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My friend had the privilege of living in the beautiful, finished basement of his daughter and son-in-law during his final years while living with dementia.  His family worked diligently to make the stairs to his suite downstairs as safe as possible.  He climbed those stairs every day until the final ten days of his life. It is my professional opinion that climbing those stairs was part of helping him enjoy maximized safety and physical ability until the end of life….which meant that he rarely had a fall and he was able to ambulate with simply a cane. We were able to go out and about in the community until the week before he passed.  Climbing those stairs was an important part of him having a far richer experience of life.

Quick, important side note:  every person living with dementia that I have the privilege of knowing has expressed their desire to live fully, which means there is some risk.  Please also remember that many have signed a Do Not Resuscitate document years before, when their cognitive skills were such that they were able to determine that living in a seriously compromised state; dependent on people and machines and drastic measures is not their wish.  So, when you are tempted to limit the life of someone living with dementia because of fear of risk, remember that they documented their desire to live fully until living fully was no longer possible. 

Even so, we do all we can to help folks remain safe in their homes.  Here are some tips regarding stairs: 

Stairs: stairs are our friend (when we make them safe!).  Stairs are an important way for people with dementia to move their bodies in ways that help their hips and legs and arms remain stronger and more capable.  But, we must make stairs safe.

• Install a second stair rail opposite the original stair rail, so folks have something for each hand to hold onto as they climb up and down the stairs.  Folks often resist this idea (caregiving by stealth may be useful here), but once the extra rail is installed, every person naturally uses that second rail and expresses relief at having two rails to give them a greater sense of confidence and stability while climbing the stairs. 
  • The two rails should be parallel.
  • Have the rails extend 4-6 inches beyond the beginning or end of the stairs so folks have rails to hold onto before they begin to go up or down the stairs.
• If the stairs have a slippery surface, and there is a chance that folks will use the stairs while wearing socks, place a non-slip stair tread rug on each step, making sure that the tread rugs are low pile, with no edges that stick up.  
• Install motion sensor lighting along the bottom of the stairwell walls so that light illuminates the stairs as people use the stairs.  
• If folks need to carry items up and down the stairs, such as laundry, consider having laundry be a task in which the person and a caregiver partner together, so the person with dementia gets to feel like they are doing normal tasks, but with the caregiver carrying the laundry up and down the stairs. This makes that two-hand grip on the stair rails possible for our companions with dementia.
• If a person has regular dizziness, lightheadedness, or expresses worry about people falling down the stairs, and they do not need to use the stairs, consider installing a very secure, solid-looking gate at the top of the stairs.  

We cannot account for and prevent every potential risk in a home, but we do our best to make the home a safe place in which people can continue to live and live well.  

Watch for more home safety tips, coming soon.  Please note that our safety tips will capitalize on living well, and living fully, versus living in fear of risk.  Ponder your own wishes for a moment…would you rather live fully with some risk, or live minimally because of fear of risk.  My observation is that our folks who are older and our folks living with dementia would choose to live fully every time.

Convinced because of what my companions with dementia have taught me,

Jill