20: Environment Issues: Designing Safe Environments

This program will present principles and strategies for:

• Improving home safety
• Designing safe environments

• There are no easy answer when its comes to the care of another
• Our hope is to offer you useful information and guidelines for caring for someone with dementia
• These guidelines will need to be adjusted to suit your own individual needs

Aging Changes and Dementia Factors Affecting Safe Environments Aging Factors

• Decreased mobility and flexibility
• Vision loss
• Hearing loss

Dementia Factors

• Recognition declines (agnosia)
• Memory declines (amnesia)

What could be the reason for Robert’s yelling?

• A. He fell down and is in pain.
• B. He forgot the way back to his room.
• C. He wanted to go outside and became frustrated when he could not unlock the door.
• D. All of the above.

Choice A: He fell down and is in pain, is a possibility.

• Make sure there are chairs, couches, or benches for sitting and resting
• Arrange furniture to keep walkways unobstructed
• Provide good lighting without glare

Choice B: He forgot the way back to his room, is another good choice.

• Use signs to serve as cues for important places like the bathroom
• Make sure that furniture remains in the same positions

Choice C: He wanted to go outside and became frustrated when he could not unlock the door, is another possibility.

• All exterior doors should be under close surveillance and locked when the person should not be going outside

Choice D: All of the above, is the answer

• Because it is very difficult to predict what a person with dementia might do, caregivers must consider all possible behaviors
• Keep in mind that today’s modifications may work now but may not work as the illness progresses, or modifications that didn’t work today may work tomorrow

• Install smoke alarms and carbon monoxide detectors
• Cover electrical outlets
• Remove hazardous materials and poisonous plants
• Restrict access to dangerous areas (stairwells, decks, pools)
• Reduce noise distractions inside and outside
• Post “No Solicitation” signs
• Use answering machines set to the lowest number of rings
• Keep telephones, cell phones, and computers out of the way
• Password protect computer files and screen for misuse of the Internet

• Secure all doors and windows
• Disguise doors
• Hang signs that say, “STOP” or “Do Not Enter.”
• Keep a spare key hidden outside
• Disable or remove bathroom door locks
• Cover windows

Click here to learn more about home modification and safety.

• Install handrails
• Carpet or apply safety grip strips on stairs
• Avoid or tack down extension cords
• Place furniture for sitting throughout the home
• Keep walkways unobstructed
• Provide good lighting without glare
• Adjust water heater to 120 oF
• Consider installing anti-scald devices
• Install single-handle faucets
• Avoid flammable/volatile compounds near heaters
• Place red tape around objects that can cause burns
• Remove fire hazards
• Use electric blankets, pads, and sheets with caution

Why doesn’t Robert want to go into the bathroom?

• A. He doesn’t want to leave the kitchen.
• B. He has a fear of bathing.
• C. He is afraid of slipping on the bathroom floor.
• D. He doesn’t remember how to get to the bathroom.
• E. All of above.

Choice A: He doesn’t want to leave the kitchen, is a good possibility.

Choice B: He has a fear of bathing, is also a good possibility.

Choice C: He is afraid of slipping on the bathroom floor, is another possibility.

Choice D: He doesn’t remember how to get to the bathroom, may also be a possibility. Choice E: All of the above, is the best answer.

• Use color to contrast floors, walls, furniture, and different rooms
• Use different lighting to separate rooms
• Use familiar objects such as paintings to identify rooms
• Use signs and photos on walls and doors
• Use aromas to identify rooms
• Use furniture as landmarks
• Use different floor surfaces

• Provide familiar objects
• Label cupboards and drawers
• Organize and remove clutter
• Provide adequate lighting
• Keep floors clean and dry
• Keep a clear path to seating with sturdy furniture
• Provide comfortable furniture and decor

• Store dangerous tools and chemicals in locked cabinets
• Remove potentially hazardous content or latch or lock cupboards and drawers
• Remove knobs for the oven and stovetop
• Cover the burners
• Use shut-off timers on ovens and toasters
• Install locks on the stove if necessary
• Supply fire-resistant items
• Consider locking refrigerators
• Dismantle the garbage disposal
• Remove choking hazards

• Water temperature
• Sharp knives and objects
• Poisons

• Night light
• Drain trap
• Junk drawer

• Lock away prescription drugs
• Some people incorrectly believe that if one pill works, two may work better, without considering the dangerous side effects
• Organize a pill caddy
• Caregivers should control the medications

• Clearly identify the bathrooms with signs and/or painted door
• Install acoustic ceiling tiles
• Provide good lighting without glare
• Remove or disable bathrooms door locks
• Bathtubs should be accessible on at least 2 sides
• Install nonskid surfaces
• Keep floors dry
• Consider installing carpeting
• Install water-resistant surfaces
• Use color contrasts between the floor, walls, countertops, and sink
• Install grab bars
• Place rubber cover over bathtub faucet
• keep toxic substances in locked cabinets
• Remove clutter

• Cover electrical outlets
• Remove electric appliances from bathrooms
• Toothbrushes

• Try to have things that the person needs or wants close to the bed
• Provide adequate lighting for getting to the bathroom or for wandering
• Consider an intercom system
• Remove any throw rugs and other tripping hazards
• Remove any burn risks
• Remove fans if objects can be placed in the blades
• Place mats by the bed
• Get a hospital-type bed with rails
  • Get a bed that can be raised and lowered
  • Keep the bed in it’s lowest position
  • Use a proper sized mattress or a mattress with raised foam edges

• Unsafe zones
• Restrict access to tools, fluids, sporting equipment found in garages
• Restrict access to cars and car keys
• Restrict access to laundry equipment, water softener, circuit breaker, and furnace found in basements

• Outside activities can improve health and overall well-being
• If a person is inclined to wander, and the yard is not enclosed, a caregiver should stay outside with the person

• Install non-slip, glare-free walking paths
• Repair uneven or damaged walkways/surfaces
• Prune bushes and foliage
• Mark stairs and uneven edges
• Prevent confined spaces by using fencing and walls that do not completely obscure the view
• Place landmarks for entrances and exits
• Make sure all plants and materials are nontoxic
• Create an area protected from harsh weather
• Bring part of the outdoors inside

• Basic home safety measures
• Securing doors, windows, electrical outlets
• Installing smoke and carbon monoxide detectors.
• Restricting hazardous materials
• Restricting access to dangerous areas
• Reduce the risk of falls and burns, especially in kitchens and bathrooms

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

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