Seniors For Living

Second in a series of four; read part 1: Creating a Dementia-Friendly Home: Setting a Firm Foundation

Getting back to the simple yet complex question of “where does one begin?” we look again to the Alzheimer’s Association. Here are five simple steps to begin the process of creating a dementia-friendly home:

1. Assess your home: Look at your home through the eyes of a person with dementia. What objects could injure the person? Identify possible areas of danger. Is it easy to get outside or to other dangerous areas like the kitchen, garage or basement?
2. Focus on adapting rather than teaching: Avoid trying to re-teach the person about safety. Instead, identify possible risks and take precautions.
3. Simplify the activities: Most accidents, especially in the area of personal care, occur when the person is rushed. Break up activities into simple, step-by-step tasks, allowing the person plenty of time to get tasks done. Give extra help with tasks that have become hard to do.
4. Support the person’s needs: Try not to create a home that feels too restrictive. The home should encourage independence, social interaction and meaningful activities.
5. Be realistic about what you can do: You can’t prevent every problem. Rely on your common sense while paying close attention to objects or activities that could be dangerous.

Keeping these principles in mind will be critical as environmental, emotional, and other unexpected barriers present themselves. Building a home requires careful planning and meticulous craftsmanship; creating the home to adapt to your loved one’s ever-changing needs is the same.

A personalized action plan – your own blueprint – is highly recommended by professionals like Catherine Verrier Piersol. Piersol, MS, OTR/L, serves as the Clinical Director for Jefferson Elder Care and the Jefferson Center for Applied Research on Aging and Health (CARAH). She is also an Assistant Professor for the Department of Occupational Therapy at Thomas Jefferson University.

“We (at CARAH) have developed a standardized approach to prevent certain problems from occurring within the home,” says Piersol, who firmly believes that negative outcomes such as wandering can be prevented if this proactive approach is taken.

Piersol and the team of experts at the Living Laboratory, which is housed in CARAH and serves as a venue for hands-on research and interventions, work with clients to create a strategic, problem-solving approach that identifies antecedents to behavior (triggers). The team considers what the individual’s trigger might be before anything happens, then seeks a way to make the environment conducive to prevention.

A common trigger is boredom; in this case, Piersol and her team would help caregivers figure out what type of activities will engage the care recipient. Knowing the trigger can change the consequences of the behavior – all before the problem actually occurs.

If the person is prone to wander, for instance, alarms on doors is one possible solution. A creative approach: Cover doors that lead outside with a mural that looks like a bookcase (The Alzheimer’s Store is a good source for such creative equipment for home adaptations), or even a simple stop sign, which is easily recognizable to a PWD. Meredith Gordon, safety expert for the Alzheimer’s Association, recommends placing a small black area rug in front of a door; the person with dementia may see it rug as a black hole and give up on that exit.

According to Piersol, there are four key elements (explained in greater detail in a podcast on the CARAH website) that support an action plan and encourage its success:

1. Create a clutter-free environment (remove misleading stimuli; minimize background noise such as the radio or TV; put items away when you are finished using them, etc.).
2. Communication strategies: the caregiver’s reaction and approach (both verbal and non-verbal) can change everything.
3. Simplifying tasks: for example, if the PWD is having problems brushing his teeth, you may just need to model the action first, or prepare the toothbrush with water and paste before handing it to your loved one.
4. Engagement in activities is crucial to preventing boredom, depression, and agitation.

Almost all of the CARAH team’s interventions with elderly clients are done in the home or community setting. “Our approach for working in the home also takes in the unique cultural environment,” she adds. This is important, because it will help reduce the care recipient’s agitation if the spirit of your home remains intact even as changes are made to ensure safety.

Although my grandfather was limited to a hospital bed in his master bedroom during the final months of his battle with Alzheimer’s, our family had done their best to keep the spirit of the home intact in that small space. Several of his favorite woodcarvings, postcards from the grandchildren, and pictures of family members and his childhood home in Norway were hung within his line of vision. The inevitable collection of disposable undergarments, medications, and rubber gloves was difficult to avoid, as these items needed to be handy, but there were enough warm, sentimental items to keep it from feeling too much like a sterile hospital room.

Although it took a few arrangements before all were reasonably happy with the outcome, it was well worth the effort. Remember, flexibility is the cornerstone of this building process and it takes a village to do it.

-Michelle Seitzer

Next installment -Meaningful Activities