Environment

• Routine, Structured, Consistent (e.g., same things at the same time of day)
• Tranquil, Calm (e.g., limit number of visitors at one time)
• Continuity (e.g., furniture in the same place, routine schedule, memorabilia within sight)
• Free of distractions, avoid over-stimulation
• Avoid under-stimulation (e.g., use music)
• Orientation / visual cues (e.g., calendars displaying one day at a time)
• Contrasting colors for emphasis, camouflaging colors to de-emphasize
• Be sensitive to lighting/glare and use soft lighting to eliminate shadows, dull finish on floors, turn on lights at least 2 hours before sunset to reduce the incidence of sundowning
• Remove or cover mirrors, if necessary

Safety

• Adequate lighting
• Check stored food for spoilage
• Lock up unsafe items (e.g., guns, poisons, medications, tools)
• Secure hazardous areas (e.g., pools, stairs, stove, hot tubs, refrigerator, glass doors)
• Remove clutter; clear pathways
• Take knobs off of stove; unplug appliances (e.g., microwave)
• Cover thermostats
• Avoid look-alike objects (e.g., edible vs. non-edible)
• Water temperature (120 degrees or less)
• Helpful devices (e.g., grab bars, hand-held shower head, bath chair)
• Remove lock or cover latch on bathroom door
• Tack down electrical cords
• Use chairs with arms

Home Safety Checklist

Throughout the Home

• Have all expired and unneeded prescriptions been discarded?
• Has the house or apartment been cleared of clutter and simplified as much as possible? (What you want to create is an environment which has what the person with dementia needs, but as few other objects as possible.)
• Are the furnishings and often-used items always kept in the same place?
• Is constant noise and confusion avoided? Are the television and radio shut off when not in use? (A person with dementia generally does better in a quiet, calm environment, although soft, classical music may be calming.)
• Have area rugs been removed or fastened down?
• Are electric and extension cords in good condition ad secured in a way that minimizes the possibility of someone tripping over them?
• Is the house or apartment well lit?
• Are shiny floors with busy patterns avoided? (If the person bumps into walls or furniture despite good lighting, placing reflector tape on furniture corners or along baseboards may help.)
• Are there working night lights in the hallways?
• Are they turned on at night?
• Do all stairways have banisters?
• Are the stairs and hallways free from clutter which could cause a fall?
• Is the top of each stairway protected with a safety gate to prevent falls? (Such gates may only be needed at night.)
• Is there adequate space for the person to pace and otherwise move freely? (Many persons with dementia become agitated and need space to move around.)
• Have all tools and appliances the person can no longer use been safely removed or locked up? (Such tools and appliances may include an iron, hairdryer, razor, electric mixer, or food processor, sewing machine, lawnmower, electric knife, heating pad, or power tools.)
• Have all firearms been locked up?
• Are the car keys in a place where the person cannot find them?
• Have all paints, solvents, insecticides, and poisons been locked up?
• Are all doors secured in such a way that the person cannot get out without assistance? (Wandering is a common symptom of Alzheimer’s disease and can be extremely dangerous if the person becomes lost or disoriented outside. Locks can help prevent wandering but must be installed in such a way to make the person’s “escape” difficult without making access to the house impossible in the event of an emergency, like a fire. Because Alzheimer’s disease makes the acquisition of new knowledge difficult or impossible, installing a new and unfamiliar lock or placing an old lock in a different place on the door may be enough to prevent the person from opening the door.)
• Are all windows secured in such a way that the person can’t get out without assistance? (It is essential that the windows be easily opened in the event of a fire. If you have any questions about the safest way to secure your windows; consult the fire Department.
• Have all radiators been blocked off or covered with radiator guards?
• What about exposed hot water pipes?
• Is the use of cigarettes and matches either prohibited or carefully supervised? (Cigarettes and matches handled by an intellectually impaired person are a major fire hazard.)
• Have interior doors been altered to prevent the person from accidentally locking himself in a room? (This can be done by removing the locks or taping the door latch open.)

Kitchen

• Is the stove inoperable when not in use? (Improperly operated stoves are a major cause of accidental injury and fire. For the safest and most effective way to make the stove inoperable consult the dealer, our repairmen, the gas company, or an electrician.)
• Have all cleaning products, polishes, bleaches, and detergents been removed or locked up?

Person with Dementia’s Bedroom

• Has everything the person doesn’t need and use regularly been removed from the room to make it as simple and uncluttered as possible? (Remember to go through all closets and drawers, removing everything except the clothes the person uses on a day-to-day basis.)
• Is there a sturdy lamp by the person’s bed which he can operate easily without knocking it over? (A remote control on/off switch with a simple push-button control may be helpful.)
• Have all area rugs been removed from around the person’s bed? (These are easy to slip on, particularly when getting out of bed at night or when in a hurry.)
• Is there a clear and unobstructed path between the person’s bed and the bathroom?
• Is the person’s room well lit?
• Is there a working night light in the person’s room?
• Is it turned on at night?

Person with Dementia’s Bathroom

• Has everything been removed from the bathroom except such essentials as a towel, a bar of soap, a toothbrush, and some toothpaste? (It is best to keep the bathroom as simple as possible and to provide the person with shampoo, an extra towel, a denture case, shaving cream, etc. only when needed. As the disease progresses, even the towel, soap, toothbrush, and toothpaste may be used inappropriately if left out.)
• Have all medications (both over the counter and prescription) and toiletries been removed from the bathroom? (Remember to clear out or lock up the medicine cabinet. You should dispense all medications.)
• Are there non-slip decals or a non-skid mat in the tub or shower? (To avoid confusing the person, it is best to use mats and decals which blend in with the color of the tub or shower.)
• Are there grab bars in and near the tub and shower for the person to hold onto while getting into the tub and while taking a bath or shower? (The mere presence of grab bars does not guarantee safety. Make sure that they are bolted to the wall and that they are installed at a height and in a location convenient for the person to use.)
• If the person has difficulty using the bathtub, is the bathroom equipped with a bathtub bench and a hand-held shower?
• If the person has difficulty using the toilet because of stiffness or unsteadiness, is the bathroom equipped with grab bars around the toilet and with an elevated toilet seat available through most medical supply houses?
• If the bathroom is far from the person’s bedroom, is a portable commode kept in the bedroom?
• Are small rugs and bath mats removed except when the person is betting out of the tub or shower?
• Do the rugs or mats have non-skid bottoms? (Such rugs and bath mats should be used only to keep the person from getting the floor wet and making it slippery.)
• Does the bathroom have a working night light?
• Is it turned on at night?

Although not directly related to the home environment, there are a number of additional safety precautions a family caring for an Alzheimer’s person should take. For example, the family should have a written emergency plan describing procedures to be followed in the event of a medical emergency, a fire, or the person’s wandering away from home. The plan should be posted near the telephone, along with the phone numbers of the Police and Fire Departments, the local poison control center, and your family doctor. Notify the local police precinct immediately if the person wanders away.

Keep a recent photograph of your relative on hand, as well as photocopies which can be quickly distributed to the police and to neighbors if the person gets out unaccompanied. Obtain an identification bracelet for the person which gives his name and address and indicates that he is memory-impaired.

It may be wise to inform your neighbor that your relative has Alzheimer’s disease, particularly if he has a tendency to wander. Informing them of the nature of his illness, and telling them what to do if he is seen outside alone, may help prevent his wandering beyond the neighborhood. There are innumerable stories of disoriented persons with dementia being returned home by caring neighbors and local merchants.

A final safety precaution involves the decision about whether to leave your relative alone at home. You will have to use your judgment about whether he is intellectually intact enough to be left alone for even short periods of time. A person whose behavior makes him a potential danger to himself or to others – or a person who can neither recognize nor respond appropriately to an emergency situation – should not be left unsupervised.

Responding to an emergency situation frequently requires that a person be capable of communicating the need for help to others. One reason why a person with dementia may be incapable of responding is that he can no longer communicate that need clearly. The ability to both understand and use language diminishes as Alzheimer’s disease progresses.

You can purchase the items you need to make your home safe at places like Toys-R-Us, hardware stores, home safety catalogs, and online.