Locks and Wandering (Part 1 of 3)

(The first in a three-part series of articles.)
by Mark L. Warner, AIA

This is the first in a series of three articles on home modifications to help caregivers manage loved ones who are prone to wandering. This article will be devoted to locks, while the second will be on alarms and other means of alerting caregivers about attempts to leave home. The third article will be on unconventional devices to prevent wandering, such as diversions and deterrents. We would be very interested in hearing your comments and suggestions for future articles.

Wandering occurs for many reasons and imposes many dangers for those with Alzheimer's disease (AD), who may stray out of the house or fall as a result of merely trying to get out of bed. We are often asked to recommend products and strategies, and thus we decided to make it the topic for this month's newsletter.

While there are many types of devices and companies, each situation is different. People change from day to day and from stage to stage. And to make matters worse, what works for one person may or may not work for another.

"When you've seen one person with Alzheimer's Disease,
You've seen one person with Alzheimer's Disease!"

Installing locks, even for the safety and well-being of someone you love, is a very delicate subject. Not only does it prey on our souls to "lock our loved one in their own home," but there are also considerations in case of an emergency; for example, have the exits been dangerously sealed?

But the rhetorical question must still be asked: "Is it more important to keep the door locked for my Dad's safety, or unlocked in case there is a fire?" The question is soon answered the first time he becomes lost or darts out of the home in search of another.

Locks are the first and most important barrier necessary to prevent a wandering-prone loved one from leaving the safety of home.

Leaving Home

By far, the most serious danger posed in the earlier stages of the disease is when Mom or Dad may decide they want to go for a walk, go searching for "home," or maybe just walk outside to get the paper. When they turn around, the home they expect to see is gone and they find themselves standing helplessly in front of a residence that is totally unfamiliar to them. Too many people with AD have found themselves in exactly this situation, only to wander the streets in hope of finding the ever-elusive home of their past. Others may be trying to escape imagined abusers or an unfamiliar person looking back at them from the mirror, but whatever the reason, leaving home also means leaving the safety and security that also resides there.

Locks

The most common and obvious strategy to prevent a confused family member from opening an exit leading to the outside is to lock it. First take a look at all of the opportunities and avenues for escape from your house. Not only do we have doors, but we also have windows, sliding glass doors (sometimes leading to balconies), and the often overlooked garage door. People who are convinced that terrible things are happening in their home have been known to take extreme measures to escape them, including going over balconies, through windows and over fences. At some point it may become necessary to install locks (and alarms) on doors, windows and sliding glass doors leading out of your home. Remember, the alarm will sound only if the lock is opened.

Hide the Locks

The next strategy is to make sure your loved one cannot unlock the door. However, you do not want to create the feeling in your loved one that their home is a prison. Your family member may have lived in this very home for fifteen years or more without limitations upon where it was possible to go or what it was possible to do. Now the discovery that their very own front door is locked to keep them inside might understandably result in anger or upset. Imagine how this might contribute to delusions of being in jail or trapped in their own home.

Among the tricks to consider when installing locks is to locate them in places where your loved one is less likely to notice them. Remember the old adage:

"What you can't see (modified from ‘what you don't know') can't hurt you."

Many people with AD seem to have a form of tunnel vision. In other words, they see only what is immediately in front of them, not things in their peripheral vision. They often don't think to look up high or down low, for example. As a result many caregivers choose to place locks in the upper or lower corners of doors.

Use More than One Lock

Next, take advantage of the disease. Alzheimer's affects the way your loved one thinks. Unlocking a single lock may be difficult, but to open two locks is even harder and more time-consuming. Furthermore, one lock is either "locked" or "unlocked." Two locks require the right combination (unlocked/unlocked) to successfully open the door. The remaining three combinations (locked/locked, locked/unlocked and unlocked/locked) all result in a door that will not open.

Different Kinds of Locks

As you may have guessed already, a combination of locks should be used. Different types of locks that require different skills to open may be too complicated for your loved one to figure out. And the time spent trying to unlock them is more time allowing the caregiver to discover the loved one involved in this dangerous activity.

So Many Locks

This could be the lyrics for a song. " You've got slide bolts, dead bolts, hook & eye latches, . . . " A mere trip to the hardware store or your home improvement center is sufficient to convince even the most diehard skeptic of the many ways one can lock a door or window.

Hook & eye latches and slide bolts are among the most common, simple locks for a door. Today, with a little investigation at the store, you can find hook & eye latches that have a spring-loaded catch that makes this simple-to-open lock surprisingly more complicated. Now, you don't merely slip it out of the eye; you also have to pull back the safety catch.

Dead bolts are among the most secure locks. Some are operated by keys and others by knobs that turn. One very serious warning here is that in case you do choose a keyed dead bolt, remember that keys can "disappear." If there is ever a fire in your home, there won't be time to go looking for the key.

The good news, however, is that there are lots of creative solutions. We have heard stories of caregivers who have made several spare keys. One caregiver slept with the key attached to a bracelet on her wrist, while another kept several keys in prime locations (reasonably close to the door). The assumption here was that their loved one was no longer able to make the connection between the remote key and the locked door. Another caregiver kept a key several feet from the door, but on an elastic string that easily stretched to reach the door, while another family stored the key on the ledge (or hook) over the door. Please be very careful with these strategies. As important as it may be to prevent your loved from wandering away from home, lives have probably been lost struggling to find these keys in the chaos of a fire.

Sliding Windows and Doors

Sliding windows can be locked with inexpensive clamps, dowels or bars placed in their tracks that limit how far they can be opened. These devices can allow the window to be opened wide enough to let in a breeze, but not wide enough to enable a person to crawl out.

You can also use pins designed to lock sliding glass doors, available at most home improvement centers. Have a professional install them. You need to avoid breaking the glass and to ensure that the pin is installed at a slight downward angle so that it won't fall out over time or as the result of vibration (if someone shakes the window or door out of frustration).

Just In Case

Despite our best attempts, sometimes we are outsmarted by our loved ones. It seems that it only takes a second for even the slowest, frailest, most confused person to be blocks down the street, without anyone having noticed. In these cases, additional precautions should be taken.

The Safe Return Program

The Safer Return Program, sponsored by the national Alzheimer's Association, offers families a bracelet or necklace that will identify their family member and alert police and rescue personnel. Your loved one will have her own identification and emergency phone numbers filed to notify you and help return her home. This program has saved countless lives and is a very wise step, if and when wandering or leaving home becomes a concern. For more information call (800) 272-3900 or go to Safe Return registration form.

Notify your neighbors and the children who play outside. Let them know of your concerns and ask them to come get you if they ever see your family member outside alone.

Keep a full tank of gas in the car and fresh clothes on a chair at night just in case you have to go on a quick search of the neighborhood.

Again, more than one strategy is key. Once you've identified the dangerous exits from your home and installed a lock on them, the next step is to alert yourself in the event they are being tampered with. This involves some kind of alarm; that will be the subject of next month's article. Your homework for this month is to identify the exits and install locks. Next month you will get a new assignment!

Remember, there is no guarantee that all of these strategies will work for everyone, all of the time. Keeping a close eye on your loved one is still the best plan. There is no substitute for good caregiving!

Useful Products

Hook & eye latches -- your local home improvement center or hardware store

Slide bolts -- your local home improvement center or hardware store

Dead-bolts -- your local home improvement center or hardware store

Sliding Glass Door and Window Pins -- your local home improvement center or hardware store

You may also want to call your local locksmith to make recommendations in your home about hard-to-lock doors and windows. A locksmith is also the perfect person to install these devices.

Mark Warner, AIA is a registered architect, gerontologist, author and international speaker. He is the author of The Complete Guide to Alzheimer's-Proofing Your Home, the first book in the Homes That Care series on age-related conditions and how to create homes for those suffering from them. His firm, Ageless Design, Inc. offers consultation and assistance in the design of environments for seniors. For more information please visit his web site, call (561) 745-0210. We would like to hear from you.  E-mail Mark at Ageless Design

Additional Resources

Other Home Care & Independent Living Articles
Other Alzheimer's & Dementia Care Articles
Ageless Design Website
Best Book: The Complete Guide to Alzheimer's-Proofing Your Home, Mark Warner, Purdue University Press, West Lafayette, Indiana, 1998.

Ageless Design, Inc., 1999. All Rights Reserved.

Available from ElderCare Online™             www.ec-online.net             1999 Ageless Design, Inc.