The Home Environment

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In this section we cover how the home environment might be changed a little to improve the wellbeing of someone with dementia. Do also read our section on how the home and garden can be improved from a safety point of view.

Whilst we give many tips here, try not to change your loved one's environment unnecessarily or by too much at once, as this could make their home look unfamiliar - which is obviously unsettling. Someone with dementia may be able to use something they're familiar with, but find a new 'simplified' replacement bewildering. Changes may need to be more gradual the more advanced dementia is, and equally in the very early stages of dementia it's worth considering making changes ready for the future. If you live a long distance away and can't visit frequently, then as far as possible make changes at the start of a long visit, so that you can see whether any of them turn out to be unhelpful and need to be reversed (though obviously while you're there you can help explain the changes and see whether that cures the problem).

An occupational therapist may be able to help further, both with suggestions for improvements to the home environment and with provision of loan equipment or access to funding.

Access to drink

We take it for granted because it isn't a difficulty for us, but for someone with dementia it may not be obvious how to get their favourite drink and something to drink it from, or they may forget they need to dilute squash. It's very important to have easy access to drink, to avoid dehydration. Consider having cups of ready-diluted squash available, or labelling where to get a drink.

Emergency Call, Fall and GPS Tracker Systems

See our section on emergency call, fall and GPS tracker systems. This includes making sure these systems aren't prevented from working by the telephone.

Video calls / phones

See our section on video calls, & phones, which includes the following:

devices for receiving video calls without having to press any buttons
easy to use telephones with picture button calling
making sure landline phones are put back on the hook.

Lighting

Good lighting is important from several points of view, noting that old folks are only a third as sensitive to light as younger people (but don't make lamps unpleasantly bright or dazzling to them). It might also help with day/night sleep patterns (though there is no magic cure), and for this it's also worth trying the new whiter 'daylight' bulbs in the day rooms and slightly orange 'warm white' bulbs in the bedroom, as explained below.

Poor lighting can be a safety issue, with unseen objects being tripped over, and it can also make objects hard to find or cause shadows that seem menacing. Also, if the room looks gloomy it can make you feel gloomy.

Bulbs - daylight white vs. warm white, and LEDs

Old incandescent bulbs, and most fluorescent bulbs, tend to produce a slightly orange light ('warm white' or approximately 2700K), whereas LED bulbs are available in this or in a whiter light that is nearer to natural daylight ('cool white' or approximately 6000K). The extra blue component in these 'daylight' bulbs helps tell your body clock that it's daytime, and so are better for the day room, whilst the 'warm white' bulbs might be better for the bedroom if there are sleep issues.

LED bulbs are also available in brighter versions. Whilst they're more expensive to buy, they're more efficient and the electricity saving makes them cheaper in the long run. They don't get hot, and are plastic rather than glass, making them safer.

We would very strongly advise you not to buy LED bulbs that aren't made by a well known brand or that don't come from a reputable supplier - they often don't work on first use, or fail early - either giving no light or blinking on and off. 'Energizer' brand bulbs are the best we've found, though still not perfect - say one or two in ten may fail early. Always keep spare bulbs somewhere safe (to be fitted by a carer), whatever type you use.

For the bedbound

For people who are bedbound during the day (most likely in a nursing home), a floor standing uplighter is much better than a ceiling light that shines directly in their eyes. A dimmable one is recommended, and an LED bulb is much better than the old halogen ones which can generate a tremendous amount of heat in the summer, and which use ten times the electricity.

Motion sensor lights

Some organisations recommend lights for corridors and toilets activated by a motion sensor, in case someone gets up at night to go to the toilet and can't find the light switch. Our concern would be that such a light coming on would mean the person wouldn't switch on the main light as they otherwise would automatically, and once motion stops and a timer runs out then the light will go off again, when the person doesn't understand why, is far from the switch, and won't have the automatic prompt of passing the switch. Of course if they move again and are still visible to the sensor then the light would come on again - there would need to be more than one sensor near stairs. There is also the potential for the person to be worried they can't turn the light off. We can only recommend weighing up the pros and cons for your particular case.

Room temperature

Someone with dementia or poor mobility may be unable to control their own body temperature by adjusting clothing or room heating. In our section on their body temperature we include the following issues relating to the room:

having shawls available during the day, and bedclothes layers the person can roll up or down for themselves at night
central heating settings at night
central heating can be controlled and monitored remotely via the internet by retrofit systems
the heat from direct sunshine through windows in the summer
having an electric fan ready for hot days in the summer.

Consider whether spare rooms, particularly bedrooms, should be heated in case the person with dementia gets lost and spends time in them.

Fresh air

It's important to ensure that the house is sufficiently well ventilated, otherwise breathing the same air all day can result in sleepiness during the day, headaches, or increased confusion etc.

Whilst you want to avoid windows being open enough for a burglar to get in, modern windows have a position where they can be fixed slightly ajar but not opened from the outside. For old-style windows, consider installing a 'window limiter' / 'window restrictor'.

Make sure there isn't a draught, especially where chairs or beds are.

Bed and bedroom

In our section on sleeping we include the following issues:

checking that the mattress and pillow are comfortable
considering a pressure relief mattress topper
using 'blackout' curtain linings and/or a valence or pelmet to prevent light getting through the curtain and triggering the person to get up too early.

Have a pillow of the right thickness for the person, but adjustment can be made, especially for someone sitting up in bed, by putting a folded shawl under the pillow. Don't use a small item that could work loose from under the pillow.

Chairs

See our section on preventing pressure sores for information about pressure cushions that can avoid discomfort and serious health problems. Obviously check that chairs are comfortable.

In our section on standing up from a chair we include the following issues:

correct height of the seat
depth, from the front of the seat to the backrest
chair arms as an aid to standing
standing aids
a lifting cushion to aid standing.

Toilet / Bathroom

Standing up from a toilet

There are two aids for standing after using the toilet: the height of the toilet seat can be increased by attaching a 'raised toilet seat', and a 'toilet frame' can be used to provide an arm each side of the toilet to push up with - see our section on standing up from a toilet.

Shower and bath aids

There are many different types of aids to make showers or baths easier and safer to use, such as non-slip mats, grab rails, shower seats, bath steps, bath boards etc. Since manoeuvering over the side of a slippery bath is potentially very dangerous, and people's abilities vary widely, we feel that it's best for an occupational therapist to advise on the aids that are most suitable for your particular needs.

Tap turners

If the person has difficulty turning taps, there are aids that fasten to the tap and have a hand-length lever to turn, although you may need to check they understand how to use them (consider making a label if necessary).

A selection of these is shown on the Complete Care Shop website, under bathroom tap turners. (We don't receive any money for mentioning this shop - but we have used them and do find their range useful.) Also see the Living Made Easy website, under at home - household - tap and knob turners (note that the different products aren't ranked or rated, and you should check that any supplier listed is reputable).

Room layout

Whilst it's preferable not to rearrange the layout of rooms unnecessarily, to avoid them seeming unfamiliar, it's worth considering whether the chair that's mainly used is in the best position. Things to consider are:

the view of the things of interest (such as the television without the sun shining on the screen, or of the window and any bird feeder)
the view of how to get to the toilet or back to the bedroom (especially if they get up at night) etc
access to the telephone
not tripping over electrical leads, phone cables, television aerial cables etc
room to manoeuvre a walking frame
being able to avoid having the sun shining directly in your eyes (bearing in mind it will move round during the day)
whilst being near a window in the sun can be nice, in the summer direct sun can be very warming so shade should be available
avoid placing two chairs side by side at the sort of distance apart that the gap between them might be misinterpreted in poor light or by someone with poor eyesight as a chair with arms that in reality belong to the chair on each side.

That's obviously a long wish list of potentially conflicting requirements, so you'll probably have to make compromises.

Care homes sometimes slide a 'cantilever' table into the seat of an empty chair, to save space. If there aren't enough empty chairs nearby then this may cause someone to try sitting on the table.

Signs, labels and talking buttons

It can be very useful to have signs on things (e.g. on the toilet door) and to things (e.g. the way to the bedroom), and labels helping how to use things (e.g. the telephone).

It can also be reassuring to have a simple reminder of what will happen in the day, for example to say that a carer will come to cook lunch and tea, or to say that you phone them however many times it is every day. If they worry they've forgotten to do something, the reminder could say there's nothing they need to do - they can enjoy some music or watch the television.

'Talking buttons' are available (see below) that can play a short message you've recorded.

Don't overdo it

Avoid the temptation to label everything regardless of whether it's been found necessary, as the result will be too overwhelming.

Also be aware that it's possible for signs to make someone go over to the sign to read it frequently (especially if it's too small to read from where they sit), when they had no present need for the thing being signposted.

Where to put a reminder

You may need to try putting a reminder in different places and see which works best. For example, a reminder that you phone them every day might be better by the phone, or it might give greater reassurance by being visible from where they sit in the living room. A reminder that a carer will come to cook lunch and tea might be best in the kitchen.

In addition to signs on toilet, bedroom and kitchen doors, consider whether or not it's necessary to label cupboard doors to make cups etc easier to find without rummaging through the first cupboard they come to. It's probably best not to label and draw attention to cupboards you don't want them going into.

Buying or making signs

Whilst there are commercially available signs for things like toilet doors, showing an outline of a toilet, you can easily make all your own signs on a computer, using free clip-art from the openclipart.org website or elsewhere. Also see the next subsection for arranging arrows and text within a sign.

Some good signs are available in the UK from the Alzheimer's Society shop, under helpful products - signage.

Signs pointing the way

For signs pointing the way to things we recommend using a solid black arrow with white text on top of the arrow itself, since text next to the arrow might be misinterpreted as being the place itself rather than the way to the place.

Consider whether you might need an additional arrow pointing the other way on the other side of the place being directed to, if necessary to avoid someone continuing in the direction of the last arrow and looking for the next one.

If you have Microsoft Word you can create an arrow easily by selecting the series of menus Insert/Shapes/Block Arrows, and this has the advantage of being able to move parts of the design around later. Alternatively you could use a graphics program like Microsoft Paint, although in many of these you can only edit the part of the design you're currently adding.

Instructions with steps

When a reminder is needed for how to use something, for example a telephone, make sure the instructions are short, are made up of separate steps, there's a reasonable space between each step (but not too much so that they may miss the continuation to the next).

Make sure the text is large enough for the person to read easily.

Check that they're able to understand the directions, and modify them if necessary.

If possible stick the instructions down so that they won't be moved away from the thing they're about (and it's a good idea to have a spare or two printed out and kept somewhere so that a carer can replace a lost one).

How to stick signs and labels

'Blu Tack' is useful for sticking paper labels to a wall and repositioning them - avoid reusing old dirty pieces, but even fresh pieces age and can leave slight marks on the wall.

If you use tape then we recommend 'Scotch Magic Tape' rather than Sellotape or other brands, as it peels away more cleanly - though of course all tapes can damage the surface.

Talking buttons

Talking buttons are useful when a recorded voice message is easier for your loved one to understand than reading printed instructions, or when the sound of your voice is more reassuring. However, when a series of steps must be given printed instructions will be easier to follow one by one.

There are many varieties of talking button available from online shops such as Amazon and eBay, and often there are multi-packs that are cheaper per button. Check the recording time available as it varies quite widely between different types.

A good choice is called 'Talking Tile', because it has a clear removable cover that allows you to put your own photograph or label inside, and it can record for up to 80 seconds.

Don't forget to keep spare batteries, and if necessary a small screwdriver so that a carer can open the battery compartment to replace them.

Light switches

Whilst not wanting to make unnecessary changes that could make things appear unfamiliar, if your loved one has difficulty seeing a white light switch on a pale wall you could consider fastening a coloured border around the switch (we'd suggest doing this on the wall rather than on the switch itself, to avoid changing the appearance of the switch). Aim to use the same colour border in all rooms.

Bathroom light pulls are usually easy to replace with a larger and more colourful pull knob if necessary - simply undo the knot the existing pull knob sits on, swap over the knobs and reknot.

Day/Night clocks, talking clocks and watches

Day/Night clocks

The best clock we've seen for displaying whether it's day (and morning, afternoon or evening) or night is called the 'Day and Night Clock' and is available in the UK from the Alzheimer's Society shop, under 'day and night clock'. We don't recommend children's 'sleep trainer' clocks, which use a more abstract system based on stars, moon and sun.

Talking clocks and watches

For someone who's unable to read a clock, there are several talking clocks and watches available on the market. These can be as simple as a large button that speaks the time when pressed (you may need to label it so they know that's what it does), or a clock with a button on top. Devices such as this can have mixed results with different people - but if you find it useful then we'd strongly recommend having one by the bedside as well as one in the day room, otherwise your loved one may get up in the night just to consult the day room clock.

Unfortunately, many of these clocks have features we don't like, so study their details carefully - for example the first press may give the time but then the second press may give the date; or there may be an alarm set button that could be confused with the talking time button and result in an alarm being set by mistake; or a twenty four hour clock may be used or else it may not be clear whether it's am or pm.

A selection of these products available in the UK is shown on the Complete Care Shop website, under daily living - big digit & talking clocks and the Complete Care Shop website, under medical supplies - sensory aids - big digit & talking watches , and for those outside the UK this may give you some ideas and product names to look for. (We don't receive any money for mentioning this shop - but we have used them and do find their range useful.) Also see the Living Made Easy website, for 'talking clock' and the Living Made Easy website, for 'talking watch' (note that the different products aren't ranked or rated, and you should check that any supplier listed is reputable).

TV remote controls and channels

Limiting the channel list

It's useful to go into the TV or set-top box's menu and limit the channel list to ones that are of interest.

Big button remote controls

Various 'big button TV remote' controls are available - for dementia the ones with the fewest controls are the best - i.e. on/off, volume up/down and channel up/down. Consider sticking on better labels if necessary.

If you use a separate set-top box

Note that if a separate set-top box is used then most big button remote controls won't cover turning both that and the TV on/off (and may not cover turning the TV on/off but changing the set-top box's channels). However, the 'Flipper Big Button Remote Control' handles this from a single button, when set up by a capable person, and is available on the AlzProducts website or the Amazon website. (We don't receive any money for mentioning these shops.)

Clutter

As noted in more detail in our section on trips and slips, clutter on the floor is obviously a trip hazard, but also clutter in a cupboard or on a table could end up spilling onto the floor too.

Also consider whether the visual impact of clutter on shelves or in cupboards and wardrobes could be confusing to look at or make it more difficult to find an item wanted. You'll need to be careful not to make the area look unrecognisable to them, though, or to take away something it turns out they cherish or use and will go hunting for - it's best to involve the person in the decisions of what to tidy out of the way, and to keep things somewhere safe until you're sure they're not wanted or missed.

Items on the wall

Mirrors

Some people with dementia might potentially find a wall mirror such as one in the hall confusing (perhaps including not recognising the old face in the mirror as theirs). We wouldn't suggest removing mirrors unless they're found to be a problem, but you could consider putting a label 'mirror' across the top if you think it could be a problem.

'Busy' paintings and patterns

If a person's eyesight is poor (for example they don't use their glasses) or the room isn't well lit, paintings or printed curtains might potentially be confusing, too 'busy' or may be unsettling in the half-light. They may make the person frequently get up and walk over to them to see what they are.

If you find that's the case you could try replacing them with simpler ones that are identifiable from a distance, ideally letting your loved one help choose the new ones. (If you replace curtains keep the old ones just in case the change proves to be unsettling, and make sure they're easily distinguishable from the walls without being so distracting that they become a focus of attention.)

Making simple wall art

For later stages of dementia, simple wall art can be created from coloured card, for example by taking sheets with different colours, cutting each into a square and sticking them next to each other to form a rectangle (avoid oddly shaped outlines that don't look like a picture). There are also many photos available on the internet of things like a sea of flowers that you could print out (subject to copyright).

Photos

It's also nice to have photos of loved ones' faces in the day room (or in an album if in a care home). We'd avoid putting new photos in the bedroom, unless in a care home so there's nowhere else to put them, in case they're mistaken for real people in the dark. We'd suggest adding a big label with their name, and perhaps their relationship e.g. '(SON)'. Having a frame line around the photo might help avoid any confusion with a real person, but avoid a black frame line in case it's thought to denote they've passed away. Be careful in case a photo of a loved one who has passed away may upset them.

Attaching things to walls

We've already mentioned 'Blu Tack' and 'Scotch Magic Tape' for sticking very light things such as card or a photo print to a wall and repositioning them, but for heavier items '3M Command' strips and hooks are useful as you don't need to nail into the wall. Note that they can't be used on papered walls or rough surfaces, the wall must be cleaned with rubbing alcohol (isopropyl alcohol / isopropanol) not a general cleaner, also each strip has a stated weight limit, and whilst the whole thing can be removed from the wall it can't be re-used without a refill strip. Alternatively if you use nailed-in picture hooks make sure there aren't any electrical cables, gas, water or heating pipes etc in the wall. Don't hang anything heavy over a bed or chair.

Spare items

Make sure there's a good supply of spare items, accessible to the person and/or the carer as appropriate, for things like:

toilet rolls (at least one spare in the bathroom, and others stored elsewhere)
light bulbs of all the required types
batteries for hearing aids, smoke detectors, carbon monoxide detectors, heating thermostats, doorbell, clocks, talking buttons, remote controls, torches etc, and any small screwdrivers needed to open battery compartments (not accessible to someone who can't change them)
wirebound notepad and pen
plasters and first aid items
other general supplies such as handwash, shower gel, shampoo, deodorant, toothpaste and brush, tissues, kitchen rolls, bin bags, cleaning products, washing-up liquid and scourers, dishwasher detergent, salt and rinse aid, clothes detergent etc. (Make sure that chemicals are kept safely, to prevent them being mistaken for drink or food - consider keeping them in a cupboard with a child-proof lock.)
bird food (not accessible to someone who might mistake it for food).

Notepad and pen

A notepad and pen is useful for someone with dementia to make notes of things they want to ask when they see you or a carer. It can also help you to see what issues they face when no-one else is there.

It's useful to have one in the day room and also one beside the bed, to prevent someone getting up in the night just to find the notepad.

A wirebound pad makes it easiest to have a flat page to write on, whilst keeping pages in order and allowing old pages to be removed.