Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer’s disease is the most common type of dementia. Dementia is not a normal part of aging – it is caused by damage to brain cells that affects a person’s ability to communicate, remember, learn, reason, and problem solve.
In the early stages of dementia, many people are able to live independently and safely alone. However, as dementia progresses, it can become unsafe for a person to continue living alone. This is a difficult topic for families to discuss, but being proactive and planning ahead is important.
Early Warning Signs
In the early stages of dementia, a person may begin having difficulty with complex tasks like paying bills, cooking, driving, remembering appointments, and taking medications correctly. Getting lost or disoriented in familiar places can also occur.
Here are some early warning signs that it may be time to stop living alone:
- Neglecting personal care such as forgetting to bathe, brush teeth, change clothes
- Extreme weight loss or gain due to forgetting to eat or difficulty preparing food
- Unsafe cooking habits like forgetting food on the stove
- Poor home maintenance such as hoarding items, not cleaning, or home in disrepair
- Not paying bills or managing finances leading to loss of utilities or lack of money for food/needs
- Getting lost in the neighborhood and wandering
- Difficulty driving including forgetting routes, traffic rules, or having accidents
While early stage dementia patients may insist they are fine living alone, family should pay close attention to these red flags that the living situation is becoming unsafe.
Safety Risks
As dementia progresses to the middle stage, the risks of living alone become more pronounced. Without proper supervision, the senior’s safety and health can be jeopardized.
Some of the biggest risks include:
- Falls – Dementia affects spatial awareness and gait leading to unsteady walking and frequent falls.
- Wandering – Middle stage patients may wander and become lost or injured.
- Nutrition – Forgetting to eat, difficulty preparing food, or inability to go grocery shopping can lead to malnutrition, dehydration.
- Self-Care – Inability to bathe, groom, dress, or manage toileting/incontinence needs cleanly.
- Medication Errors – Forgetting medicines, taking wrong dosages, mixing medications.
- Unsafe use of Appliances– Increased fire risk from stovetop or from inability to properly turn off appliances.
- Financial Exploitation – Dementia patients can unknowingly give money to scammers and lose lifesavings.
Without supervision, dementia patients are more vulnerable to all these risks that can endanger their health and safety. A medical emergency or health decline can also go unnoticed if the senior is living completely alone without regular contact from caregivers and family.
Stage of Dementia
The level of safety risk depends heavily on what stage of dementia the senior is experiencing.
- Early Stage: Usually safe to live alone with monitoring from family. Start planning for the future.
- Middle Stage: 24/7 supervision is needed. Assistance required for many daily tasks.
- Late Stage: Around the clock caregiver assistance required for all tasks.
Assessing what stage of dementia the senior is in can help determine if independent or assisted living is still appropriate, or if they need the higher level of care provided in a memory care facility.
Early Stage
Early stage dementia is often not severe enough to make independent living completely unsafe. At this point, the senior may just need some assistance and monitoring. Having family check on them, deliver food, help with bills, provide rides, and monitor their health can enable them to continue living on their own.
However, steps should still be taken to prepare for the time when 24/7 supervision does become necessary. This includes discussing future financial and care plans with them, setting up power of attorney, getting affairs in order, exploring senior housing options, and altering the home environment to be safer and more dementia friendly.
Middle Stage
The middle stage of dementia is when 24/7 monitoring becomes essential. At this point, the senior’s judgment, reasoning and safety awareness are too impaired for them to be left alone. They will need prompting and hands-on assistance for many daily living activities like:
- Bathing
- Dressing
- Grooming
- Using the bathroom
- Transferring in/out of bed and chairs
- Eating nutritious meals
- Taking the right medications at the right time
- Avoiding safety hazards in the home
This 24/7 assistance and supervision is usually beyond what family caregivers can provide on their own at home. Options include hiring in-home caregivers, moving in with a family member, or transitioning to a memory care facility.
Late Stage
Late stage dementia involves a near total dependence on others for all aspects of care. The senior is unaware of needs, surroundings, or unable to communicate. They require assistance for:
- Mobility – Unable to walk without assistance
- Eating – Unable to feed themselves
- Toileting – Incontinence and diaper changes required
- Transfers – Unable to move from bed to chair without total assist
- Bathing/Grooming – Total hands-on care for washing and hygiene
- Medication – Can not self-administer any medications
- Behavior – Increased confusion, wandering, anxiety, agitation are common
At this late stage of dementia, safety concerns and need for round the clock intensive care make living at home nearly impossible. The senior generally requires the constant monitoring and medical oversight provided in a memory care facility.
Tips for Discussing a Move
Persuading a senior with dementia to move from independent living can be difficult. Here are some tips for having a constructive discussion:
- Schedule regular discussions to plant the idea over time
- Present it as a positive move to somewhere they can receive more assistance
- Don’t argue if they disagree, just continue the conversations
- Involve medical providers to reinforce the recommendation
- Focus on safety, wanting the best care for them, and taking a precautionary approach
- Share stories of others who have made a similar move to normalize it
- Remind them it is not permanent if they respond well and stabilize
With patience and the senior’s best interest in mind, families can usually guide the living transition while keeping the senior’s dignity.
In-Home Care Options
For seniors who need monitoring and assistance, but are not ready to leave home, bringing caregivers into the home is an option. This allows them to maintain independence while getting needed support. In-home care options include:
Home Health Aides
Home health aides can assist with activities of daily living like bathing, dressing, meals, medication reminders. They have limited hours and cannot monitor the senior overnight. Cost is $25-$35/hour without insurance.
Live-In Caregiver
A live-in caregiver resides with the senior and provides around the clock assistance. This option allows the senior to remain at home with 24/7 support. Cost averages $4,000 per month.
Adult Day Programs
Adult day care provides social interaction and activities during weekdays. The senior returns home in the evenings and weekends. Cost is around $70 per day.
While in-home care can extend independent living, it is still not a permanent solution. As dementia progresses, a transition to a licensed senior care facility will become necessary for safety.
When to Make the Move
The risks posed by dementia at some point outweigh the senior’s desire to live independently. General guidelines of when assisted living or a memory care facility becomes necessary include:
- The senior can no longer safely manage medications or medical conditions like diabetes
- Personal care like bathing, dressing, hygiene are neglected
- Malnourishment or weight loss from forgetting meals or inability to shop
- Unsafe home conditions such as no working utilities, hoarding, vermin
- Extreme confusion, wandering, agitation, or other mental health changes
- A major medical emergency has occurred like a bad fall, accident, or hospitalization
- The current in-home care situation is unsustainable – exhausted family caregivers, unaffordable private caregivers
While there may not be one definitive moment, recognizing when independent living poses a safety threat is important. Continuing to argue with the senior to give up their home can damage your relationship. Consulting medical providers and focusing discussions on health and concern for their wellbeing can help guide the transition process.
Choosing the Right Facility
Once the decision is made to transition from independent living, selecting the right assisted living or memory care facility is key. Important factors to consider include:
Staffing
Look for facilities with 24/7 trained staffing to assist residents, administer medications, and monitor safety.
Care Approach
Seek places with a gentle, person-centered philosophy focused on supporting resident dignity and improving quality of life.
Safety
Tour facilities that offer appropriate safety features like secured courtyards, wandering alerts, controlled access.
Engagement
Choose centers that engage residents with daily intensive programming, sensory rooms, familiar activities.
Healthcare Access
Pick facilities partnered with medical providers, home health, and hospice for on-site health needs.
Recovery Potential
Consider places that offer dementia therapy to stabilize cognition and possibly enable a return to independent living.
Matching the senior living environment to the specific care needs of dementia residents can ease the transition and improve safety as their disease progresses.
Conclusion
Deciding when independent living is no longer safe for someone with dementia is difficult. While wanting to preserve their independence as long as possible, there comes a point where constant supervision and a higher level of care become essential.
Warning signs like personal care neglect, malnutrition, medication issues, wandering, and home safety hazards can indicate it is time to move. In-home caregivers can provide some support, but are not a permanent solution. Transitioning the senior to an assisted living or memory care facility is usually best, before an emergency or health decline occurs. With a person-centered approach and focusing discussions on safety and quality care, families can guide the process successfully while maintaining strong bonds.
