Help for Patients and Caregivers : Alzheimers

Safety: Steps to Enhancing Your Home
Safety: Steps to Ensuring Safety
How to Be a Long-Distance Caregiver

• 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

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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

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• 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