[11] Horizons: Home Safety

Dementia Horizons | Workshop 11 | Home Safety

Video Module 11 Transcript

Home. What does that mean to you? Are you surrounded by pictures and mementos that have a story or bring you joy? Does home mean safety, peace, and familiarity? When you come home, do you love a particular scent or smell? Our job today is to learn how to adapt a home for someone whose brain and senses are changing over time, due to progressive cognitive impairments that we call Dementia. That way, you can better understand why modifications to create a safer home environment are necessary in the first place.

It is also essential to know how the underlying diseases or disorders that can cause Dementia may impact the senses.

Let's start with vision or eyesight. Peripheral vision narrows, meaning that the person sees primarily what is directly in front of them, like looking through a tunnel, with less ability to see what is happening on the sides. Because of this, people living with Dementia may then bump into objects if pathways are narrow or cluttered.

Also, identifying shapes and objects can be difficult if the lighting is dim. For example, the vacuum can look like a small child in the distance. Shadows can be misinterpreted, especially at night, looking like strangers entering the room. The shape, purpose, or function of an object can be misconstrued, so a TV remote control and a cell phone can look the same. Because of changes in the brain, which keeps track of what does what and how, managing devices can become overwhelming.

Depth perception changes over time. It may be more difficult to safely walk up or down stairs, or know how to step into or out of a bathtub. As you can anticipate, there is a higher risk of slips, falls, and injuries. The brain also controls our ability to move our legs and maintain balance while walking. As Dementia progresses, steps shorten, people may shuffle their feet; and reflexes slow, creating another reason why the risk of trips and falls is a common concern.

The sense of smell may diminish, making it problematic to identify smoke, foul odors, or spoiled food. It is also common for hearing to become impaired with age. Therefore, older people living with Dementia can have more difficulty deciphering sounds and voices. This is especially true when there is too much background noise or people are talking simultaneously. Although this may not happen to everyone with Dementia, hallucinations can occur. Hallucinations are perceptions of having touched, heard, seen, tasted, or smelled something that does not exist.

Given this wide range of potential changes, I hope you can see why creating a home environment that supports safety and thriving is wise and loving. Hearing all of this may be overwhelming to absorb.

Take four deep breaths.

By anticipating challenges and making proactive adjustments inside and outside the home, care partners and caregivers can significantly enhance the quality of life for those living with Dementia and provide reassurance for themselves. You can do hard things, and I am here to help you get started.

Let's start by imagining yourself walking into the kitchen. Objects might look different to a person living with Dementia. Now, scan the room. Take inventory of what is inside the cabinets and drawers, and consider the following recommendations.

• Remove knives and other sharp utensils.

• Purchase kitchen appliances, such as coffee makers, with automatic shut-off.

• Disconnect the garbage disposal, or make it very difficult to turn on.

• If possible, remove the knobs from the stove.

• Lock up cleaning supplies. People may misinterpret cleaning solutions for juice. Be especially sure to secure dishwasher soap pods. They are poisonous and commonly mistaken for candy.

• Remove anything mistaken for food, such as fake fruit in a bowl.

• Clear the refrigerator of expired food regularly.

• Some cabinets may require safety locks to keep items hidden and secure.

• Keep the fire extinguisher or fire blanket within easy reach.

• Label cabinets so that things are easier to find. This will also help support a sense of independence.

• Use chairs that are sturdy, with armrests that make it easier to get in and out of.

• As you walk through the hallways, clear the pathways. Remove throw rugs that can be tripping hazards, and add additional lighting where necessary.

• Consider using non-skid wax on floors. If not, be sure the person wears non-skid shoes or slippers when walking on wooden or tile surfaces.

• Some people with Dementia find it easier to locate rooms in the house if way-finding signs are in place. These signs usually have the room's name in large print and a picture.

• Use brightly colored tape or paint to mark the edges of steps, or changes in the flooring.

• Install or secure handrails on stairs. If steps become too challenging, the person may need to remain on one main floor.

• If clear glass doors or partitions are present in your home, use decals to prevent people from bumping into them.

Now, let's imagine going into the bedroom or bedrooms.

• I would encourage you to decorate the bed with a color that contrasts with the rug or floor so that it can be easily identified. For example, a blue bedspread and a cream colored carpet.

• Install motion detector nightlights for times when someone wakes up and needs to find the restroom.

• Again, be sure to remove throw rugs.

• Listen for low battery chirps from smoke alarms, and don't wait to change them.

• Supervise the use of heating pads or electric blankets.

• Remove clutter, and label drawers and cabinets.

Moving into the bathroom. This is an area that requires particular attention:

• Remove or secure prescription or over-the-counter medications from cabinets, and place mouthwash and colognes where they can be supervised during use.

• Replace door locks with non-locking levers.

• Install grab bars in shower and bathtubs.

• Use a non-slip bath mat.

• Install non-slip toilet seats that contrast with the color of the floor, making them easier to see.

• Set water temperature to avoid scalding.

• Use overflow valves or flood sensors to avoid or detect flooding.

Find yourself now in the living room:

• Remove throw rugs, and use non-slip surfaces if possible.

• Do your best to declutter. It's easier to pay attention when there is less overstimulation.

• Remove long cords to avoid tripping.

• Perhaps in the living room or somewhere else, create a calm and inviting space for the person living with Dementia to relax and have access to meaningful activities such as books, magazines, simple puzzles, paper and pencils for drawing, and music for listening.

• If guns or a knife collection exists, secure and disable them.

Safety, autonomy, and comfort also apply to the backyard and garage:

• Secure the keys to the snowblower or lawnmower and car.

• Place power tools out of reach.

• Disconnect the gas or electric source for the grill.

• Adjust uneven pathways.

• Create a space for gardening, walking, sitting and spending time in the fresh air and sunshine.

• Consider adding a bird feeder or gentle wind chime.

Now, you may be wondering, how do I make these changes when the person with Dementia may resist? Start gradually, one slight modification at a time. Have a friend or family member take the person out for a meal or for the day, while the remodeling happens. Do not say anything in advance. Wait to see if the person recognizes the changes. Be matter of fact. Avoid saying you needed this "because...". Instead, say "We needed to make a slight improvement."

Creating a safe home environment for individuals living with Dementia requires a combination of understanding, empathy, creativity, and practical adjustments. It's a journey, but ultimately, it can significantly improve the quality of life for both the individuals living with Dementia and their loved ones. Consider these adaptations as a way of loving your spouse, parent, or sibling differently.

There we have it: home sweet home. Thank you for joining me today. There was a lot to take in, but use our support material to review and help you implement changes over time. Thank you again. Be well.