“Is it safe for me to leave my loved one with dementia alone?”
This question popped up as I was working on a piece about caregiver self-care. Dementia caregivers constantly ask me “How do I take time for myself if I’m ‘on duty’ or ‘on call’ 24/7?” Most dementia caregivers know they need to take care of themselves, but they find themselves last on their lists because the needs of their loved ones seem greater than their needs. There are also times where the caregiver has to go somewhere, like a doctor’s appointment or to the hospital for a test, and taking the person living with dementia is not an option. Sometimes, the person living with dementia is insistent that they can be left alone. Yes, you want to respect their wants and autonomy. The last thing you want to do is to put in place unnecessary restrictions. But how do you know if leaving them alone is safe?
Although this was not the intention for today’s blog, you can also use the questions I provide to decide if your family member living with dementia can continue to safely live alone…or if someone needs to be with them. I will go deeper into safe living arrangements during a future blog post.
For today’s blog, I want to talk about supervision needs. Specifically, how do you know if you can safely leave your loved one with dementia alone…and for how long?
Many people living with dementia can be safely left alone for a couple of hours, and even overnight, depending on the answer to these 3 questions:
- Are they are able to safely move around their home without falling?
- Can they can independently meet their basic needs?
- Can they can demonstrate the ability to get help?
Let me explain these three items in more detail.
1. Safe Mobility
Mobility refers to moving about the home independently or using an aid such as a walker, cane or wheelchair. The “safe” part means that the person living with dementia can navigate the environment without losing his or her balance and falling. This means that the person living with dementia usually navigates the environment without observed unsteadiness or previous falls.
When I mention safe mobility, I want to note that there is no such thing as 100% fall-proofing anyone or any environment. Even when floors are kept clear, throw rugs are removed, and the environment is kept uncluttered, a mishap can happen. I live in a small, tidy house and I had a near fall the other day when I stepped on one of Amira’s toys. As I felt the toy underfoot, I thought I was stepping on one of my fur babies and I reacted quickly, nearly losing my balance. This event was an infrequent occurrence.
In the case of your family member, you need to consider if there have been past falls and if so, if the fall (or falls) was an unusual event. If you are noticing more frequent falls, or patterns to falls, then you likely should not be leaving your loved one alone.
2. Ability to Independently Meet Basic Needs
For the purpose of this blog or podcast, I am defining “basic needs” as the ability to safely and appropriately dress, correctly take medication, meet hydration and nutrition needs, and engage in personal safety. Note that I said nothing about bathing because, while bathing is important, a skipped shower or bath for a day or so does not affect your decision to leave them alone for a couple of hours or even overnight.
Safely and Appropriately Dress
The ability to safely and appropriately dress refers to putting on clothes in the correct order that are appropriate for the household temperature. The person living with dementia should be able to go into their closet or drawers and select the outfit. If they are unable to dress themselves, or if they require cueing and direction, they cannot be left alone even for a short time period. Why? Because if they are unable to perform this basic skill, they are likely operating with the self-care capacity of a 5- or 6-year-old. I don’t mean they think they are small children, because people living with dementia may forget a great deal but they always know they are adults. I mean that they may have the same self-care capacity as a very young child…and you would not leave a young child alone and unsupervised.
The person living with dementia must be able to take the correct medication at the correct time without you reminding or cueing them. It is ok to have the medication pre-poured into pillboxes. If the pillbox comes with an alarm and the person living with dementia follows the medication schedule and responds to the alarms, that is fine, too.
Many families do daily medication checks and are satisfied if they see empty pillboxes for the correct days. If the person living with dementia takes medication throughout the day, you may want to check the daily compartments in the middle of the day or before the evening medications are usually taken. Why? Some people living with dementia will take the entire day’s medications all at once. Or, they will take the morning dosages no problem, but may forget about the mid-day medication. When they see the multiple filled compartments at bedtime, they take both the mid-day and bedtime medications. This can definitely be a problem for medications that have to be spaced out throughout the day, like certain blood pressure medications. If you stop by after supper, check the pill boxes to make sure that the morning and afternoon compartments are empty. Inconsistent emptying of compartments, or medications being taken on the wrong day, indicate that your family member may be safely left alone for a couple of hours but not for any length of time that includes two or more medication times. A possible work-around for this is to check with the prescribing clinician to see if long-acting (or once daily) medications can be swapped for short-acting dosages.
Eating and Drinking
If you are planning to leave your family member alone for a couple of hours so that you can have a few hours to yourself, their ability to prepare a meal may not be a concern. What you do want to watch out for is any use of appliances that can create a fire hazard. You do not want your loved one living with dementia to decide to make a cup of tea, put the kettle on, and then forget about it. On the other hand, if you need to go somewhere for several hours and mealtimes are involved, you want to make sure that your family member can safely reheat prepared meals or is happy munching on an already-made salad or sandwich.
Some people living with dementia have difficulty with impulsive behavior and may eat large quantities of food that makes them ill. I’ve had patients with frontotemporal dementia eat 5-pound bags of candy in one sitting or consume an entire container of dry pancake mix as a meal. If this is your situation, you may want to secure problematic foods and keep small quantities of healthier foods within reach.
If you are leaving them alone for several hours, you also want to make sure that they know to stay hydrated. As I’ve discussed in other podcasts and blogs, dehydration can cause a lot of health problems, like dizziness (and then falls) and urinary tract infections. To be fair, it can be a challenge to have anyone living with dementia drink enough fluids.
This is a biggie. When I first moved into my neighborhood, I noticed my neighbor watering his garden. I approached him and asked about the trash pickup schedule. As soon as I started interacting with him, I knew immediately he had some type of cognitive problem. I saw that my question upset him, because he kept repeating that his wife told him when to take out the trash and he didn’t know the pickup schedule. Then he told me his wife was not home, and that I was welcome to come in and wait for her. I quickly changed the subject to his beautiful flower garden, and he immediately relaxed. After a few minutes of pleasantries, I said my goodbyes and returned to my house.
My neighbor’s willingness to invite a stranger into his house was not a good sign. Perhaps he was following old patterns, where his wife’s friends stopped by and visited with him while awaiting her return. But I was a stranger and unknown to him or his wife. I wish it were not so, but there are bad people who prey on the vulnerabilities of others. If you have any concern about your family member opening the door to strangers, or even inviting them into the house, you may want to reconsider leaving them alone. Or, you may want to install some type of front-door security where you can monitor who is ringing the doorbell.
Another related issue is wandering. If you have any concerns about your family member leaving the house to get the mail, or to take a walk, and then getting lost, you may want to reconsider leaving them alone for any length of time.
3. Getting Help
The last topic I want to discuss is your loved one’s ability to know that they need help and how to get help.
There have been times in my clinic where family members are not providing the level of supervision the person living with dementia needs. The family members are not being neglectful or mean. Quite the opposite. They are invested in promoting their loved one’s independence. The family members tell me that their loved one knows to call the police or the fire department “in case of emergency.” I assess this ability in clinic. I first ask, “If you see a fire in the house, what do you do?” Almost all answer, “I call the fire department.” I then hand them my cell phone and say, “Show me.” Some start to push the numbers, “9-1-1.” Others look blankly at me, confused by the request. For these people, I gently explain to the family that it is no longer safe for their loved ones to be left unsupervised. To be fair, most of these individuals living with dementia were also having trouble with safe mobility and meeting their basic needs. However, if your loved one is not having any difficulty with safe mobility and meeting their basic needs, it can’t hurt to make sure that they are able get help.
If the answers to all of these questions is “yes” (yes they
they are able to safely move around their home without falling, if they can independently meet their basic needs, and they can get needed help—then they can safely remain at home by themselves while you run some errands or take some time for yourself. If you will be away for several hours, or even overnight, the ideal situation would be to have someone check on them. If you think your loved one will fuss at you for having someone check in, you can always have the visitor bring something—like a dish or plate that they are returning (doesn’t matter if the dish or plate isn’t yours)…or flowers…or the grandkids. This way, the purpose of the visit feels more social and less like a “check in.”
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Dr. Rita Jablonski
Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.