A Guide to Safe Guarding Your Home

For many people, their home represents their life accomplishments; this is especially true for individuals diagnosed with dementia or Alzheimer’s Disease and their caregivers. Most families want to keep their loved one at home for as long as possible so the person can be in familiar surroundings. Therefore, it is important to create a safe environment for your loved one to live in while they can still remain at home.

When caring for a senior with Alzheimer’s or memory problems in the home it is important to avoid accidents, minimize injuries in the event of an accident, and remove “triggers” that could cause agitation or challenging behaviors.

The following are suggestions for safe proofing your home. It is important to accommodate the needs of the caregiver as well as the senior with dementia. There are no fixed rules. Each person’s home is different, just like each person with dementia or Alzheimer’s related memory loss. There will be unique behaviors or characteristics that require continual reassessment. Be sure to walk throughout the home as the disease progresses to monitor it for safety issues that may arise.

1. Start with a Plan—Survey your home thoroughly prior to making changes. Look for areas and items that could be hazardous to your loved one. Survey the home as if you were the senior person with dementia then decide what area should be tackled first. The following suggestions can assist you with beginning your plan:

Þ Simplify—As Alzheimer’s Disease progresses, it becomes more difficult for seniors to process environmental information. The simpler things are in the home, the fewer environmental inputs there are to interpret and distract the person.

Þ Create walking paths throughout the home—Paths should be as straight and direct as possible. For example, a path from the kitchen to the dining room will need to be free of furniture and decorative items (ALL THROW RUGS SHOULD BE REMOVED).

Þ Reduce clutter—Open spaces make both access and decision making easier, while decreasing the potential for over-stimulation.

Þ Utilize labels—Labeling areas and items in the home may provide visual cues to maintain the senior’s independence within the household. For example, attaching pictures of silverware outside the utensil drawer or hanging a “BATHROOM” sign on the bathroom door. It is important to use symbols and/or the language the person can relate to at their current level of function. Therefore, it may be necessary to change the kind of labels you use as the cognitive level changes.

2. Identify “Zones” in your home – Think of your home in terms of zones as you start to develop a plan. As you survey your home, look at all cabinets, drawers, doors, and living spaces as one of the following zones:

Þ Danger Zone — This is an area that should be off-limits to your loved one. This zone includes any places, objects or features that may be potentially dangerous. These types of rooms should be secured and can be used to store breakables, tools, chemicals, or any other items deemed unsafe for seniors with dementia. Doors leading to these rooms should be kept locked and alarmed if possible.

Examples Include:

  • Garage (access to a car, tools, garden chemicals, etc.)
  • Basement
  • Attics
  • Workshops
  • Hobby rooms (machinery, paint, etc.)
  • Staircases
  • Outdoors (pools, spas, unfenced areas)
  • Computer rooms
  • Kitchen

If you cannot lock these areas, then removing dangerous items and/or disabling potentially dangerous applications and machinery is a must.

Þ Respite Zone — This space should be considered a sanctuary for the caregiver. This is a place where the caregiver can relax undisturbed and conduct personal affairs. Having a place to get away and have time alone can greatly reduce burnout and stress.

Examples Include:

  • Renovated attic
  • Spare room
  • Office in the home

Þ Safe Zone — This zone should include everything else in the house not identified as a danger or respite zone. It is preferable to safety-proof a room than declare it off limits. As much of the house as possible should remain available to the senior with Alzheimer’s to wander, hide things, rummage and exhibit the behaviors that are common with the disease. This zone should be free from agitating or harmful situations.

The following are helpful hints to creating safe areas:

  • Lighting — Reducing shadows and dark areas in the home can help eliminate sights that may be misinterpreted or trigger confusion. Ways to enhance lighting include adding night-lights to hallways, pathways and bathrooms, and replacing light bulbs in lamps with brighter wattages.
  • Bathrooms — This room can be one of the most dangerous rooms in the home. Possible dangers include: slips and falls, burns, poisoning, cuts, electrocution, and drowning The following are ways to create a safer bathroom:
    • Adding shelving units behind the toilet to display toilet paper, clean towels, Kleenex and other items (shelving must be able to double as a grab bar). Having these items displayed and easily available will eliminate confusion.
    • Safety proof or relocate wall hooks, glass shelves, throw rugs, mouthwash, laxatives, sleeping aides, cough syrup, and other medications (prescription and over the counter).
    • Remove all electrical appliances that can be dropped in water: electric razors, lighted portable mirrors, space heaters, irons, electric rollers, hairdryers, small radios or TV’s.
    • Identify or mark hot and cold faucets with large letters.
    • Lower household hot water temperature to 105 – 110 degrees when practical.
    • Modify the door to give access to the caregiver in case of an emergency (possibly remove the lock, move it to an unusual place, or have it specially keyed)
    • Make the room warmer – install a heating lamp in the ceiling with a timer (space heaters are never advised). Many people with dementia stop using the bathroom (because it seems too cold) without being able to verbalize this discomfort.
    • Install firmly mounted grab bars along the wall of the bath/shower and toilet. Consider shower seats and adding non-slip floor surfaces to wet areas.
    • Consider eliminating exhaust fans that whirl or make noise, as this may cause further confusion and/or irritation.
  • Kitchen — Dangers may include the same found in bathroom zones. Reducing items on shelves and cutting out pictures and taping them on cabinets to identify its contents are just two ways to simplify decision making and eliminate confusion for your loved one with Alzheimer’s. Eventually the kitchen may become a danger zone and off limits as the disease progresses. The following tips can be useful for safety proofing your kitchen:
    • Remove products, appliances or other items that may be dangerous and accessible such as stove knobs, oven door handles, and chemicals.
    • Remove all spoiled food from the refrigerator and check expiration dates on all products.
    • Remove any medications stored in the refrigerator or install a lock on the door.
    • Consider installing a childproof lock on the oven to prevent it from being turned on and forgotten, as well as, being used to store or hide household items.
    • Disconnect or remove the microwave to prevent it from becoming an ‘explosive.’
    • Use the fuse box or install timers to control electrical outlets for stoves, coffee makers and other appliances.
  • Windows & Doors—Some people with Alzheimer’s dementia will never wander; however, most do. It is important to take the necessary precautions before your loved one exhibits this behavior to ensure their maximum safety.
    • Make “Safe Zone” doors easy to use. Door levers are easier to operate than round, smooth, hard to grip knobs.
    • Install safety handles, locks and/or alarms on all doors that lead outside or to “Danger Zones.”
    • Make sliding glass doors as visible as possible. Install decals at the person’s eye level to prevent the person from walking into the glass door.
    • Adding fake windowpanes may help camouflage door access to “Danger Zones.”
    • Install devices on your windows and sliding glass doors that will limit how far they can be opened. Simple clamps or pins can easily be installed.
    • Reduce glare or reflections from windows that can be misunderstood by your loved one.

Preparing your home to care for a senior with Alzheimer’s Disease or any dementia related disorder is difficult. It is important to plan ahead rather than react to a crisis. Careful planning, foresight, knowledge, and patience is needed to safe proof your home. We are here to help.

Reference: The Complete Guide to Alzheimer’s Proofing Your Home, Mark L. Warner, Purdue University Press, 1998.

Provided by Barton House

UnCommon Alzheimer’s Care

For more information regarding safe guarding your home or any other Alzheimer’s or dementia related care issues or concerns, please contact us at Barton House at (877) 222-7866.

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Dementia–The Importance of an Accurate Diagnosis and the Qualified Specialists to Make It

Being able to retrieve information stored in memory becomes more difficult as we age, but recent memory loss so severe that it interferes with an individual’s daily functioning is not part of the normal aging process. It is a symptom of dementia, a gradual decline of intellectual functions such as remembering, thinking and reasoning. The most common type of dementia is Alzheimer’s disease (A.D.), a progressive, degenerative, terminal disorder that gradually damages and destroys nerve cells in the brain.

Although a definitive diagnosis of Alzheimer’s can only be made by analyzing the brain on autopsy following death, current methods of evaluation by qualified doctors specializing in the care of senior adults can make a diagnosis of Alzheimer’s 90% accurate. Other diseases that can cause similar symptoms can be ruled out in the process and treated.

What Should Be Included in an Evaluation?
It is important that the person suspected of having Alzheimer’s disease undergo a thorough physical, psychiatric, and neurological evaluation so that reversible conditions such as thyroid disease, metabolic problems, depression, adverse drug reactions, head injuries, etc. can be ruled out or treated.

There is no single diagnostic test for Alzheimer’s, but physicians specializing in the care of the geriatric/elderly patient can reliably diagnose the disease with a series of evaluations and tests:

  • Medical evaluation and family interviews—a detailed report from the patient and family member including observable changes and current symptoms.
  • Physical exam including lab tests to identify health problems such as thyroid, vitamin deficiencies and diabetes that might be responsible for symptoms.
  • Neurological exam including an EEG, an MRI and/or CT scan.
  • Neuropsychological testing and mental status examinations which assess reasoning, word-finding skills, writing ability, abstract thinking and cognitive skills.

Who Should Do the Evaluation?
Most senior adults prefer to rely on the physicians they have been seeing for their medical needs for many years. But their doctor may not have the knowledge of current advances in evaluation tools, medications, and treatments that physicians who specialize in care of the geriatric patient, and in memory problems/Alzheimer’s disease in particular, do.

Physicians who specifically work with older adults may be:

  • Family and Internal Medicine physicians with a geriatric specialty
  • Geriatric Psychiatrists
  • Neuropsychologists
  • Neurologists with a specialty in Alzheimer’s and Parkinson’s diseases

If your family physician is not familiar with specialists in your area, your local Area Agency on Aging and Alzheimer’s Association may be able to make recommendations.

Although there is no prevention or cure for Alzheimer’s, early detection can allow the family and the individual time to plan for the future and make legal and medical decisions according to the individuals’ wishes. Your loved one may have the opportunity to participate in one of the many research studies of experimental Alzheimer’s treatments. Medications prescribed in early to middle stages of the disease can help slow the deterioration process.

Provided by Arden Courts Alzheimer’s Assisted Living, 11630 Four Iron Drive, Austin, TX 78750 (512) 918-2800

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Types of Senior Housing and Care

ACTIVE ADULT COMMUNITY Usually offer a choice of spacious homes rather than apartments, often with a clubhouse in which a variety of activities are planned for residents. Monthly fees may cover services such as housekeeping and maintenance, but meals are usually not included.
APARTMENTS Apartments for seniors who are totally independent. Meal service, activity, programs and services usually aren’t included.
CCRC Continuing Care Retirement Community. Full service communities offering a long-term contract that provides for a continuum of care, including retirement, assisted living and nursing services, all on one campus.
RETIREMENT Totally independent living with amenities such as meals, transportation and activities usually included in a monthly fee.
ASSISTED LIVING Multi-unit facilities that provide assistance with medications and daily activities such as bathing and dressing.
RESIDENTIAL Usually single family homes licensed to provide assistance with medications, bathing and dressing.
GROUP HOME Serves the Elderly and Disabled who do not require constant medical supervision but cannot live independently. These persons may be on medication but must be self compliant and ambulatory (assistance such as wheelchair or walker allowed.
ALZHEIMER’S Facilities offering specialized programs for residents suffering from Alzheimer’s Disease or other forms of memory loss. These programs can be offered by Residential, Assisted Living or Nursing facilities.
NURSING/REHAB Facilities licensed to provide skilled nursing services under the supervision of licensed nurses.
CONGREGATE CARE Usually single family homes licensed to provide assistance with medication, bathing and dressing. Also licensed to provide skilled nursing services under the supervision of licensed nurses.
SUB-ACUTE Facilities licensed to provide nursing services, but specializing in higher levels of care.
REHAB Comprehensive rehabilitation services include inpatient and outpatient treatment designed to restore and strengthen abilities.
HOME CARE Includes both companies that provide licensed health care services in the home and companies who provide non-medical assistance with such tasks as bathing, dressing, meal preparation and transportation. Medicare and Medicaid provide financial assistance in some cases.
HOSPICE Hospice care may be provided in the home or a senior care facility. Services can include pain management and a variety of emotional, spiritual and physical support issues. Medicare, and Medicaid provide financial assistance, in some cases.
DAY CARE Various programs provide a range of geriatric day services, including social, nutrition, nursing, and rehabilitation. Not all programs provide all services.
SITTER SERVICE Services of sitters, aides or private duty nurses or therapists in the home, hospital or residential facility on a private pay basis. May include personal care assistance, grooming, medication supervision, light housekeeping, transportation, nursing care or therapy.
CARE MANAGEMENT Offer advisory services addressing a wide range of senior issues, such as selecting a senior residence, choosing in-home care providers, and various financial options. Typically care managers evaluate a senior’s situation with regard to health needs, housing choices and financial needs and then provide a recommended care plan.
BEHAVIORAL HEALTH These are usually hospital-based programs that provide a range of geriatric psychiatric services in either an in-patient or outpatient basis. Medicare & Medicaid (or Medi-Cal) provide financial assistance in some cases.
PHYSICIAN CARE Medical professionals who offer health services or referrals to match the special needs of patients.


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Selecting a Continuing Care Retirement Community

In recent years, many attractive options for seniors interested in retirement living have emerged. One popular option is the Continuing Care Retirement Community, or CCRC. This type of community is different from other housing and care options for seniors because it offers a long-term contract that provides for housing, services and nursing care, usually all in one location.

Continuing Care Retirement Communities offer some distinct advantages, including physical and financial security, independence and access to health care, companionship of friends and neighbors of similar age, and access to community facilities and privacy. The CCRC’s emphasis on the individual, coupled with a supportive environment, allows you to continue to pursue your lifelong interests.

There are many different options in the CCRC industry. For example, consider the community size when making your decision; do you prefer a large community with many options and services, or something smaller and more individualized? Would you prefer a more “formal” environment or are you a casual person at heart? There are CCRCs of all types and sizes, and you should find one where you will feel most at home. Use the list below as a starting point for asking questions when visiting or contacting these senior retirement communities.

If you have decided that a Continuing Care Retirement Community is the best option for yourself or a family member, it is best to visit a few facilities. Here is a checklist of things to keep in mind and questions to ask as you decide what facility is best for you:

  1. Find out what kinds of services the facility offers and which ones are included at no extra cost. Sometimes extra services are only available for additional fees.
  2. Inquire as to what kinds of contracts are available to you. The CCRC contract is a legal agreement between you (the consumer) and a Continuing Care Retirement Community. This agreement generally secures living accommodations and services, including health care services over the long-term. Determine what fee structure and contract option best suits your personal circumstances. The three most common types of CCRC agreements are:
    • Extensive contract: this offers unlimited long-term nursing care for little or no substantial increase in your usual monthly payments.
    • Modified contract: this includes a specified amount of long-term nursing care beyond which you are responsible for payment.
    • Fee-for-service contract: you pay full daily rates for all long-term nursing care required.
  3. Find out if the CCRC is subject to licensure. Ask to see the most recent inspection reports.
  4. Find out what the payment schedule is. Also, find out if the residents own or rent their living space.
  5. Before signing a contract, have your accountant or lawyer review the contract.