It starts one day, without warning. A pot forgotten on the stove, a key left in the door overnight, a frightened phone call from the middle of the street because suddenly everything looks unfamiliar. The first signs are almost always small, momentary, the kind that are easy to explain. But they accumulate. One day the wallet disappears and is found in the freezer. The next day, the way from the garden to the building is no longer clear. Something in perception goes wrong. Not dramatic, but noticeable. In the background, a feeling begins to rise that cannot be ignored. And then someone in the family says what until now was only hovering in the air: Maybe it’s worth talking to a doctor. Sometimes what until then was “a bit of confusion” gets a clear name: The beginning of dementia.
The next stage is not only medical, but it is just as important. Is the environment, the home in which they live, still serving them? Does the home still help them understand the day, find the kitchen, get to the bathroom at night, identify the place where they feel they belong?
In the early stages of dementia, it is possible and advisable to continue living at home. But there is a necessity to actively adapt the environment to the new situation. The problem is that people keep the old furniture, even though the cognitive reality has changed.
How do you adapt the home for a dementia patient?
A professional safety assessment by an occupational therapist for home safety
You should ask the family doctor for a visit by an occupational therapist for the purpose of a comprehensive safety assessment. This is a professional examination carried out in the home, in which factors such as accessibility, fall risks, lighting, room signage, and additional adaptations that can prevent dangerous situations are examined. It is important to make sure there are no loose rugs that could slip, that the lighting in the home is sufficient even at night, that the bathroom includes an accessible shower instead of a bathtub, and to install safety grab bars in vulnerable areas
Continuous personal supervision
In many cases, especially when dementia progresses, there is a need for a live-in foreign caregiver. The presence of another person who knows the routine, helps with orientation, supervises, and provides a sense of security can make a huge difference. For the family, this is also an emotional anchor that allows them to continue their routine without fear.
The living room and open spaces
Remove physical obstacles from the living room. It should become a simple, calm space, without visual overload. It is advisable to keep passages open, move away non-essential items, and place each piece of furniture in a fixed location. Frequent changes or random placement of objects increase the feeling of confusion.
The kitchen
The kitchen can become dangerous very quickly: Open gas, boiling water, knives within reach. It is important to lock certain drawers, reduce visible items, and choose electrical appliances with safety mechanisms. Essential utensils see, like cups and plates, should be in clear colors, on a fixed and accessible shelf.
The bedroom
At night, confusion increases. A constant night light helps with orientation, as does placing clothes ready for the morning. The bed should be accessible and at a comfortable height, and the entire space free of obstacles. It is recommended to avoid heavy shadows that may appear threatening.
Bathrooms
Most falls occur in the bathroom. Therefore, it is important to provide grab handles, anti-slip surfaces, simple and accessible faucets, and clear signage. Sometimes a simple sign with a picture of a toilet can prevent unnecessary embarrassment.
Doors and passages
When a tendency to wander begins, it is advisable to install high locks or a silent alarm on the door. Inside the home, clear signage should be placed on every door, not to label, but to reassure. Even if the person has lived in the home for decades, in moments of confusion every door looks new.
In every country where environmental guidelines for dementia have been examined, the same principles come up again. The home should be consistent, predictable, simple. A clear routine contributes to a sense of control. Contrasting colors help distinguish objects from the background. Excess stimuli, such as clutter on the walls, or unnecessary items, only worsen the difficulty.
The goal is not to take the person out of their life, but to allow them to remain within it, with proper adaptation. As long as they are protected, understood, and feel part of the space, the home is still the best place for them.
But even the best home is not always enough. Over time, signs begin to appear that indicate that the home framework is no longer supportive. When a person no longer recognizes the way to the kitchen. When they leave the house at night and have difficulty returning. When the caregiver is worn down, or the confusion increases and fear rises, it is necessary to reconsider whether the home is still safe, or whether it is time to move to another framework.
This is not a simple decision, but it is also not the end of the road. Sometimes, a suitable institution can restore security, routine, and calm. Therefore, before making a decision about changing address, it is important to ask whether all the necessary changes have been made within the existing home. Sometimes, that is all that is needed to restore a sense of stability.
Dr. Shahar Bar is a specialist in geriatrics and director of the rehabilitation geriatrics department at the Medical Care Medical Center