Making Your Home Safe for Someone with Dementia

By Kerri Fivecoat-Campbell | Originally published by Next Avenue | July 30, 2025

Lee and her husband, Ray, were both excited when they decided Ray would fly to Hawaii to meet Lee. Lee had spent several weeks visiting their son and great-granddaughter there. (Next Avenue is using their middle names to protect their privacy.)

Ray had been showing signs of progressing dementia for at least two years, but he managed well at home while Lee was in Hawaii, preparing meals and taking care of their dogs.

That changed when Ray had three connecting flights on his journey from their home in Sioux Falls, South Dakota. “(Ray) was excited, stressed and tired before the flights began,” Lee says.

“About 20% of people with dementia develop psychotic symptoms, and it’s most likely to happen when they are disconnected from familiar faces and places.”

By the time he boarded his flight from Seattle, Washington, to Hawaii, he became paranoid and delusional, experiencing hallucinations that a grim reaper-like figure was throwing people from the plane.

When he disembarked in Hawaii, he was convinced the figure was chasing him. Ray ran into a gift shop, swiping merchandise to the floor and knocking a digital device from someone’s hands. “He was trying to get them to call the police so they would arrest him and take him somewhere safe,” Lee recalls.

When she found Ray, he was surrounded by police and paramedics, who determined he was experiencing a psychotic breakdown.

Fortunately, instead of being arrested, he was taken to a hospital and put on a 24-hour hold. After determining it was safe, he was released to Lee the next day.

“About 20% of people with dementia develop psychotic symptoms, and it’s most likely to happen when they are disconnected from familiar faces and places,” says Evan Ciarloni, M.D., a specialist in geriatric and internal medicine and a medical adviser for Kinnect in Jackson, Mississippi.

Creating Safe Spaces

“One of the things caretakers often do is think their loved one with dementia has more functional capacity than they do,” says Tina Sadarangani, Ph.D., R.N., and an assistant professor at New York University in New York.

She adds there are 53 million caregivers helping care for patients with some form of dementia. “It’s really an unheralded position and even professionals find it hard to stay objective and look at how far the disease has progressed,” Sadarangani says. “That’s why it’s so important for a professional to monitor the progression of the disease. Since it is progressive, earlier diagnosis and adaptations can help the patient stay safer, provide them more function and stay at home longer.”

“One of the things caretakers often do is think their loved one with dementia has more functional capacity than they do.”

Ciarloni adds that making the home safe begins by having a primary care physician who specializes in geriatric issues. “There is a shortage of neurologists, and they are overwhelmed with patients,” Ciarloni says. “Doctors who specialize in geriatrics typically have some training in memory care and we can help caregivers be proactive. The right team will help the patient maintain their independence and dignity.”

Local doctors who specialize in geriatric and memory issues can be found through a simple internet search. “If you live in a rural area, connecting with the nearest academic medical center or telemedicine may be an option,” Ciarloni says.

Once the caregiver finds a physician who specializes in geriatrics, caregivers should make sure the patient is evaluated at least every six months so their doctor can monitor the progression of the disease, as well as recommend occupational therapists to assess the home and lifestyle.

Until a home can be assessed by a professional, Sadarangani says caregivers should examine their lifestyle and home room by room to mitigate potential dangers and prevent potential disasters.  

Lifestyle Concerns

Establish a routine. Ciarloni says one of the most important lifestyle aspects is establishing a routine and sticking to it as much as possible. “It helps reduce the possibility of anxiety, agitation and depression if the patient knows what to expect from each day,” Ciarloni says.

Take away the car keys. “This is usually the most difficult and complex conversation to have with a patient,” Sadarangani says. “You know it’s time if you don’t feel comfortable having kids or grandkids in the car with them.” Sadarangani says occupational therapists can do a driving assessment or you can ask your doctor to have the conversation with the patient. “Sometimes the patient will be more willing if you tell them it’s not about their safety, but the safety of everyone else.”

“You know it’s time if you don’t feel comfortable having kids or grandkids in the car with them.”

Ensure the patient is getting physical activity. If a patient is able, going to an exercise class at a senior center or gym can also help them with social interaction. If they are unable, Ciarloni says it’s important they maintain their physical strength with an occupational or physical therapist at home.

Ensure social interaction. Social interaction through church, senior centers or other activities will help the patient with depression and anxiety.

Make sure the patient engages in activities that give a sense of purpose. These can include hobbies such as art, writing and other activities, and also household chores, so they feel they are contributing, such as cleaning, helping with laundry or gardening.

Room-by-Room Considerations

“The goal is to create a safe space that is also soothing and comforting,” Sadarangani says. “The home should have as little furniture as possible and be clear of clutter, which can cause a tripping hazard.”

Sadarangani says a major source of falls includes area rugs, which should be removed from the home. Sadarangani also suggests that caregivers help organize medications and monitor them daily. Door alarms, video cameras and tracking devices that patients wear, as well as on their phones, may help if patients begin to wander.

“Bathrooms are a major danger zone, but the goal is helping the patient maintain privacy while making it a safer place.”

Bathrooms: “Bathrooms are a major danger zone, but the goal is helping the patient maintain privacy while making it a safer place,” Sadarangani says.

The following can be installed in the bathroom or adjusted for safety:

• Grab bars by the toilet and in the shower
• Raised toilets, which help prevent falling
• Handheld shower head, which may encourage patients reluctant to shower to do it more often
• Non-slip mats in the shower
• Shower seats if the patient has a high risk of falling
• Lowering the temperature on water heater to prevent scalding
• Securing or removing medications
• Installing a bidet attachment to the toilet which may help reduce the risk of urinary tract infections  

Kitchens. Cluttered kitchens with sharp objects are also an area of concern in the home.

• Remove and secure any cleaning supplies that may be harmful
• Remove and secure sharp objects such as knives
• Label cabinets and drawers which helps patients reduce frustration and reduce the occurrence of anxiety and agitation

Bedrooms. “One of the most overlooked rooms in the house is the bedroom,” Sadarangani says. “Many falls happen at night, so it’s important to make it as safe as possible.” She recommends these simple steps:

• Installing nightlights
• Making sure there is a phone on the bedside table with emergency contacts easy to find
• If the patient is having bladder issues and must get up in the night, a bedside commode may help reduce the risk of falls

Caring for the Caregiver

The experts remind caregivers that part of creating a safe and healthy environment includes caring for themselves by seeking respite care, engaging with others going through the same experiences in caregiving groups and making sure they are eating properly, getting enough rest and taking advantage of other services.

“I think my greatest fear is that I might die first. That would leave him with no one.”

Since returning home, Lee has established a routine. She also drives Ray where he needs to go, including to work out at a local gym three times a week. She has assigned him household tasks so he will feel useful, including in the garden, which they both enjoy. They’ve joined a senior center that offers secure daycare options and respite. She’s removed the area rugs from the home and checks in on Ray when he is sleeping and showering. She is currently having a family member install a tracking app on his phone.

Still, she feels overwhelmed and fearful. Lee is 78 and Ray is 75. “I think my greatest fear is that I might die first. That would leave him with no one,” she says.

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