best.
* Place light switches next to room entrances so the lights can be turned on before entering a room. Consider "clap-on" lamps beside the bed.
* Use 100-to 200–watt lightbulbs for close-up activities (but make sure lamps can handle the extra wattage).
* For those who tend to wander, create a safe path through the home for a "wander loop."
* Put reflector tape on furniture and sharp corners.
* Use reflector tape to create a path to follow from the bedroom to the bathroom at night.
* Cover radiators with radiator guards.
* Use child-proof plugs in all electrical outlets.
* Lock the cellar and garage doors; hide the garage remote control.
* Lock liquor cabinets.
* Remove or lock up all poisonous household items. Colorful cleaning products may be mistaken for food.
* Remove all sharp items.
* Remove poisonous plants from the house and yard.
* Install safety latches/locks on the doors and fenced/ gated exteriors. Install alarms on the doors.
* Rid the home of firearms or store them in a locked cabinet, with the bullets in a separate locked cabinet.
* Cover smooth or shiny surfaces to reduce glare, which upsets or confuses the person with Alzheimer's.
* Eliminate shadows by creating a uniform level of light with uplights that reflect off the ceiling. (Ask a lighting store for a lamp that doesn't cast shadows.)
* Cover or remove mirrors if they are upsetting to the person with AD, who may not recognize himself.
* Store car keys in a locked container; ask a mechanic to disable the car so you can still use it but the person with AD cannot.


BATHROOM SAFETY

Take great care when setting up the bathroom. With some forethought potential dangers can be avoided.

Safety

* It is difficult to get in and out of a tub enclosed with glass doors. A shower curtain may make life simpler.
* Nonskid decals will make the tub less slippery and may even provide a useful distraction at bath time.
* When the person in your care is no longer able to stand firmly and confidently in the shower, a shower bench can provide safety and security in the tub as well as the shower.
* Clear out or lock the medicine chest and the cabinet under the sink where poisonous substances have been kept.
* If the person with Alzheimer's disease shaves, a cordless rechargeable electric razor is safest. A safety razor should only be used with supervision.
* A raised toilet seat that has hand rails will make it easier to get up and down. Replace an uncomfortable hard toilet seat with a soft cushiony one.
* A shut-off mechanism and a mechanism to control water temperature in sink, tub, and shower will prevent accidental flooding and burns.
* Put screens over open drains.
* Put wastebaskets out of sight. (Otherwise, a person with Alzheimer's may urinate in them or remove things from them.)
* Have no electrical cords dangling near the washbasin.
* Install an automatic hot and cold water mixer.
* If possible, have the toilet seat and washbasin in a contrasting color to the floor.
* Cover a sharp edges with rubber cushioning.
* Put lights in the medicine cabinets so mistakes are not made when giving medicine. People with AD should not be taking medications themselves.
* Remove locks on bathroom doors.
* Use nonskid safety strips or a nonslip bath mat in the tub or shower.
* Think about putting a grab rail on the edge of the vanity. (Do not use a towel bar.)
* Remove glass shower doors or replace them with unbreakable plastic or a shower curtain.
* Use only electrical appliances with a ground fault interrupted (GFI) feature.
* Install GFI electrical outlets.
* Set the hot water thermostat below 120° F.
* Use faucets that mix hot and cold water, or paint hot water knobs/faucets red.
* Insulate (cover) hot water pipes to prevent burns.

Comfort and Convenience

* People beyond the early stage of Alzheimer's disease should not be left alone in the bathroom. They may stuff the toilet with paper and cause a flood.
* If possible, the bathroom should be in a straight path from the bedroom of the person in your care.
* Put in a ceiling heat lamp.
* Provide soap-on-a-rope or put a bar of soap in the toe of a nylon stocking and tie it to the grab bar.
* Place toilet paper within easy reach.
* Try to provide enough space for two people at the bathroom sink.
* If possible, have the sink 32"–34" from the floor.
* Use levers instead of handles on faucets.


BEDROOM SAFETY

Guard rails on the bed may sometimes be helpful supports when getting in and out of bed, but may also add to the risk of falls if the person attempts to climb over them. Consult with a physical therapist about the best way to use them, if at all, for the person in your care. A bed cane may turn out to be a safer alternative. It can offer support and increase balance. It is like a grab bar, with a wooden base that fits between the mattress and the box spring.

Night lights should be placed so that a person can find his way from the bedroom to the bathroom. Consider ''clamp-on'' lamps attached to the bed or wall lamps, which are less likely to fall over and cause a fire than lamps on a night table. Check for types that do not get hot.

* Place an alarm mat at the side of the bed, use an infrared sensor beam for sounding an alarm when a person crosses it, or attach a monitor to clothing.
* For anyone who is a wanderer, lower the bed height by removing casters, box springs, or legs; place the dresser at the end of the bed.
* Put in a monitor to listen to activity in the room of the person in your care. (Most are inexpensive and are portable.)
* Make the bedroom bright and cheerful.
* Make sure enough heat (65° F at night) and fresh air are available.
* Provide a firm mattress.
* Provide TV and radio.
* Think about having a fish tank for fun and relaxation. Be sure it is secure and the person in your care cannot knock it over by accident.
* Use throwaway pads to protect furniture.
* Install blinds or shades that darken the room.
* Place closet rods 48" from the floor.
* Provide a chair for dressing.
* Keep a flashlight at the bedside table.
* Provide a bedside commode with a 4" foam pad on the seat for comfort.
* Hang a bulletin board with pictures of family and friends where it can be easily seen.
* Provide a sturdy chair or table next to the bed for help getting in and out of bed.
* Make the bed 22" high and place it securely against a wall. Or use lockable wheels. This will allow the person to get up and down safely.
* Use blocks to raise a bed's height, but be sure to make them steady so they don't move.


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By Maria M. Meyer, Mary S. Mittelman, Cynthia Epstein, and Paula Derr