Mark Warner A.I.A., NCARB and Ellen Warner, M.ED.

Caring for a loved one with Alzheimer's disease may be one of the greatest challenges a family can experience. Until recently, information on how to "Alzheimer's-proof" your home has been difficult to find.

The purpose of this article is to provide information on modifying the home to care for a person with Alzheimer's. It is intended to make it easier for families and caregivers to create a safer and more sensitive home environment. We describe the steps to take and products that are available to modify your home and tackle the difficulties you may encounter along the way.

Alzheimer's affects the brain and its ability to process information -- each case is unique. You should not expect logical conclusions from a person who is losing their ability to think rationally. There are no rules and every suggestion must be reviewed in terms of your special situation, needs and abilities of your loved one.

Since each person goes through the stages of Alzheimer's at their own pace, in their own way, what works today may not work tomorrow. Locks that are effective one day may be opened with ease the next. Child-proof devices are helpful, but remember they were designed for children, not adults. The job of a caregiver is to watch, listen and constantly adjust to changes.

ADAPT THE HOME FOR ALL FAMILY MEMBERS
Approach home modifications so that all family members will be safe and comfortable. This includes the person with Alzheimer's, the caregiver(s), the rest of the family and visitors. We recommend that you identify the following three areas:

AREA ONE: THE DANGER ZONES
Two areas of the house are "out of bounds" to the person with Alzheimer's disease.

Area One consists of rooms such as the garage, basement and closets where breakable, dangerous or valuable items have been stored. Doors leading to these restricted areas and to the outside should be locked, alarmed or controlled by wander-prevention devices.

AREA TWO: THE RESPITE ZONE
The second restricted area is dedicated to the caregiver. Anyone caring for someone with Alzheimer's should have a "respite zone." "Burn out" is a big problem for caregivers and there needs to be a place where one can get away, relax and have time alone while someone else provides care.

AREA THREE: THE SAFE ZONE
Finally, the remainder of the home should be accessible to the person with Alzheimer's disease. In this area it is okay to roam, rummage and hide things. "Child-proof" plug outlets and remove medicines, dangerous tools, appliances and chemicals, as well as important documents, bills and valuable/breakable objects.

INSIDE THE HOME
Safety-proofing the home is critical and you will need to examine every situation thoroughly. Remember that eventually people with Alzheimer's lose their ability to think rationally. For example, an electrical plug may appear to be a curious hole to explore or hide something, like a paper clip. Even an aquarium that combines water and electricity creates a potentially deadly situation.

Secure the windows and balcony doors if you live on an upper floor. Often the person you are caring for does not realize that they live on an upper floor even if it is obvious to you. Easily installed, inexpensive window clamps are available at most hardware stores and will prevent a window or sliding door from opening wide enough to allow a person to walk through.

Remove both toxic and seemingly harmless products that, if eaten in excess, could cause illness - items like toothpaste or sweeteners. Keep sharp utensils and electrical appliances out of reach. Disconnect the garbage disposal, a popular spot to hide things.

Your entire home should be well lit to help the person with Alzheimer's see where they are going. This is especially important for "dead-end" corridors that are often dark and shadowy. An Alzheimer's sufferer may not realize how to turn around and come back.

Lower the thermostat on your hot water heater to its lowest setting or no higher than 120 degrees to prevent accidental burns. You can also install inexpensive anti-scalding devices on the faucets of the sinks, showers and bath tubs.

Install a seat and a hand-held showerhead in the bath or shower. Showerheads with "on-off" buttons at the hand-held portion offer better control for dealing with fears of water or bathing. Grab bars and non-slip bath/shower mats are also advisable. Remove all electrical appliances from counters and the control knobs from the stove, oven and inside the refrigerator.

If falling becomes a problem, place furniture to provide support when traveling through a room. Remove furniture that rolls, falls over easily or cannot support a person's weight. Eliminate throw rugs and low furniture, such as small ottomans or magazine racks, that can cause falls or trips. Remove furniture that is hazardous or difficult to see, such as the ever-popular glass table and glass shelving. Watch out for extension cords and telephone lines that may be tripped over, snagged or walked into, pulling an attached lamp or appliance to the floor.

DOORS
For doors that lock from the inside, such as the bathroom, either remove the lock or keep an emergency key nearby. For the front door, have an extra key well-hidden or give one to a trusted neighbor for emergencies.

YOUR BACK YARD
Safe-proof your yard as well. Identify and remove dangerous plants in your yard and home that can be eaten or cause injury. Most yards are landscaped with little or no thought to the toxicity of the plants selected. A simple call or visit to your local poison control center will help you identify the dangerous ones. Move thorned plants that can physically hurt, such as rose bushes or cacti. Make sure your yard is enclosed with a fence not easily climbed and there are locks on the gate.

WANDERING
Wandering is a serious problem. There are significant differences for dealing with nighttime and daytime wandering.

Night wandering presents unique challenges. While caregivers are asleep, it is easier for a person with Alzheimer's to wander off unnoticed. Place a simple door alarm on the knob of the bedroom door. If the knob is turned, the alarm will sound and alert the caregiver that someone is on the move. With these alarms in place the caregiver can safely and comfortably get a good night's sleep knowing that movement will not go unnoticed. (Test the alarm to make sure the caregiver can hear it from their bedroom.)

Daytime wandering often involves a continuous "wandering path" that can be a source of stimulating and healthy activity. Look for such opportunities in your home and back yard often they are created for you.

Remember to remove low furniture and anything that your loved one might trip over, bump into or knock over. Don't overlook higher shelves or wall-mounted fixtures along the way. While the same rules apply to outside paths, it is also a good idea to trim shrubbery and remove any items that prevent a full view of the path.

PATTERNING
People with Alzheimer's often develop patterns or repeat activities that they find comfortable and enjoyable. By observing their movement around the house you may notice early clues to wandering paths and places where your loved one feels safe. Once these more regularly visited areas become apparent, check them carefully for potential problems. Make sure they are safe, interesting and offer familiar items your loved one will recognize and enjoy.

SIMPLIFY DECISIONS
At the onset of the disease simplify every facet of your loved one's environment. Remove clutter, create predictability and simplify choices. Instead of six boxes of cereal in the cupboard, have two. Survey your home for any potentially agitating situations. It is important that your home is a calm, safe environment that encourages decisions and tasks that can be completed successfully.

Place large, easy-to-read signs or pictures cut out of magazines on cabinets and drawers to illustrate the contents. Turn this into a family project and make it fun.

ALZHEIMER'S IS A PROGRESSIVE DISEASE
Modifications and precautions, appropriate in the earlier stages, may or may not be appropriate for the middle or later stages. For example, mirrors are important to encourage your loved one to continue grooming for as long as possible. However, in later stages many people are confused and agitated by reflections in mirrors even their own. You will want to remove or cover mirrors if this becomes a problem.

STORAGE FOR CRITICAL SUPPLIES
As the disease progresses the world shrinks for the Alzheimer's sufferer. More and more time is spent in fewer and fewer rooms. Before this happens, it is important to move supplies and frequently used items to these rooms, close to where you may need them in times of crisis.

Caring for someone with Alzheimer's disease is an enormous challenge. Nevertheless, for many families, keeping their loved one at home is rewarding and well worth the challenge. Contact the Alzheimer's Association at 800-272-3900 for the number of your local chapter. Get involved in a support group and share your ideas with other caregivers.