Alzheimer’s Caregiver Tips: Safety, Personal Care, and More

Exploring Causes and Solutions

It is important to identify the cause of the challenging behavior and consider possible solutions.

• Identify and examine the behavior
• What was the undesirable behavior? Is it harmful to the individual or others?
• What happened before the behavior occurred and did something trigger it?

Tips for Enhancing Communication with Alzheimer’s Patients

See Tips for Better Communication with Alzheimer’s Patients for more detail.

Home Safety and Alzheimer’s Disease

When caring for an individual with Alzheimer’s disease at home, safety and accessibility are important concerns. There are simple steps you can take to make the home safe for the person with Alzheimer’s.

1. Make potentially dangerous places less accessible.

• Lock or disguise hazardous areas.
• Install door locks out of sight.
• Use special safety devices, such as child-proof locks and door knobs, to limit access to places where knives, appliances, equipment, and cleaning fluids are stored.

2. Accommodate for visual changes.

• Diffuse bright light by removing or covering mirrors and glass-top furniture, and cover windows with blinds, shades, or sheer draperies.
• Add extra lighting in entries, outside landings, areas between rooms, stairways and bathrooms because changes in levels of light can be disorienting.
• Place contrasting colored rugs in front of doors or steps to help the individual anticipate staircases and room entrances.

3. Avoid injury during daily activities.

• Monitor the temperature of water faucets and food because the person may have a decreased sensitivity to temperature.
• Install walk-in type showers, grab bars and decals to slippery surfaces in the bathroom to prevent falls.
• Supervise the person in taking prescription and over-the-counter medications.

4. Beware of hazardous objects and substances.

• Limit the use of certain appliances and equipment such as mixers, grills, knives, and lawnmowers.
• Supervise smoking and alcohol consumption.
• Remove objects, such as magazine racks, coffee tables and floor lamps, to create safe wandering areas and reduce the possibility of injury.
• Clean out the refrigerator regularly and discard inedible food.
• Lock firearms in a cabinet or drawer, or remove them from the house. Don’t allow unsupervised access to firearms.

5. Be prepared for emergencies.

• Keep a list of emergency phone numbers and addresses for local police and fire departments, hospitals, and poison control help lines.
• Check fire extinguishers and smoke alarms and conduct fire drills regularly.
• Enroll the person with Alzheimer’s disease in the Alzheimer’s Association Safe Return^® program, a nationwide system designed to identify, locate and return to safety persons who are memory impaired.

Alzheimer’s and Driving Privileges

Driving is a complex activity that demands quick reactions, alert senses and split-second decision making. For a person with Alzheimer’s, driving inevitably becomes difficult. A diagnosis of Alzheimer’s disease does not mean the person has lost all ability to drive. Caregivers should evaluate the person regularly to determine if it is safe for him or her to drive.

For many, restricting driving privileges signifies a loss of independence and mobility, often forcing people with the disease to rely on friends, family, and community services for transportation. This sense of dependence may prevent people with dementia from giving up the car keys.

Tips to Limit Driving

Hygiene and Personal Care for Alzheimer’s Patients

People with Alzheimer’s disease may need help with routine activities related to grooming and hygiene. The need for assistance can be very difficult for them because it signifies a loss of independence and privacy. It is also difficult for caregivers, especially when they assist with activities that interfere with the individual’s privacy. In this section, you will find tips on handling grooming and hygiene tasks for an individual with Alzheimer’s disease.

How to Get Dementia Patients to Bathe

Bathing is often the most difficult personal care activity that caregivers face. Because it is such an intimate experience, the person with Alzheimer’s may perceive it as unpleasant, threatening or painful and, in turn, exhibit disruptive behaviors such as screaming, resisting, and hitting. These behaviors often occur because the person doesn’t know what bathing is for or doesn’t have the patience to endure such unpleasant aspects as lack of modesty, being cold, or experiencing discomfort. Try the following:

• Do everything you can in advance to make the process easier, such as increasing the room temperature and having bath towels nearby.
• Make the person feel in control. Involve and coach him or her through each step of the process. You may need to experiment to determine if the individual prefers showers or tub baths and what time of day is best.
• Create a safe and pleasing atmosphere. Place non/slip adhesive on the floor surface and grab bars in the bathtub to prevent falls. Test water temperature in advance to prevent burns.
• Respect the person’s dignity. Some individuals may be self-conscious about their nakedness.
• Allowing the person to hold a towel in front of their body, both in and out of the shower, may ease anxiety.
• Don’t worry about the frequency of bathing. It may not be necessary to bathe every day.
• Sponge baths can be effective between showers or baths.
• Be gentle. The person’s skin may be very sensitive, so avoid scrubbing and pat skin dry instead of rubbing.
• Be flexible. You may experience the most difficulty when attempting to wash the person’s hair.
• Use a washcloth to soap and rinse hair to reduce the amount of water on the person’s face.

Using the Bathroom

It is common for persons with Alzheimer’s disease to experience loss of bladder and/or bowel control. This can be caused by many factors, including medications, stress, a physical condition, the environment, and the person’s clothing. If incontinence is a new problem, consult your doctor to rule out potential causes such as a urinary tract infection, weak pelvic muscles or medications. If the problem continues, try to:

• Provide visual cues. Signs may assist an individual in finding the bathroom. Placing colored rugs on the bathroom floor and lid covers on the toilet may help the bathroom stand out.
• Avoid having items nearby that can be mistaken for a toilet, such as a trash can.
• Monitor incontinence. Identify when accidents occur and plan accordingly. For example, if they happen every two hours, get the person to the bathroom before that time. To help control incontinence at night, limit the intake of liquids after dinner and in the evening.
• Remove obstacles. Make sure clothing is easy for the individual to remove.
• Provide reminders. Because the person with Alzheimer’s may forget to use the bathroom, you may need to remind him or her periodically. Also watch for visible cues such as restlessness or facial expressions that may indicate the person needs to use the bathroom.
• Be supportive. Help the person with Alzheimer’s retain a sense of dignity despite incontinence problems. A reassuring attitude will help lessen feelings of embarrassment.

Dental Care for Alzheimer’s Patients

Good oral hygiene can be a challenge for individuals with Alzheimer’s. Brushing is sometimes difficult due to the individual’s inability to understand and accept assistance from others. To help the individual:

• Provide short, simple instructions. “Brush your teeth” may be too difficult. Instead try: “hold your toothbrush,” “put paste on the brush,” and “brush your top teeth,” etc.
• Use a mirroring technique. Hold a brush and show the individual how to brush his or her teeth.
• Monitor daily oral care. Brush teeth or dentures after each meal and floss daily. Remove and clean dentures every night, and brush the person’s gums and roof of the mouth. If the person refuses to open his or her mouth, try using oral hygiene aids available from your dentist to prop the mouth open. Strained facial expressions during dinner or refusal to eat may indicate oral discomfort.
• Caregivers are essential in helping the person maintain oral hygiene, noticing any problems and seeking help from a dentist. Notify the dentist in advance that the person has Alzheimer’s so that an oral care routine can be developed.

Dressing a Patient with Alzheimer’s

Physical appearance contributes to everyone’s sense of self-esteem. Clothing can be a form of self-expression, so it’s important to consider the person’s tastes and dislikes. To help the person with dressing:

• Simplify choices. Each morning, offer two choices of shirts and pants for the individual. Keep the closet free of excess clothing.
• Organize the process. Lay out clothing in the order it needs to be put on, or hand the person each piece while giving short, simple instructions. Don’t rush the individual; it will only create anxiety.
• Be flexible. If the individual wants to wear the same outfit repeatedly, try getting a duplicate of the outfit or have similar options available.
• Choose comfortable and simple clothing. Cardigans or shirts that button in front are sometimes easier to work than pullover tops. Substitute Velcro™ for buttons, snaps, or zippers that may be too difficult to handle. Make sure the individual has comfortable shoes that are not slippery.

With all personal care activities, it is important to incorporate the individual’s past routine whenever possible into the current one. As you assist the person, be patient and creative. An approach that worked one day may not work the next, so be flexible.

Long-Distance Caregiving for Alzheimer’s

Caring for a loved one who lives far away can be emotionally and financially exhausting. Concerns about your loved one’s safety, nutrition, health, and care may seem overwhelming. You may also feel guilty and anxious because you cannot be there every day to see how the person is doing. This section offers advice on coping with long-distance caregiving and considerations for when it’s time to move your loved one into an assisted living facility.

Make the Most of Visits

Few long-distance caregivers are able to spend as much time with their loved one as they would like. The key is to make periodic visits and use your time effectively:

• Make appointments with your loved one’s physician, lawyer, and financial adviser during your visit to facilitate decision making.
• Meet with neighbors, friends, and other relatives to hear their observations about how the person is doing. Ask if there have been any behavioral changes, health problems, or safety issues.
• Take time to reconnect with your loved one by talking, listening to music, going for a walk, or participating in activities you enjoy together.

Consider Carefully Before Moving a Loved One into Your Home

The decision to move the person to your home is influenced by many factors. Here are some things to think about before moving the person into your home:

Moving a person with Alzheimer’s disease from familiar surroundings may cause increased agitation and confusion. You may want to talk with your loved one’s physician or a social worker or call your local Alzheimer’s Association chapter for assistance before making a decision. In some situations, an assisted living or a residential care setting may be a better option for the individual.

Caring for a Loved One in a Facility

• Whether your loved one lives in an assisted living or a residential care facility, it is important to maintain ongoing communication with the care staff and friends who visit regularly.
• Work with the managing nurse and physician. Agree on a time when you can call to get updates on the person’s condition and progress.
• Call family, friends, or other visitors and ask for their observations.
• When you visit, meet with the staff members who have primary responsibility for your loved one’s care.

Resolving Family Conflicts

Caregiving issues can often ignite or magnify family conflicts, especially when people cope differently with caregiving responsibilities. Family members may deny what is happening, resent you for living far away, or believe you are not helping enough. There may also be disagreement about financial and care decisions. To minimize conflicts, try to acknowledge these feelings and work through them.

• Have a family meeting. Talking about caregiving roles and responsibilities, problems, and feelings can help ease tensions. You may want help from a professional counselor or clergy.
• Recognize differences. Some family members may be hands-on caregivers, responding immediately to issues and organizing resources. Others may be more comfortable with being told to complete specific tasks.
• Share caregiving responsibilities. Make a list of tasks and include how much time, money, and effort may be involved to complete them. Divide tasks according to the family member’s preferences and abilities.
• Continue to communicate. Periodic family meetings or conference calls keep the family up-to-date and involved. Discuss how things are working, reassess the needs of both the person with Alzheimer’s and the caregiver, and decide if any changes in responsibilities are needed.

Many long-distance caregivers feel guilty for living far away from the person with Alzheimer’s. This guilt, compounded by the grief related to seeing a loved one’s decline, may make it difficult to emotionally recover from a visit. It is important to seek support from family, friends, a counselor, or the Alzheimer’s Association to help deal with these feelings. See 6 Ways for Caregivers to Manage Feelings of Guilt for more tips.

Coping with stress

Caregivers — both family and professionals — are most often the abusers of older people. In many cases, stress and frustration may provoke unintentional violent feelings in caregivers. Family caregivers may feel isolated, depressed, and resentful toward their loved as the disease progresses and may become abusive without realizing it. Other issues, such as substance abuse, emotional problems, and dependency may also lead to mistreatment.

If you are having difficulty dealing with stress related to caregiving, it is important to get the support you need through a counselor, clergy, or Association-sponsored support group. Learn more by viewing our infographic on Senior Abuse Awareness & Prevention.