Safety:
Steps to Enhancing Your Home
Safety: Steps to
Ensuring Safety
How to Be a Long-Distance
Caregiver
Safety:
Steps to Enhancing Your Home
Modifying the Environment
When caring for an individual with Alzheimer's disease
at home, safety and accessibility can be important
concerns. The person may experience changes in:
- Judgment (forgets how to use familiar household
appliances and equipment properly)
- Orientation to time and place (gets lost on
her own street or is unable to recognize or
find areas in the home)
- Behavior (becomes easily confused, suspicious
or fearful)
- Physical Ability (Has trouble with balance,
or depends on a walker or wheelchair for mobility)
- Senses (experiences changes in vision, hearing
sensitivity to temperatures and depth perception)
With some creativity, flexibility
and problem-solving, the home can be adapted to
support these changes. This article provides simple
steps to make the home safe and supportive for the
individual with Alzheimer's.
Before modifying your home,
consider the following:
Assess the environment. Identify possible hazards
by looking at your home through the eyes of an individual
with Alzheimer's. What objects could cause the person
injury? Can the person easily get outdoors or access
dangerous areas such as the kitchen, garage or basement?
Focus on adapting rather than
teaching. Avoid reteaching the person
with Alzheimer's about safety issues. Instead, identify
potential risks and take the appropriate precautions.
Simplify the activities.
Most accidents, especially in the area of personal
care, occur when the person with Alzheimer's is
rushed. Break activities into simple, step-by-step
tasks allowing her plenty of time to complete them.
Giving extra assistance, such as laying out clothes
in the order that they are put on, will also help
her with simple tasks that have become hard to do.
Support the person's needs.
Try not to create an environment that is
too restrictive. The home should encourage independence,
social interaction and activities that are meaningful.
Be realistic about what you
can do. You will never be able to prevent
every problem. Rely on your common sense while paying
close attention to objects or activities that could
be dangerous.
CREATING A SAFE ENVIRONMENT
Once you have identified potential safety problems,
take the following steps to modify your home.
MAKE POTENTIALLY DANGEROUS
PLACES LESS ACCESSIBLE
The person with Alzheimer's may be at risk if she
has access to certain areas of the home or the outdoors.
The following action steps will help to make potentially
dangerous areas more difficult to access:
Lock or disguise hazardous
areas. Cover doors and locks with a painted
mural or cloth. Use "Dutch" doors, swinging
doors or folding doors to hide entrances to the
kitchen, stairwell, workroom and storage areas.
Install locks out of sight. Place
deadbolts either high or low on exterior doors to
make it difficult for the person with Alzheimer's
to wander out of the house. Keep an extra set of
keys hidden near the door for easy accessibility.
Remove locks in bathrooms or bedrooms so she is
not able to lock herself inside.
Use special safety devices. Child-proof
locks and door knobs can help limit access to places
where knives, appliances, equipment, cleaning fluids
and other poisonous products are stored. Use automatic
shut-off devices for appliances such as an iron,
toaster oven and coffee maker.
Accommodate Visual Changes. As
the disease progresses, changes in vision may make
it difficult for the person to distinguish colors
and understand what is being seen. Consider the
following:
Diffuse bright light. Reduce glare by removing or
covering mirrors, and glass-top or highly polished
furniture. Cover windows with blinds, shades or
sheer draperies to block bright sunlight. Avoid
using bare light bulbs or clear "decorator"
bulbs without shades. Taking these action steps
may help to reduce agitation in the person with
Alzheimer's.
Create an even level of lighting.
Add extra lighting in entries, outside landings,
areas between rooms, stairways and bathrooms because
changes in levels of light can be disorienting to
the individual with Alzheimer's.
Use different colors. Place contrasting
colored rugs in front of doors or steps to help
the individual anticipate staircases and room entrances.
However, avoid using very dark colored rugs since
it may be perceived as a hole. Apply colored decals
to glass doors and large windows because she may
think they are open doors.
Install special lighting. Use night
lights in hallways, bedrooms and bathrooms to prevent
accidents and reduce disorientation, especially
if the person wanders. Illuminated light switches
and timers for lights in these areas can also assist
her at night.
BEWARE OF HAZARDOUS OBJECTS AND SUBSTANCES
Even the most basic appliance or household object
can become dangerous to the person with Alzheimer's.
To reduce risk of injury:
Limit the use of certain appliances and equipment.
Remove electrical appliances such as an electric
razor or a hairdryer, from the bathroom to reduce
the risk of electrical shock.
Put away kitchen appliances and equipment including
knives, mixers, grills, guns, lawn mowers or power
tools, since the person may not remember how to
use them safely. Also, consider removing the knobs
on the stove or installing a hidden gas valve or
circuit breaker so she can not turn on the stove.
Supervise smoking and alcohol consumption. Keep
an eye on the person who uses cigarettes, cigars
or pipes because she may not realize the dangers
related to smoking. Monitor consumption of alcohol
because it can have many negative effects, especially
when mixed with medication.
Be prepared for the unexpected. Persons with Alzheimer's
have been known to eat items such as small rocks,
dirt, plants, flowers and bulbs. Take precaution
by removing toxic plants and any decorative fruits
(wax, plastic, etc.) that the person may think are
real. Also, remove vitamins, prescription drugs,
sugar substitutes and seasonings from the kitchen
table and counters.
Keep the refrigerator safe. The person with Alzheimer's
may not be able to distinguish the difference between
fresh and rotten food. Clean out the refrigerator
regularly and discard inedible food. Keep foods
that are safe to eat in the front of the refrigerator
and at eye level where she can easily see them.
Keep walking areas clear. Remove objects, such as
magazine racks, coffee tables and floor lamps, to
create safe wandering areas and reduce the possibility
of injury.
AVOID INJURY DURING DAILY ACTIVITIES
Since a majority of accidents in the home occur
during daily activities such as bathing, toileting,
and eating, it is important to take special precautions.
Monitor temperatures. As the disease
progresses, the person may have a decreased sensitivity
to temperature. Consider setting hot water heaters
at 120 degrees and installing automatic-mixing or
anti-scalding devices to the faucets. Meanwhile,
help her mix hot and cold water, and always turn
off hot water first when finished. Also, it is important
to check the temperatures of foods before serving
to make sure that they are not too hot or too cold
to consume.
Prevent falls. Install walk-in
showers and grab bars in the shower or tub and at
the edge of the vanity to enable the person to move
around safely and independently. Shower seats and
commode chairs are also helpful if she has limited
mobility. Add textured decals to slippery surfaces
and apply adhesives to keep throw rugs and carpeting
in place, or remove them completely. Place padding
on the edge of counters and bathroom fixtures if
they are sharp.
Supervise taking prescription and over-the-counter
medications. The person may experience
many difficulties related to medication use, either
forgetting to take them, or taking too much. Consider
using locked pill dispensers operated on a self-timer
to assist her. Make medicine or kitchen cabinets
less accessible by installing locks.
CREATING A SUPPORTIVE ENVIRONMENT
While it is important to make the environment safe,
it is equally important to create an atmosphere
that supports the changing needs of the individual
with Alzheimer's.
Encourage independent movement. Eliminate hazardous
objects, limit access to danger-points such as stairwells,
kitchens and outside doors so the person can move
safely and independently. If necessary, make room
to accommodate walkers and wheelchairs.
Involve the person in activities. Let her participate
in preparing meals, rinsing the dishes, folding
clothes, raking leaves and other activities with
your supervision. These activities enhance self-esteem
and make her feel more valued around the home.
USE SURROUNDINGS TO INITIATE ACTIVITIES
Leave out scrapbooks, photo albums or old magazines
that help the person to reminisce and encourage
conversation. Try using music the person once enjoyed
in the past to prompt activities such as dancing,
clapping or other types of exercises. It is important,
however, to keep the noise level to a minimum since
loud distracting sounds may cause agitation.
Create access to the outdoors.
Encourage the person to enjoy supervised outdoor
activities such as gardening or walking. A backyard
with a fence allows her to safely go outside on
her own. If she is unable to go outdoors, consider
doing indoor activities in a room with many windows
or on an enclosed porch.
Be prepared for emergencies.
Keep a list of emergency phone numbers and addresses
for the local police and fire departments, hospitals
and poison control helplines. Check fire extinguishers
and smoke alarms, and conduct fire drills on a regular
basis.
If the person has a tendency to wander, enroll her
in the Alzheimer's Association's Safe Return program.
The program is a nationwide system designed to identify,
locate and return to safety persons who are memory
impaired
TIPS FOR CREATING A SAFE AND
SUPPORTIVE ENVIRONMENT
Kitchen
- Lock up cleaning supplies
- Turn off electricity to the garbage disposal
- Hide knives and other utensils
- Put away the toaster, blender, and any small
appliances
- Unplug larger appliances such as the microwave
- Remove knobs from stove or hook up stove to
a hidden gas valve or electric switch
- Keep fire extinguisher nearby
- Clean out refrigerator regularly
Bathroom
- Set water temperature at 120 degrees
- Install grab bars
- Apply textured decals on slippery surfaces
- Supervise the use of hairdryers, electric
and hand razors
- Remove locks from the bathroom door
- Discard dangerous items from the medicine
chest
Bedroom
- Avoid using electric blankets
- Monitor use of heating pads
- Install night lights between the bedroom and
bathroom
Garage
- Put away hand and power tools such as drills,
axes, saws and picks
- Limit access to large equipment such as a
lawnmower, weedwacker and snowblower
- Lock up poisonous products such paints and
fertilizers
Throughout the home
- Disguise outdoor locks or install deadbolts
- Remove or tape down throw rugs and carpeting
- Apply colored decals to large windows and
sliding glass doors
- Remove poisonous plants
- Create an even level of lighting near doorways,
stairways and between rooms
- Remove object that block walking paths
Outdoors
- Disconnect gas grills
- Lock gates to fences
- Supervise the person in areas that are not
enclosed
- Put away car keys
ALZHEIMER'S ASSOCIATION: SOMEONE TO STAND
BY YOU
The Alzheimer's Association is the only national
voluntary organization dedicated to conquering Alzheimer's
disease through research and to providing information
and support to people with Alzheimer's disease,
their families, and caregivers. For more information
call: (800) 660-1993
http://www.alzoc.org/support
Safety:
Steps to Ensuring Safety
Preventing Wandering and
Getting Lost
When someone with Alzheimer's disease wanders and
becomes lost, it is a frightening experience that
puts that person at risk for serious or fatal injury.
This article offers ways to prevent unsafe wandering
and to prepare for an emergency situation.
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Wandering can be aimless or purposeful roaming that
can cause a person to become lost, leave a safe
environment, or intrude in inappropriate places.
Wandering is one of the most frequent and challenging
problems that caregivers face.
Seven of every ten people with dementia will wander
and become lost during the course of the disease,
and most will do so repeatedly.
Someone with Alzheimer's disease may not only wander
by foot but also by car or other mode of transportation.
Understanding Wandering
Wandering may be triggered when a
person with Alzheimer's:
- no longer recognizes familiar people, places,
and objects
- feels lost in a new or changed environment
- tries to fulfill former obligations, such
as going to work or taking care of a child
- takes medications that have side effects such
as restlessness and confusion
- tries to relieve stress caused by noise, crowds,
or isolation .
- is restless due to lack of physical activity
- is fearful of unfamiliar sights, sounds, or
hallucinations
- searches for something specific such as food,
drink, the bathroom, or companionship
- looks for a way out of the home
- experiences confusion at certain times of
the day or night
Preventing Wandering
It is hard to predict when a person will wander
and become lost. However, caregivers can take steps
to prevent wandering incidents.
Structure the Day
Establishing a daily routine that includes meaningful
activities and sufficient physical exercise can
help lessen wandering behavior. Ask the person to
help with simple household activities such as sweeping
the floor or folding clothes. Also try playing familiar
music and dancing or taking walks together outdoors.
Making Your Home Safe
To prevent unsafe exits from the house or backyard,
place door and window locks out of sight and reach,
either very high or very low. Use a double-bolt
door lock, and keep the key handy in case there
is an emergency. You may also want to:
- install high-tech devices such as electronic
buzzers or bells to signal when a door is opened
or place a pressure-sensitive mat at the door
or person's bedside that sounds an alarm to
alert you to movement.
- put hedges or a fence around your patio or
yard and be sure to place locks on any gates.
Inform Your Community
Talk to Your Neighbors
Alert your neighbors about the person's condition,
and keep a list of their names and telephone numbers.
Ask that they call you if they see the person outdoors
without supervision. Also inform others such as
the doorman in your apartment building or staff
in the senior residence or retirement community
where your loved one resides.
Involve Your Local Police
Tell your local police about your loved one's potential
for wandering. Advise them that the Alzheimer's
Association has a national Safe Return program to
help police locate or return someone who is lost
from wandering.
Survey the Neighborhood
Identify dangerous areas near the home, such as
bodies of water, open stairwells, dense foliage,
tunnels, bus stops, high balconies, and heavy traffic
roads. Check these places first if someone becomes
lost.
Be Prepared For A Wandering
Incident
Take steps in advance to prepare yourself in the
event that your loved one becomes lost.
Gather Important Information
Having reliable and accurate information
will help those involved in a search:
- Post the Alzheimer's Association checklist
of what to do when the person in your care becomes
lost.
- Keep a list of the person's age, height, weight,
hair color, blood type, eye color, identifying
marks, medical condition, medication, dental
work, jewelry, allergies, and complexion.
- Make multiple copies of a recent close-up
photograph.
- Make a list of places the person may go, such
as familiar walking routes, former neighborhoods,
places of worship, workplaces, or favorite places.
- Keep scented clothing on hand to give to police.
Wearing plastic gloves, store a piece of the
person's unwashed clothing in a bag where it
will not be disturbed. Replace it monthly to
retain the scent.
- Make a list of possible dangerous areas you
have identified in the neighborhood.
Register in the Safe Return
Program
One of the most serious worries for a caregiver
is whether the wandering person will return home
safely. The Alzheimer's Association Safe Return
program is the only nationwide system that helps
identify, locate, and return individuals with Alzheimer's
and related disorders who wander and become lost.
Safe Return provides:
- Identification products for the memory-impaired,
including a bracelet or necklace, clothing labels,
and wallet ID card. These products alert others
that the individual is memory-impaired and may
need assistance and also list the Safe Return
24-hour crisis number.
- Registration in a national database including
important information that can be accessed quickly
when someone wanders and gets lost. This information
can be critical in helping law enforcement agencies
and others in their search.
- Connection to more than 200 community-based
Alzheimer's Association Chapters across the
country that offer assistance and support. Some
chapters have scholarship programs to help pay
for the registration fee.
To register:
Complete a Safe Return registration form. To obtain
a copy, contact your local Alzheimer's Association:
call (800) 660-1993 or download
the form from the Association's Web site.
Tips to Prevent Wandering
- Check to see if the person is hungry, needs
to go to the bathroom, or feels uncomfortable.
- Encourage movement and exercise to reduce
anxiety and restlessness.
- Involve the person in daily activities such
as folding laundry or preparing a meal.
- Remind the person that you know how to find
him and that he's in the right place.
- Reduce noise levels and confusion.
- Reassure the person who may feel lost, abandoned,
or disoriented.
- Alert police ahead of time that you care for
a person with dementia.
- Make a plan of what to do if the person becomes
lost.
Additional Resources
The following materials are available
from your local chapter or the national office of
the Alzheimer's Association:
- Just the Facts and More-Wandering
- Steps to Planning Activities: Structuring
the Day at Home
- Steps to Enhancing our Home: Modifying the
Environment
- Steps to Enhancing Communication: Interacting
with Persons with
- Alzheimer's disease
- Services You May Need Fact Sheet
- Safe Return Brochure
- Alzheimer's Disease: A Guide for Law Enforcement
Officials
The Alzheimer's Association is the
only national voluntary organization dedicated to
conquering Alzheimer's disease through research
and to providing information and support to people
with Alzheimer's disease, their families, and caregivers.
Founded in 1980 by family caregivers, the Alzheimer's
Association has more than 200 chapters nationwide
providing programs and services, including support
groups, to assist Alzheimer families in their communities.
The Association is the leading funding source for
Alzheimer's research after the federal government.
Information on Alzheimer's disease, current research,
caregiving techniques, and assistance for caregivers
is available from the Alzheimer's Association. For
more information call: (800) 660-1993.
http://www.alzoc.org/support
How to Be a Long-Distance Caregiver
I am miles away.
If you are caring for someone who lives far away,
you are not alone. Currently, more than six million
Americans are long-distance caregivers.
Long-distance caregiving for someone with Alzheimer's
disease can be especially difficult. Concerns about
your loved one's safety, nutrition, health and care
may seem overwhelming. You may also feel guilty
and anxious because you cannot be there every day
to see how the person is doing. However, with the
right mix of services, ongoing coordination and
support, long-distance caregiving can work.
How can I help?
How do I know what services are needed?
Visit the person with Alzheimer's disease to determine
what kind of assistance he or she may need. Make
the following observation:
- Is there appropriate and adequate food available?
- Is the person eating regular meals?
- What is the condition of the living environment?
Has it changed?
- Are the bills paid?
- Do friends and relatives visit regularly?
- Is the person maintaining personal care routines
such as bathing and grooming?
- Is the person still able to drive safely?
If you are unable to answer these questions,
the person's doctor, neighbors, family members
and friends can be good sources of information.
How do I make the most of my visits?
Few long-distance caregivers are able to spend
as much time with their loved one as they would
like. The key is to make periodic visits and
use your time effectively:
- Make appointments with your loved one's physician,
lawyer, and financial adviser during your visit
so you can facilitate the making of important
decisions.
- Meet with neighbors, friends, and other relatives
so they can share their observations about how
the person is doing. Ask if there have been
any behavioral changes, health problems, or
safety issues.
- Take time to reconnect with your loved one
by talking, listening to music , going for a
walk, or doing other activities you enjoy together.
What support systems are available?
There are many individuals and organizations
that can help you locate and arrange appropriate
services for your loved one.
- Alzheimer's Association chapters provide information
on caregiving, referrals to local services,
a Helpline , and support groups. To locate the
chapter nearest you, call (800) 660-1993.
- Geriatric care managers can help assess the
individual's needs, identify local services,
and work with physicians, attorneys, and other
professionals to oversee and coordinate care.
For more information, call the National Association
of Professional Geriatric Care Managers at (520)
881-8008.
- Eldercare Locator is a free service provided
by the U.S. Administration on Aging to help
find local resources such as adult day programs,
respite care elder abuse/ protective agencies,
Medicaid/MediCal information, and transportation.
To learn more, call (800) 677-1116 or call your
local Chapter.
- Home health care workers can be hired to help
the person with bathing, toileting, preparing
meals, and taking medication. Call your local
chapter of the Alzheimer's Association for more
information.
- The local Area Agency on Aging (AAA) has services
to help with long-distance caregiving, such
as home observation programs. Check with your
AAA to see what programs are available in your
area.
Who else can I turn to for support?
Establishing an informal support system can
help ensure the person's safety and give you
peace of mind.
- Family members and friends can provide companionship.
Ask them to visit once a week or so, depending
on how far away they live.
- Neighbors can regularly check on your loved
one. Ask if they will remain alert to anything
unusual such as the smell of smoke or the sound
of an alarm coming from your relative's home.
- Community organizations such as churches,
synagogues, neighborhood groups, and volunteer
organizations often provide companion services.
What if I need to take time off from
my job?
Sometimes you may need to take time off from
work to resolve a crisis, accompany your loved
one to a doctor's appointment, or address a
pressing legal or financial matter.
With more than three million working Americans
caring for elderly parents, both government
agencies and private businesses are trying hard
to meet the needs of caregivers.
The Family and Medical Leave Act (FMLA) entitles
eligible employees to take up to
twelve weeks unpaid leave. Check with your employee
benefits department to see if you are covered
by FMLA. Also be sure to ask them about the
benefits provided by your state.
Should I move the person with Alzheimer's
disease to my home?
The decision to move the person to your home
is influenced by many factors. Here are some
things to think about before moving the person
into your home:
- Does he or she want to move? What about his
or her spouse?
- Is your home equipped for this person?
- Will someone be at home to care for the person?
- How does the rest of the family feel about
the move?
- How will this move affect your job, family
and finances?
- What respite services are available in your
community to assist you?
Moving a person with Alzheimer's disease from
familiar surroundings may cause increased agitation
and confusion. In making the decision, you may
want to talk with your loved one's physician
or a social worker or call your local Alzheimer's
Association chapter for assistance. In some
situations, an assisted living or a residential
care setting may be a better option for the
individual.
What if I care for a person who lives in a care
facility?
Whether your loved one lives in an assisted
living or residential care facility, it is important
to maintain ongoing communication with the care
staff and friends who visit regularly. Here
are some suggestions:
- Work with the managing nurse and physician.
Agree on a time when you can call to get updates
on the person's condition.
- Call family, friends, or other visitors and
ask for their observations.
- When you visit, meet with the staff members
who care for the person most.
What if I am not the primary caregiver?
The primary caregiver may be a spouse, sibling,
or another relative that lives with or close
to the person with Alzheimer's. As a long-distance
family member, supporting the primary caregiver
is one of the most important things you can
do. Here are some ways to help:
- Stay in close touch with both the caregiver
and the person with Alzheimer's through telephone
calls, cards, e-mail, etc.
- Recognize that the primary caregiver must
make final decisions. He or she provides the
daily care and is usually the best person to
decide what needs to be done.
- Take on caregiving tasks. You can help by
handling bills, completing insurance forms,
making phone calls, and finding out what support
services are available in the caregiver's community.
- Plan periodic visits to give the caregiver
a break. You can spend time with the individual
or run errands for the caregiver.
How do I deal with family conflicts?
It is possible that the primary caregiver may
feel resentment toward you for living far away
or believe you are not helping enough. And you
may disagree with the caregiver's decisions
or feel shut out. To minimize conflicts, try
to acknowledge these feelings and work through
them. Here are some suggestions:
- Have a family meeting. Talking about caregiving
roles and responsibilities, problems and feelings
can help ease tensions. You may want help from
a professional counselor or clergy.
- Recognize differences. Some family members
may be hands-on caregivers, responding immediately
to issues and organizing resources. Others may
be more comfortable with being told to complete
specific tasks.
- Share caregiving responsibilities. Make a
list of tasks and include how much time, money,
and effort may be involved to complete them.
Divide tasks according to the family member's
preferences and abilities.
- Continue to communicate. Periodic family meetings
or conference calls keep the family up-to-date
and involved. Discuss how things are working,
reassess the needs of both the person with Alzheimer's
and the caregiver, and decide if any changes
in responsibilities are needed.
What additional resources are available?
The following resources are available from your
local chapter or the national office of the
Alzheimer's Association:
- Respite Care guide: How to Find What's Right
for You
- Steps to Understanding Legal Issues: Planning
for the Future
- Steps to Understanding Financial Issues: Resources
for Caregivers
- Steps to Enhancing Communication: Interacting
with Persons with Alzheimer's disease
- Residential Care: A Guide for Choosing a New
Home
The Alzheimer's Association is the only national
voluntary organization dedicated to conquering
Alzheimer's disease through research and to
providing information and support to people
with Alzheimer's disease, their families, and
caregivers.
Founded in 1980 by family caregivers, the Alzheimer's
Association has more than 200 chapters nationwide
providing programs and services, including support
groups, to assist Alzheimer families in their
communities. The Association is the leading
funding source for Alzheimer's research after
the federal government.
Information on Alzheimer's disease, current
research, caregiving techniques, and assistance
for caregivers is available from the Alzheimer's
Association. For more information or to locate
the chapter nearest you call: (800) 660-1993.
http://www.alzoc.org/support
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