Alzheimer’s, Dementia and Living Alone

 

Living in a place that is safe, familiar and comfortable is important to everyone, including people with Alzheimer’s disease or other dementias. A diagnosis of dementia does not automatically mean that a person is incapable of living alone. Some people may be able to live on their own for some time after the diagnosis. Others may be at too much risk to continue living alone.

 

It is often difficult to decide when a person is at too much risk to continue living alone. When people who live alone have Alzheimer’s disease or other dementias, diagnosis may occur later in the disease because their symptoms may go unrecognized.

 

A premature move from home should be avoided. Moving people with dementia away from home to live, for example, with a son or daughter, or in a long-term care setting, may feel like a loss of freedom. Being able to access support and safety services, however, may result in more independence.

 

Each person’s living situation should be monitored and assessed carefully, as the disease progresses.

 

For People with Dementia

 

Loss of independence: Some people with Alzheimer’s disease and dementia can tell when living alone is no longer safe or desirable. Others may want to stay in their own home for as long as possible, even if there are some safety concerns. They may be worried that a move away from home would mean a loss of self-reliance and control in their daily lives.

 

Premature move from home: The person with the disease may have a higher tolerance for risk than family members and caregivers and may feel pressured into moving out of the home earlier than necessary.

 

Living alone: Many people with Alzheimer’s and dementia continue to live successfully on their own for some time. Here are some ideas to help:

  • Speak to a local community support agency (Memory Matters) or doctor about possible local resources for housekeeping, meal preparation or transportation.

  • Talk to your bank manager about bank-at-home services.

  • Arrange for direct deposit of checks.

  • Sort out closets and dresser drawers to make it easy to choose what to wear. Have a family member help you if necessary.

  • Leave a set of house keys with a trusted neighbor.

  • Use electrical appliances that shut off on their own.

  • Install a smoke detector and check the batteries regularly.

  • Leave written reminders to yourself like “turn off the stove” or “unplug the iron.” Place them where you will see them.

  • Label cupboards with words or pictures that describe what is inside, for example, dishes, knives and forks.

  • Write telephone numbers in large print and post by the phone. Include people to contact in an emergency.

  • Write your address down and post by the phone. Keep a map with you that shows where your home is.

  • Accept help when it is offered.

  • Ask for help when you need it.

  • Take your time.

  • If something is too difficult, take a break.

 

For Family Members, Caregivers and Health-care Professionals

 

Determining when living alone is no longer safe or desirable: When people with dementia no longer understand their own safety and can’t look after themselves, family members and health-care professionals may need to weigh the risks of living alone against the benefits of supporting him/her to live at home. In many families, caregiving falls to one person. Hold a family meeting when he/she is at an early stage of the disease, so that you can plan what each family member can realistically do to help, now and in the future.

 

Barriers within the health-care, community care and legal systems: Family members and health-care professionals often face barriers when trying to determine if a move from home is needed or if additional support can be provided in the home. These barriers include the difficulty of sharing information under privacy and confidentiality regulations; the limited availability of services to support independent living; and the complexities of competency legislation (the laws that determine when a person is no longer able to make certain decisions).

 

Preferred choice

 

Living environments that provide safety, quality of life and support: People with Alzheimer’s and dementia need to live in safe environments that support quality of life. The amount and type of support available are important factors in determining if a person can live alone. For example, a person with a large family, or someone who lives in a community with many services may be better able to live alone than someone with no family, living in a community with limited services.

 

Family members and health-care professionals can help reduce risks for people with dementia who want to live alone. For example, if he/she frequently leaves the stove on, consider disconnecting the stove and finding other ways to provide hot food, such as Meals on Wheels. Wherever possible, the person with the disease should take part in discussions concerning their own future.

 

Some factors to consider:

 

Overall well-being

  • What is his/her quality of life at home?

  • Is there a good balance of stimulation during the day?

  • Could he/she benefit from the level of care and support provided by another environment, such as a son or daughter’s home, dementia activity center, retirement home or long-term care home?

  • Is there help from community support agencies?

Health

  • Is he/she able to take medication properly?

  • If sick, would he/she be able to understand and take appropriate action, such as calling for help?

  • Is he/she able to take care of personal hygiene, such as bathing and toileting?

  • Are there current or past health problems that might put him/her at risk of harm?

Nutrition

  • Is he able to maintain a proper weight?

  • Is he able to eat nutritiously throughout the day?

  • Is he able to store and prepare foods properly?

  • Is he eating inappropriately (cat food)?

Safety

  • Is he/she at risk of harm? If yes, is the amount of risk acceptable to them? To family members? To caregivers?

  • Is it possible to find a level of risk with which everyone is comfortable? For example, the risk of falling on the stairs might be considered an acceptable risk if he/she has no problems with balance or walking.

  • Does he/she pose a risk to others? For example, does he/she live in an apartment and cause fires with the stove or cigarettes?

  • Is he/she able to react and take appropriate action in an emergency, such as a fire?

  • Is his/her home safe? For example, are stairs well lit? Are there handrails?

  • Do individuals or organizations check in with him/her regularly and in the event of a blackout or other emergency situations?

Finances

  • Can he/she handle day-to-day financial transactions, such as keeping track of bills and paying bills promptly?

  • Is he/she at risk of exploitation or abuse regarding finances?

  • Can he/she handle day-to-day financial transactions, such as keeping track of bills and paying bills promptly?

 

How to Support Independent Living

 

The following day-to-day strategies may help support a person with Alzheimer’s and dementia who lives alone:

 

Safety

  • Leave a set of house keys with trusted neighbors.

  • Arrange for someone to call or visit once a day. (Memory Matters Good Morning Sunshine.)           

  • Institute Appliance safety measures: Automatic shut off kettle.

  • Stove safety: remove fuses; put burners on timers, shut off gas.

  • Lower temperature of hot water heater.

  • Emergency call system. Person has 24-hour access to help should a problem arise. Person may not be able to understand concept or use of call button.

Daily Living           

  • Get help with tasks, such as housekeeping and meal preparation.

  • Sort closets and dresser drawers to make only the necessary clothes available.   

Food      

  • Meals on wheels.

  • Delivery of hot meal once a day.

  • Provide toaster oven or microwave for heating food. 

  • Use prepared foods, non-perishable foods and foods that do not need to be stored in a refrigerator.

Medication           

  • Simplify medication routines.

  • Use a pill dispenser.

  • Have someone visit to give pills.

  • Allows only a small supply of pills at once. (Helps person take the pills on the right day and time.)   

Finances

  • Utilize bank-at-home services.         

  • Make someone else, such as a substitute decision-maker, responsible for handling finances, such as writing checks, paying bills, monitoring accounts. (Allows person to manage finances with some independence yet provides protection.)

  • Direct deposit of checks and direct payment of bills.   (This hands-free approach to banking offers fewer chances for problems.)

 

In Closing…

 

Living in a place that is safe, familiar and comfortable is important to everyone, including people with Alzheimer’s and dementia. A diagnosis does not automatically mean that a person is incapable of living alone. Some people may be capable of living on their own for some time after the diagnosis. Others may be at too much risk to continue living alone. It is often difficult to decide when a person living at home is at too much risk to continue living alone. However, a premature move from home should be avoided. Each person’s living situation should be monitored and assessed carefully, as the disease progresses.

 

Some of the barriers to making informed decisions about a person’s ability to live at home include privacy of information regulations, availability of community support programs and competency legislation. With growing numbers of people with Alzheimer’s and dementia living on their own, there is a need for more public discussion of these issues.

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