Aging in place, or staying in one’s own familiar home environment during the later years of life, is often beneficial to people with dementia. However, as dementia progresses, their home may not be perfectly suited to your loved one’s needs.
Healthcare designer Barbara J. Huelat shared some solutions for modifying a home environment to improve safety and comfort for a loved one with dementia. Huelat has spent her career implementing design principles that support healing, comfort, and safety. Through her personal experience, she has a special interest in environments that support people with dementia and their caregivers. Huelat recently collaborated with her daughter Sharon T. Pochron to write Taming the Chaos of Dementia: A Caregiver’s Guide to Interventions That Make a Difference.
“Science shows that as dementia sufferers lose their cognitive functions, they do not lose their ability to enjoy life, love and be loved, laugh, cry, and connect with relationships,” Huelat and Pochron wrote.
The principles of home design for dementia
Two key ideas to keep in mind when creating a home environment for someone with dementia are
Support physical needs.
Engage positive emotions.
“Create a safe and comfortable environment. This includes making sure that the home is well-lit, free of clutter, and easy to navigate. It is also important to remove any potential hazards, such as sharp objects or tripping hazards,” Huelat said.
Maximize natural light
Keep windows clean and curtains open in the day time to maximize the natural light in living areas.
“Natural light is important to people living with dementia because the older eye needs more light to see,” Huelat said. “And when you add dementia on top of age it becomes even more important.”
People with dementia need three times as much light as someone with normal vision. “This is important because people with dementia can get scared or confused when they can’t see something properly,” Huelat said.
Avoid shadows and glare
You may need to use higher-wattage light bulbs and additional lamps to brighten spaces for an older person. To avoid glare from the extra light, use warm white bulbs, indirect light sources, and remove reflective surfaces.
“Glare creates shapes, and people with dementia can’t figure out what they are. This becomes scary at night for people with dementia when they think they see something that isn’t really there,” Huelat said.
Also, be aware of shadows cast by the movement of ceiling fans—they can be confusing and frightening to a person with dementia.
Reduce mirrors
A mirror over the bathroom sink is useful and expected, but consider removing mirrors in other parts of the house.
“Reflective surfaces such as mirrors, windows, and glass doors, which might present distressing or unrecognizable images, provide common triggers,” Huelat wrote in her book. “Try using mirrors only over sinks or in grooming areas that often make sense to those with dementia—avoiding mirrors that can be seen from a distance or while walking, which can present images that are harder to understand.”
Remember, windows become reflective at night and can cause confusion. Once you’ve enjoyed the day’s natural light, close curtains at night.
Consider ergonomics
As dementia progresses, people become less mobile and will likely spend most of their time in a favorite chair. You can help make sure that chair is not only a comfortable favorite but also provides support for correct posture.
“Ergonomics is not only about comfort, it is also about maintaining working organs,” Huelat said. “If you see slouching, get pillows under their arm or back. Slouching can lead to respiratory problems. Good posture is essential to keep internal organs working.”
Look for these signs that a chair is a good ergonomic fit:
Upright posture
Lumbar support
Neck is relaxed and neutral.
Feet are flat on the floor.
Arms rest parallel to the floor.
An ideal chair setup will give them a sightline to the door, the bathroom, a window, and the television. Put an appropriate table with task lighting within reach.
Check safety sooner rather than later
If the home needs structural changes to make it more accessible for someone with limited mobility (which a person with dementia will very likely face eventually), it’s better to do those modifications before the need arises.
As Huelat writes, you should evaluate these parts of the house in terms of avoiding falls, making falls less dangerous, and improving access to the kitchen, bathroom, and bedroom:
Install a ramp to avoid steps at the home’s entry.
Move furniture or clutter to clear paths through the home.
Replace tub with a walk-in shower.
Add a bench and removable shower head to the shower or tub.
Install safety bars in the shower and next to the toilet and sink.
Consider if a person with a walker or wheelchair could easily move through doorways or around the kitchen.
Opt for carpet with a shorter pile, and avoid loose rugs.
Avoid hard stone floors.
Connect with nature
Spending time in nature is good health advice for everyone and equally important for people with dementia.
“Getting out in nature, especially in the morning, can reset someone’s bio clock and circadian rhythm,” Huelat said. “Even if they are bedridden or can’t walk very far, try to maintain visuals with a window, sit them out on the porch or the deck, a short walk can do wonders.”
If your person is not mobile enough to actually go outside or they are prone to wandering, here are some tips for dialing up nature inside their safe spaces:
Place indoor plants in the room.
Use water elements like rain chains outside nearby windows, an aquarium, or an indoor tabletop fountain.
Open windows for fresh air.
Make sure outdoor views through windows are unobscured.
Add window box plantings.
Place bird feeders within eyesight.
Offer your loved one binoculars to get a better look through windows.
Encourage connecting with pets or service animals.
Honor cherished items and memories
Finally, an important part of making home enjoyable for a person with memory loss is to spotlight items that stimulate nostalgia or bring them comfort. You can do this by hanging their favorite art and photos where they spend most of their time. Keep a photo album and a memory box containing items from their past within reach.
“When your person with dementia is living at home, you might think you don’t need to lean on the power of items to generate feelings of safety and a connection to others, but if your person loses mobility and becomes less able to access trickier parts of the house, perhaps consider how this shrinking of their world impacts their sense of home and its associated safety,” Huelat wrote. “You might want to move favorite photos or memorabilia from the upstairs office to the bedroom or living room if your person can no longer access the office. If you find yourself needing to move bedrooms to avoid stairs, you can minimize confusion by bringing art and other objects specific to your person.”
