By  Marlo Sollitto updated January 2022

When an aging loved one is diagnosed with Alzheimer’s disease, their family often chooses to care for them at home for as long as possible. The comforts of a familiar environment can be highly beneficial but keeping Alzheimer’s patients at home becomes increasingly difficult as they decline. Each day brings new challenges, unexpected behaviors, and changes in functional abilities.

There are no one-size-fits-all solutions in dementia care, so Alzheimer’s caregivers usually devise their own strategies for dealing with a loved one’s unique mix of symptoms. Furthermore, the effectiveness of certain strategies is likely to change throughout the course of a patient’s illness. The only way to find out what works for you and your loved one is through constant trial and error.

Devise a Daily Routine

In much the same way that a familiar home environment is reassuring, establishing a daily sequence of tasks and activities also helps keep Alzheimer’s patients focused and oriented. Begin by observing your loved one’s daily routines and looking for patterns in their mood and behavior. This information will help you alter your expectations and optimize your care plan. For example, if they tend to be less confused and more cooperative in the morning, then adapting your routine to make the most of those lucid moments may help the entire day go more smoothly.

Keep in mind that Alzheimer’s patients’ abilities and preferences often fluctuate from day to day, so try to be flexible and adapt as needed. From there, consider incorporating the tips below into your Alzheimer’s care plan to ensure a long, safe and successful home-based care experience for you and your loved one.

Learn Alzheimer’s Communication Tips

Communicating with a person who has Alzheimer’s disease can become incredibly challenging, but much of what a family caregiver does depends upon mutual understanding. Without clear communication, both caregivers and patients are left feeling frustrated and misunderstood. When combined with ample practice and patience, the following suggestions can improve interactions and facilitate daily care tasks.

• Choose simple words and short sentences and use a gentle, calm tone of voice.
• Speak slowly and clearly, but do not talk to the person with Alzheimer’s like a baby.
• Maintain respect; don’t speak about them as if they weren’t there.
• Minimize distractions and background noise, such as the television or radio, to help the person focus on and process what you are saying.
• Allow enough time for them to respond and be careful not to interrupt.
• If you can’t understand what they are trying to say, look for nonverbal clues and take their surrounding environment into consideration.
• Learn to interpret gestures, descriptions, and substitutions.
• Offer choices instead of asking open-ended questions.

Adapt Activities of Daily Living

Activities of daily living (ADLs) are basic personal care tasks that most people can do independently, but they become increasingly difficult for Alzheimer’s patients as their functional abilities decline. Understanding how memory loss impacts each ADL, timing them wisely, and adapting the steps and products involved will ensure they are completed in a way that preserves your loved one’s dignity.

Bathing

For many people with Alzheimer’s disease, bathing is a frightening and confusing experience. Elders may think they have showered recently, but in reality, their last shower was days or even weeks ago. They can become confused by the process or become afraid of the water and the possibility of falling. Sensitivity to these issues and planning ahead can help make bath time easier on both of you.

• Make sure you have all bath products, towels, and assistive devices you need set up before bringing your loved one into the bathroom. Draw the bath ahead of time.
• Be sensitive to the temperature of the water and the air. Warm up the room beforehand if necessary and keep extra towels and a robe nearby. Test the water temperature before beginning the bath or shower.
• Minimize safety risks by using a hand-held showerhead, a shower bench, grab bars, and nonskid bathmats. Never leave the person alone in the bathtub or shower.
• If they need help bathing, move slowly and tell the person what you are going to do step by step. Allow him or her to assist in the process as much as possible.
• Bathing may not be necessary every day. A sponge bath can be effective between full showers or baths.

Dressing

Getting dressed may not seem very complicated, but Alzheimer’s patients and caregivers face some unique hurdles with this task. Both physical and cognitive decline affect an elder’s ability to recognize when it is time to change soiled clothes, choose appropriate items to wear, and take off/put on clothing and footwear. Minimizing these challenges can make a significant difference in a loved one’s sense of control and independence.

• Always set aside extra time before outings and appointments so they can dress themselves as much as they are able without added pressure or having to rush.
• Allow them to choose what they want to wear from a limited selection of outfits. If he or she has a favorite outfit or clothing item, consider buying multiples or the same style in a few different colors.
• Store some clothes in another room to reduce the number of options they have to choose from. Too many options can overwhelm Alzheimer’s patients who are trying to make a decision. Keep only a couple of outfits in their closet or dresser.
• Arrange clothing items in the order they are put on to help guide them through the process.
• Choose clothing that is comfortable, easy to get on and off, and easy to care for. Dressing aids and adaptive clothing items featuring elastic waistbands and Velcro closures minimize struggles with finicky fasteners like buttons, zippers and shoelaces.

Toileting and Incontinence Care

As the disease progresses, many people with Alzheimer’s begin to experience toileting difficulties and reduced bladder and bowel control. Incontinence can be upsetting and embarrassing for a senior and difficult for their caregiver to address and manage. Sometimes incontinence is indicative of a physical illness, such as a urinary tract infection (UTI), so be sure to discuss changes with their doctor as soon as possible.

• Practice timed voiding where you create a bathroom schedule and stick to it as closely as possible. For example, take toileting breaks every three hours during the day, and don’t wait for the person to ask. This includes tracking when accidents happen to help plan ways of avoiding them.
• Watch for nonverbal cues that an elder may have to go to the bathroom, such as restlessness or pulling at clothes, and act quickly.
• To prevent nighttime accidents, limit fluid intake in the evening hours just before bedtime.
• Plan ahead for outings. Look up restroom locations, have the senior wear simple, easy-to-remove clothing, and bring an extra set of clothes and incontinence supplies in case of an accident.

Eating

Some people with Alzheimer’s disease want to eat constantly, while others struggle to get adequate calories and nutrients. Eating and drinking involve the senses as well as coordinated fine motor functions, all of which can be impaired due normal aging processes and Alzheimer’s disease. Making some mealtime adjustments can help a loved one get the nutrition they need and maintain a healthy weight.

• Allow the person to choose what they would like to eat but limit the number of options to choose from. Try to offer appealing foods that vary in taste, texture, and color.
• Serve small portions or several small meals throughout the day. Large portions can be overwhelming for dementia patients.
• Choose dishes and eating utensils that promote independence. If the person has trouble using utensils, use a bowl instead of a plate or offer utensils with thicker, easier to grasp handles. Difficulty using utensils can also be addressed by serving finger foods, such as small sandwiches, chicken fingers and fruit pieces.
• Use straws or cups with lids to make drinking easier and minimize messes.
• As the disease progresses, be aware of the increased risk of choking and aspiration due to difficulty swallowing, a condition known as dysphagia.

Find Engaging Activities and Encourage Socialization

Incorporate activities and hobbies that match your loved one’s interests and abilities into their daily care plan. Building on current skills generally works better than trying to teach something new.

• Help the person get started and break activities down into small steps.
• Watch for signs of agitation or frustration. If they become irritated, gently help, or redirect their attention to something else.
• To help maintain functional skills, enhance feelings of personal control, and make good use of time, try to include them in an entire activity process. For instance, at mealtimes, encourage the person to play a role in helping prepare the food, set the table, and clean up afterwards.
• Take advantage of adult day care services for Alzheimer’s patients, which provide various activities and social opportunities for seniors as well as respite time for caregivers.

Sundowning and Sleep Problems

Many people with Alzheimer’s become restless, agitated, and irritable in the late afternoons and evenings. This is referred to as sundowning, sundowners or sundown syndrome. Explore these suggestions for managing the mood and behavior changes and poor sleep that occur due to sundowning.

• Encourage exercise and more physically demanding activities earlier in the day, as it tends to improve sleep quality. For example, move stimulating or stressful activities like bathing to the morning.
• Limit naps later in the day, but make sure the person gets adequate rest. Fatigue can increase the likelihood of late-afternoon restlessness and exacerbate sundowning.
• Set a quiet, peaceful tone in the evening by limiting family activities and other distractions. Eliminate loud noises, play soothing music, and minimize television watching, as it can be stimulating.
• Ensure the home remains well-lit if darkness and shadows appear to trigger fear, pacing or other sundowning behaviors.

Hallucinations and Delusions

As the disease progresses, an older adult with Alzheimer’s disease may experience hallucinations and/or delusions. Learning how to respond to these symptoms is a critical component of Alzheimer’s care and often takes lots of practice.

• Hallucinations and delusions can be signs of physical illness, such as a UTI. Keep track of what the person is experiencing and discuss it with their doctor as soon as possible.
• Do not argue with the patient about what they are experiencing. Instead, validate their feelings and reassure them if they are afraid.
• Avoid violent or disturbing television programs and movies. The person with Alzheimer’s may not be able to distinguish them from reality.
• Make sure the person is safe and does not have access to anything he or she could use to harm themselves or others.

Wandering

Some people with Alzheimer’s disease develop a tendency to wander away from home, which can be incredibly dangerous. Developing a wandering prevention plan protects patients from eloping and getting lost. The onset of wandering behavior can occur at any time and without warning, so taking proper precautions is crucial.

• Notify neighbors and local authorities in advance that your loved one tends to wander. Ask them to contact you or the police immediately if the individual is seen alone off their property. Check with your local police department or fire department to see if there is a program in your area for tracking and locating wanderers.
• Keep exterior doors locked. Consider a keyed deadbolt or an additional lock up high or down low on the door. If the person can open a lock because it is familiar, installing a new type of latch or lock may help.
• Install an alarm or “announcing system” that chimes when exterior doors and windows are opened.

Improve Home Safety

Alzheimer’s caregivers must view their homes through new eyes in order to identify and correct hazards. Creating a safe home environment can prevent many stressful and dangerous situations. This process begins with a safety assessment of every room in the home, which an aging in place specialist or occupational therapist can assist with if desired.

• Remove the locks on bathroom and bedroom doors to prevent seniors from accidentally locking themselves in.
• Label all medications and keep them in a locked cabinet or medication box.
• Make sure knives, scissors, lighters, matches, guns, power tools and any other potentially dangerous items are secured and out of reach.
• Keep the house free of clutter and remove throw rugs or any other hazards that might contribute to a fall.
• Be aware of and anticipate kitchen safety issues, such as forgetting to turn off the stove or oven. Consider installing an automatic shut-off switch on appliances to prevent burns and house fires.

Address Driving Issues

Alzheimer’s disease directly affects the physical and cognitive abilities needed to safely operate an automobile. Making the decision to take away the car keys is notoriously difficult for families, and it needs to be communicated and executed carefully. Even though the person may be upset by this blow to their independence, safety must be the priority.

• Look for clues that they can no longer drive safely, including getting lost in familiar places, driving too fast or too slowly, disregarding traffic signs, getting angry or confused, and signs of damage on their car.
• Be sensitive to their feelings about losing the ability to drive but be firm in your request that they no longer do so. Be consistent; don’t allow them to drive on “good days” but forbid it on “bad days.”
• When it’s time to stop driving, your loved one may vehemently resist. Instead of arguing, provide other options for transportation that will help them maintain their routines.
• Ask the doctor to use their position of authority to persuade your loved one to stop driving. The doctor can also contact the local Department of Motor Vehicles (DMV) and request that their driving skills be reevaluated.

Learn About Burnout in Alzheimer’s Caregivers

Dementia care is incredibly demanding and emotionally challenging. Deciding to care for a loved one with Alzheimer’s at home is a huge decision that affects all aspects of a family caregiver’s life. Taking steps to prioritize self-care is crucial for your well-being and that of your care recipient.