Home Modifications for Alzheimer's Care

Alzheimer’s disease, the most common form of dementia, poses a particular set of challenges in the home environment. According to the Alzheimer’s Association, 5.7 million Americans of all ages have Alzheimer’s disease today. Home safety issues pose dangers to people with Alzheimer’s that you or I would not generally consider. On an everyday basis, home environment also affects their quality of life. In this exclusive interview, a specialist in both gerontology and interior design gives you recommendations on home modifications for Alzheimer's care.

Alzheimer's and the Home Environment

Rosemary Bakker, MS, is a certified interior designer, dementia specialist, and former Research Associate in Gerontologic Design in Medicine at Weill Cornell Medical College. In an interview with me, she discussed strategies for reducing home risks and improving quality of life for people with Alzheimer’s disease. Bakker explains, “The environment is so important to a person with Alzheimer’s. They’re much more sensitive to their environment, so there’s a lot we can do to make it safer for them, and to give them a greater quality of life.”

Making Stairs Safer for Someone with Alzheimer’s Disease

Depth perception is a serious problem for people with Alzheimer’s. According to Bakker, “They may not notice a glass door and try to walk right through it. If there’s a low cocktail table, particularly if it’s glass, they may not even see it and walk right into it. Climbing stairs can be a really big issue because if the riser and the tread are the same color, the person may not know how high to lift one’s feet, and therefore falls can occur. It can be terrifying to try to walk the stairs.”

Color contrast: “If you’re totally redoing your stairs, you can use a different color wood for the tread than for the riser. Or you can put a 2-inch color tape or even paint – I’ve known people who have even painted stripes on their carpeting going up and down the stairs – making sure that the color of that stripe is a lot brighter than the surrounding color. That can make a huge difference in function.”
Hand rails: “People with Alzheimer’s tend to have mobility issues. It can be age related, for example arthritis, or it can be due to neurological changes in the brain. So having really good hand rails [on both sides] gives them a safe anchor to hold on to as they walk up and down the stairs. It can reduce their fear of stair climbing and it really can increase function.”

Bakker advises, “Walk up and down the stairs. Really hold on to those rails and make sure they are firmly attached. Sometimes an adult child may be visiting a parent, and they don’t use the handrails. They don’t really know if they’re well-installed or not. So try to test things out. Many handrails are just screwed into sheetrock."

The Best Lighting for People with Alzheimer’s

People with Alzheimer’s are very susceptible to glare, and to sudden changes in light levels. Bakker elaborates, “There can be a tendency to hallucinate or to see things that aren’t really there. For example, in dim lighting if there’s a large leafy plant, it may look like a person crouching."

Make sure lighting is even. "You want to make sure that things are evenly lit and that they’re not going from an overly lit room to a dark room. You really want to make sure that the lighting is kind of even. For some people with Alzheimer’s, they get afraid of dim areas.”
The best kind of lighting is glare-free: “Glare can cause confusion as to what type of surface they may be walking on, and it can also cause confusion in terms of what they’re actually looking at. So if there’s a lot of glare on a table, or there’s a lot of glare on a surface, it can distort visual perception.” Bakker recommends avoiding bare lightbulbs, and making sure that all lamps have shades.

Install more outlets: “Make sure there are not too many extension wires going across the room,” cautions Bakker. Extension cords pose a trip and fall threat to people with Alzheimer’s, but don’t let a lack of outlets limit lighting in the house. “It’s really important to get those extra outlets installed so you can plug in more lamps."

Avoid sharp changes in light levels: As we get older, our eyes change the way they adapt to light and dark. Bakker explains, “They might not see something on the ground because the person could be temporarily blinded going from a dimly lit room to a bright room, and vice versa. It can kind of blind their vision, particularly at night.”

Steer clear of bright lights at night: Besides being temporarily blinded by sudden bright light, someone with Alzheimer’s may be confused by bright lights as to what time of day it is. “So they may think, ‘Oh, the lights are on. I have to go to work.’ It can cause problems with them getting dressed at 3:00 in the morning. When you don’t understand this, you just can’t imagine that these things can happen,” cautions Bakker.

Floors Mean More When Alzheimer’s is in the House

Avoid polished floor surfaces: Polished floor surfaces cause 2 problems for people with Alzheimer’s disease. The first is perceptual issues, as Bakker describes, “Walking in a room with a lot of glare on the floor can get them confused as to where to place their foot. Make sure that the floor doesn’t look like a skating rink. I’ve actually had a few people tell me that the floor was wet, and it wasn’t. It was just that there was a lot of glare on it so they didn’t want to walk on the floor.” The second problem is that polished floors are slippery, which poses a risk for people who shuffle when they walk. Warns Bakker, “I don’t recommend polished marble or polished floor surfaces anywhere in the home, especially in the foyer and in the bathroom.”

Remove door sills: “A lot of people with Alzheimer’s start to develop a shuffling walk later on. They don’t pick up their feet enough, and as I mentioned they can also have visual issues with depth perceptions, so they might not even see the rise of the door sills. It can be a common cause for tripping. Whenever possible, I tell homeowners to take up the door sill,” recommends Bakker.

Remove area rugs: Bakker clarifies, “They pose a risk for tripping and falling, particularly if a person walks with a shuffle. Instead of discarding an area rug, they could donate it or give it away to a favorite niece or grandchild.”

Bathroom Renovations for Aging with Alzheimer’s

Bathrooms affect the quality of life of the caregiver as much as the family-member with dementia.

Install an accessible shower. Bakker mentions, “Bathing is really a big issue. If you’re planning on renovating your house, or you’re planning on renovating a bathroom, why don’t you think about taking out a nearby closet and getting two or three feet of space from the adjacent room and put in a walk-in, wheel-in shower? It will make a huge difference later on, and it’s also helpful for everyone.”

Consider sink and toilet height: Bakker suggests, “Put in a sink that you might be able to sit at. It makes it much easier to give care later on if you have either a height-adjustable sink or one that you can sit at. Higher height toilets are terrific, too.”

Keep the bathroom design simple: “It gets harder and harder for them to even remember the body movements they need to move over on a transfer bench.”

Appliances Should Be Safe and Easy to Use

Clearly mark buttons and controls: Bakker recalls an example from her own mother’s struggle with Alzheimer’s: “When she was living in a dementia-specific assisted living and it was 100 degrees in August, the head nurse came up to me and said that my mother had Alzheimer’s and could no longer use the air conditioner. I took a look and saw that the controls were in a tiny gold font on a gold background, and I could hardly see the on and off controls myself. So I printed out very large on and off labels in 20 pt black font on a white background, and for 3 more years she was able to use her air conditioner. You want to make sure that the labels are easy to read.”

Bright colors help: “If you have a very complicated microwave, you may want to highlight the instant reheat button, or whatever it is that they use a lot, with red nail polish, or you can get a type of red paint that you put on appliance buttons. You want to make sure controls are really easy to use, and if they are not, apply labels,” instructs Bakker.

Smart or passive safety technologies: Bakker suggests installing a device that turns off the stove if it senses no motion. Some devices come with a preset factory setting of six minutes, but they allow you to adjust the timer before the stove turns off. She also recommends installing an automatic fire-extinguisher under the range hood.

Outdoor Spaces for Ease of Alzheimer’s Care

Create boundaries around the home: Bakker explains, “You need to think about how you can give a person freedom within the home, but make sure that they’re safe within that home and they don’t extend far beyond a boundary when it is no longer safe for them to do so.” She advocates installing monitors on the doors that trigger a chime when needed.

Prevent trip and fall hazards: “You want to be sure that if a person does go out the door, the stairs are really safe for them to use,” Bakker cautions.

Install good outdoor lighting: Bakker emphasizes lighting the path to the front door well.

Reduce Symptoms of Agitation with Noise Control

“You want to be real careful of sound control in your environment. Be sure the person is not being agitated by really noisy dishwashers or blenders,” advocates Bakker. “That can bring on really agitated outbursts. They’re hypersensitive to sound.” Bakker cites lawn-mowers and hair-dryers as other household appliances that commonly agitate people with Alzheimer’s. “The caregiver should take a look and see when they start getting agitated. That’s key. When the person gets agitated, look what happened right before it. That’s the trigger.”

Clutter Control for the Chronic Hoarder with Dementia

“We don’t really know why it occurs,” Bakker states. “Is it neurological changes that are taking place? Part of it is just terrible confusion that they have because a lot of people with Alzheimer’s don’t quite know they have Alzheimer’s. For example, they may think that people are stealing their things if they don’t know where they placed them, and so they get paranoid and start hoarding.”

Clear clutter slowly: “Take care of the safety issues first. Make sure there’s not tons of newspaper right next to the radiator. Look at your fire issues here. Look at your fall issues. If they’re going to have a psychiatric episode if you get rid of everything, you shouldn’t. Try to box things up. Put them along the walls. Try to clear out slowly. To reduce their anxiety, get involved and give them a project to do. Usually they’re missing something. One of the best things you can do is say, ‘Can I help you find something here?’ Sometimes that helps go through some clutter.”

Send belongings to relatives: “I’ve had caregivers of people with dementia help pack up and ship boxes of things to a niece somewhere because they feel like their goods are going to be safeguarded. They’re not really getting rid of them,” she recounts.

Finding the Positive

Making the home easy to navigate, providing plenty of visual clues, and tuning into triggers seem to be the best ways to make a home hospitable for someone with Alzheimer’s disease. “There is a lot of decline with dementia, but you can help the person function better by adapting the environment to meet their unique needs. There is still growth for life and the ability to love remains,” asserts Bakker. “You just have to know how to enter the person’s world and not really resist it or challenge it. Adapting the home is key to experiencing less stress and, hopefully, a calmer day."