Your goal in adapting the home for a person with Alzheimer's disease (AD) is to keep the surroundings as familiar as possible, while making the changes necessary to create a home that is calming, reassuring, safe, and supportive. This will make it possible for the person with dementia to be as independent as possible and for you to provide care as it is needed.

Creating a Safe Home Environment

Creating a safe home environment for a person with Alzheimer's disease requires changes that would be made for any older person, but you should also consider any physical or mental disabilities he or she has that are unique to Alzheimer's disease and try to plan ahead for future difficulties.

The environment should be suitable or right for the symptoms of the disease, which include:

• Memory loss
• Confusion about where he is
• Confusion about how to get to or find a particular room
• Decreased judgment
• Tendency to wander
• Poor impulse control
• Changes in vision, hearing, depth perception
• Sensitivity to changes in temperature

You can't predict every need that will come along. Alzheimer's disease symptoms get worse as time goes on. In the early stage it causes mostly thinking (cognitive) difficulties. Eventually it causes physical decline as well. In the late or severe stage, the loss of abilities such as walking has a major effect on how much care will be needed. Features of the home, such as steps and narrow bathroom doors, can become major obstacles to providing care.

While the behavior of the person in your care may sometimes seem highly unpredictable, and leave you feeling off balance and upset, you may feel more in control if you learn what to expect in the future because of the disease and make the changes to your home early on. This way you know you are getting as ready as you can for what will follow.

Not all changes to the home need to be made at once. Remember that it is difficult for a person with AD to adjust to changes in the environment. For this reason, it may be best to make some changes when the person is in the early stage of the illness and will have the easiest time getting used to them.

If you are making changes to a home in which you do not live, your parent's home, for example, be aware and sensitive to what these possessions mean to the elderly person and proceed with sensitivity. While sorting, you may come across an old childhood item of yours that your parents saved and you haven't thought about in years. The tug at your heart as you move it to the get-rid-of pile is a hint of the challenge and pain that is part of Alzheimer's care.

Some caregivers feel that so much is already being asked of them that to change a home that is familiar and pleasant is very distressing. Thoughts like, ''I don't want my home to look like a hospital'' are completely understandable. Each caregiver has to find her own way of dealing with this. Your dislike of adjusting to a raised toilet seat, for example, can give you insight into the adjustments a person with Alzheimer's needs to make just as the disease is slowly robbing him of the ability to have a say about those changes. Having compassion for the person with the illness will help you to plan for gradual changes to the home that will be needed as the disease progresses. Having an understanding of the disease will help you feel less resentment about them.

When the necessary changes are made, the home will be safer. The person with Alzheimer's disease will be able to function better, and your job as a caregiver will be less physically and emotionally stressful. The chance of a fall, an accident, and frightening experiences such as having the person in your care wander away from home will be reduced. As you think about the safety you will gain, adapting the home may seem much more worthwhile. You may find that in the end you are pleased with the steps you have taken to improve the quality of life of the person with AD and the care you can provide.

Although the list of suggestions is long, only make those changes that are relevant to your situation. The fewer changes made to get the job done the better.