Care Dementia-friendly homes

Dementia is a disease that affects the brain and usually only occurs in old age. It impairs people’s memory, concentration and cognitive functioning, among other factors. Age-related hearing and sight problems can also limit people with dementia during everyday life.

People with dementia increasingly struggle with orientation and to lead an independent life. This can all result in unease, stress and, in some situations, even risks during everyday life.

To help people with dementia orientate themselves in their environment for as long as possible, it is useful to appropriately modify their home. Certain safety measures reduce the risk of patients putting themselves or others in danger.

“Orientation” refers to a person’s cognitive abilities with regard to the place, time, situation and their own person. Dementia can impair orientation in all four areas:

• Orientation to place: people with dementia are often unable to properly find their bearings in their environment. As the condition progresses, this can even apply to places they are familiar with.
• Orientation to time: patients find it increasingly difficult to know the date and time. The sleep-wake cycle can be disrupted.
• Orientation to situation: unusual situations can severely overwhelm people with dementia. Problems with perception lead to situations being incorrectly assessed.
• Orientation to person: as the disease progresses, patients forget even important parts of their own past and may stop recognizing even their nearest and dearest.

Orientation to place

People with dementia find it increasingly difficult to orientate themselves in their familiar environment. Changes to this environment exacerbate the disorientation and can lead to anxiety and confusion. It is therefore advisable to retain the familiar environment as far as possible. It also helps to accept the order or disorder that best enables the person with dementia to orientate themselves. Familiar items should only be replaced if absolutely necessary. If changes are required, these should be made gradually and carefully.

The following tips can also help with orientation to place:

• Use contrasts. Steps and light switches can be marked with high-contrast, colored adhesive strips. Doors and furniture should clearly stand out from the wall.
• Ensure that room layouts are simple and clear.
• There should also be a visible difference between the floor, walls and ceiling. This can be achieved by ensuring that areas have a clear light-dark contrast to each other. 
• Where possible, furniture should not be rearranged, even after a move.
• Provide sufficiently bright and glare-free lighting. This prevents the formation of shadows, which can be misconstrued by people with dementia and frighten them.
• Avoid busy patterns. On the floor, people with dementia can construe these as obstacles or deep holes. Checkered patterns with dark areas are particularly unsuitable.
• Label rooms and cupboards with pictures associated with the contents. “Pictograms” are often suitable here.
• Create a color scheme suitable for people with dementia through the use of friendly, bright and warm shades such as yellow, orange, green and subtle red.

Multiple pictograms suitable for use in the home of people with dementia are available to download from the website of the Austrian Federal Ministry of Labor, Social Affairs, Health, Care and Consumer Protection.

Orientation to time

As the disease progresses, orientation to time can become increasingly difficult. This does not just mean knowing the day and current time but also the season or year.

Large clocks should therefore be visibly displayed in the home. It is important for the dials and hands to be clear and easy to see. It is also possible to get analogue clocks that additionally indicate whether it is day or nighttime. Some people with dementia find it easier to read a digital clock. “Talking clocks” provide further support with temporal orientation. These can announce the time at the push of a button. Some models also announce the date and the day of the week.

Calendars with images that relate to the month are also useful for orientation. It helps if the current day can be easily marked. Digital calendars have the benefit of always showing the correct date. However, such devices are not always recognized as calendars and cannot be used to record appointments. To help people with dementia orientate themselves more easily over the course of the year, the home can be decorated in line with the season.

The sleep-wake cycle can also be disrupted. People with dementia are often active in the evening or at night. To support the natural rhythm, it helps to let a lot of natural light into the home during the day. Modern bulbs can imitate the different lighting conditions over the course of the day. This is done by using cooler light with a higher blue component in the morning and warmer light with a higher red component in the evening. A clearly structured day also supports a healthy sleep-wake rhythm.

Orientation to situation

Over time, people with dementia often struggle to correctly assess situations. They struggle to understand why others act in a certain way or do certain things. The ability to correctly identify what items are for also decreases.

Once again, it helps people with dementia to have the most familiar possible environment with familiar items. Pictograms can be used to show the function of individual rooms or items.

People with dementia can also experience problems with perception. For example, they can see people or animals coming out of a patterned carpet. These kinds of sensory illusions can make it even harder to cope during everyday life. Some forms of dementia even cause delusions. For example, patients can be afraid of being followed or robbed.

The following tips can help prevent people with dementia from perceiving things incorrectly:

• Note the effect of floor coverings: avoid dark flooring as this can be perceived as a deep hole. On the other hand, extremely light flooring can appear “bottomless”. Shimmering, blue flooring can be mistakenly viewed as water. Matte, monochrome flooring that is not too dark is therefore the best choice.
• If a person’s hearing deteriorates, it becomes harder for them to distinguish between different noises. Sound-absorbing materials such as curtains or carpets can help make the home quieter.
• Unnecessary sources of noise should be avoided as far as possible.
• Design the home to be as irritant free as possible as this can be calming. Avoid busy patterns on pictures or wallpaper (especially photo wallpaper). Highly reflective surfaces such as glass display cases can also be distracting.
• Illuminate the rooms as evenly as possible to avoid shadows. These can be misconstrued by people with dementia and unnecessarily frighten them. Indirect lighting is also suitable for creating uniform light distribution.

Orientation to person

As dementia progresses, long-term memory also deteriorates. Patients find it harder to remember their own biography. No longer having a clear memory of your own identity can trigger uncertainty and fear. The following tips can help the person with dementia to feel more secure and assist their memory:

• Personal photos and items act as “anchor points”. They create familiarity and trigger memories. This helps people with dementia to feel calm.
• Pictures on the walls should depict calm images such as landscapes.
• Write down important appointments and telephone numbers on a large sheet of paper and display it in the home so that it is clearly visible.
• Cover mirrors or remove them by no later than the point when the person with dementia can no longer recognize themself.

Dementia can increase the risk of accidents both in and away from the home. There are various reasons for this.

Firstly, the disease often causes unsteadiness when walking, which can result in a fall. The tendency to wander around the dark home at night can also increase the risk of falling. 

Secondly, problems with perception can prevent people with dementia from correctly recognizing obstacles. Dementia can also lead to everyday domestic items becoming sources of danger – for example if a stove or iron is accidentally left on.

The following tips can help to avoid accidents:

• Trip hazards: take care to fasten down or remove rugs that can slip. Small steps that are difficult to see should either clearly contrast with the area around them or be eliminated.
• Electricity: store electrical appliances in a safe place.  Sockets can be fitted with child safety locks.
• Bathroom: attach sturdy support and grab bars to prevent people with dementia from slipping. The floor covering should also be non-slip. Floor-level showers reduce the risk of accidents while wall-mounted folding seats can provide valuable assistance when showering. It is useful for the bathroom door to open outward so that access to the room is not blocked in the event of a fall. A lock that can also be opened from the outside preserves privacy while still enabling quick access in the event of an emergency.
• Kitchen: automatic stove shut-off devices and timers are useful.
• Risk of fire: rooms should be fitted with smoke detectors in order to quickly detect fires. Remember, however, that people with dementia will often no longer know what they should do if a smoke detector goes off. Smoke detectors can therefore be connected to a home emergency call system. This automatically notifies an emergency call center of the alarm.
• Taps: label hot taps and set the water temperature as low as possible to prevent scalding (maximum 45°C). Water detectors or water regulators can be used to prevent water damage.
• Household chemicals and medication: store toxic cleaning agents, medication, alcohol and tobacco in a locked location.
• Remove any poisonous plants.
• Risk of falling: windows can be secured with lockable window handles, for example. A stair gate at the top of stairs can increase safety.
• Install door locks with an emergency or hazard function. These locks can be opened from the outside with a second key even if they already have a key in them on the inside.

Wandering and getting lost

People with dementia sometimes experience a strong urge to move and can leave their home unsupervised. This poses a risk of them getting lost and no longer being able to find their way home. The risk of them injuring themselves or others, for example in a car accident, also increases.

The following tips can improve safety:

• Wind chimes on the door or pressure alarm doormats can provide a warning if someone leaves the house.
• Car keys should always be stored out of reach of people with dementia.

If a person with dementia gets lost, technical aids such as trackers can help to find them. Such trackers are integrated into smartwatches, for example, and provide information about the person’s location. It is also possible to set an area within which the person with dementia should stay. If the person leaves the usual area, the caregiver can receive a signal notifying them of this.

A list of technical support options for people with dementia can be found on the Consumer Advice Center and German Alzheimer’s Society (Deutsche Alzheimer Gesellschaft e.V.) websites.

Even if the intention is to ensure the safety of the person with dementia, consideration should be given to whether a restriction of freedom could potentially be experienced as a threat. This can sometimes cause outbursts of anger or fear. When considering which measures to take, never lose sight of the wellbeing and dignity of the person with dementia.

People with dementia and their relatives have very different experiences of the disease. Accordingly, some living arrangements can be more suitable than others depending on the situation. It is important to find out about the different options at an early stage. Several care advice centers can help with the search.

Full information on the different housing models for people in need of care can be found in our article Residential options for people with a care grade.

Even people with dementia can live in their own home under certain conditions. It is important for them to have sufficient support from relatives and for their home to have been modified to be dementia friendly. There are various ways to support home care:

• Care and support services can relieve relatives and provide assistance with care measures, in the household or with everyday life. Some outpatient care services have an additional qualification for dementia and therefore specialize in caring for people with the condition.
• With partial residential care, care recipients spend part of the day or the night in a care facility during the week, where they receive support. 
• If care recipients require all-day care, live‑in care can be an option. With this model, a professional carer lives in the care recipient’s home. However, such professional carers can only look after the care recipient for a maximum of 8 hours per day on average. The care is therefore split between the relatives and the professional carer.

Our article on caring for people with dementia provides an array of useful information and suggestions for people who care for a relative with dementia at home.

Long-term health insurance provides a range of care services to help care recipients live in their own home for as long as possible. Further information on the various financial support options can be found in our article Benefits for care at home.

Another possible living arrangement is that of care group homes. Here 6 to 12 people in need of care all live in the same home. There is always a member of staff on site. This person is responsible for organizational matters, supports the care recipients with household tasks and looks after them. Nursing care is provided by an outpatient care service. Detailed information about care group homes can be obtained in our article on care group homes.

Information on outpatient supported group homes for people with dementia can be found in the information sheet provided by the German Alzheimer’s Society (Deutsche Alzheimer Gesellschaft e.V.) and the brochure provided by the Oldenburg Alzheimer’s Society (Alzheimer Gesellschaft Oldenburg e.V.).

If people with dementia require care and support around the clock, inpatient care in a nursing home is often the only solution. In Germany, there are multiple institutions that specialize in the provision of dementia care.

There are various websites where you can search for suitable institutions. Reputable search portals include:

• Federal Association of Public Health Insurance Companies (AOK-Bundesverband): Care Navigator (Pflegenavigator)
• Association of Substitute Health Insurance Funds (Verband der Ersatzkassen – VDEK): Care Guide (Pflegelotse)
• Federal Association of Company Health Insurance Funds (BKK-Dachverband): CareFinder (PflegeFinder)
• Society for the Promotion of Quality of Life in Older Age and with Disability (Gesellschaft zur Förderung der Lebensqualität im Alter und bei Behinderung): Home Directory (Heimverzeichnis)

The Digital Pact for Old Age (DigitalPakt Alter) website from the German National Association of Senior Citizens’ Organizations (Bundesarbeitsgemeinschaft der Seniorenorganisationen e.V.) provides virtual tours of various age-appropriate model apartments.

The German Alzheimer’s Society supports and advises people with dementia and their relatives.

The dementia information portal “Wegweiser Demenz” provided by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ) offers a range of information on self-help groups for relatives.

The website of the Consumer Advice Center of Rhineland-Palatinate (Verbraucherzentrale Rheinland-Pfalz e.V.) offers detailed information about things to consider with regard to insurance in order to be well protected in the event of dementia.