Dementia care at home: safety, routines and the help Medicare offers

Dementia changes a house. Doors that were never locked need alarms, the stove needs a plan, and a simple conversation needs a slower pace.^1,2 This note covers home safety, daily routines and communication, getting a diagnosis and a plan, what home health can and can’t do, and the Medicare program and helpline built for dementia care.

The short answer

• Make the house safe: alarms on the doors, an ID bracelet, stove knobs off when the stove isn’t in use, and medicines, weapons and sharp objects locked up.¹
• Don’t leave someone with advanced dementia alone at home.¹
• Speak quietly and simply, one step at a time, and don’t argue about a wrong memory.²
• Medicare Part B covers a separate visit to assess memory and thinking and make a care plan.³
• Home health helps when there’s a skilled need, but Medicare doesn’t cover personal care when it’s the only care someone needs.⁴
• The Alzheimer’s Association’s free helpline answers at any hour at (800) 272-3900.⁵

Making the house safe

MedlinePlus suggests:¹

• Wandering. Put alarms on doors and windows, and a stop sign on outside doors. Have the person wear an ID bracelet or necklace with their name, address and phone number.
• The kitchen. Take the stove knobs off when the stove isn’t in use, and lock up sharp objects.
• Medicines and other dangers. Lock up all medicines, including over-the-counter medicines and supplements, along with alcohol and weapons.
• Water and chemicals. Turn down the water heater temperature, and lock up cleaning products and other poisons.
• Falls. Look for tripping hazards and remove them.
• Supervision. Don’t leave someone with advanced dementia alone at home.

Preventing falls at home has a room-by-room checklist.

Routines and communication

Small changes in how the day runs and how people talk can head off a lot of frustration. MedlinePlus advises:²

• Keep habits and routines easy to follow, and the same from day to day.
• Keep clocks and calendars where the person can see them.
• Speak in a quiet voice. Talking louder won’t help.
• Use short, plain sentences, and speak slowly.
• Break directions into small, simple steps, and give the person time to answer.
• If the person gets frustrated, switch to another activity. If they remember something wrong, don’t insist on correcting it.

A diagnosis and a plan

Medicare Part B covers a separate visit to review memory and thinking, confirm a diagnosis such as dementia or Alzheimer’s disease, and make a care plan. The provider may examine the person, review their history and medicines, identify the people who support them and help update their advance care plan. A spouse, friend or caregiver can come along.³ After the Part B deductible, the person pays 20% of the Medicare-approved amount.³

That visit is a good time to start, or update, advance care planning, while the person can still say what they want.

What home health can and can’t do

Home health is skilled care. Someone with dementia can qualify when there’s a skilled need, like a wound, new medicines to manage after a hospital stay, or therapy after a fall, and they meet Medicare’s other conditions.⁴ The complete guide to home health lists them.

Medicare doesn’t pay for 24-hour care at home, or for personal care like bathing and dressing when that’s the only care someone needs.⁴ That kind of help is home care, which is paid for differently. Home health or home care explains the difference.

Medicare’s dementia care program

Medicare is testing a dementia care program called GUIDE, an 8-year model offered in every state. It gives people with dementia a care team that includes a trained care navigator, and it gives caregivers training, ongoing support and a 24/7 support line. Some participants can also get respite, a break for the caregiver, which Medicare doesn’t otherwise cover outside hospice.⁶

It’s for people with Original Medicare Parts A and B who live in the community, not in a long-term nursing home, and who aren’t in Medicare Advantage, hospice or PACE.⁶ Ask the person’s doctor whether a GUIDE program serves your area.

Help for the caregiver

The Alzheimer’s Association’s helpline answers at any hour, every day of the year, at (800) 272-3900. It’s free, it can connect callers with an interpreter in more than 200 languages, and callers can talk with a master’s-level dementia care consultant at no charge.⁵

Dementia care is long work. Ask for help before the caregiver runs out, not after.

When dementia advances

In the later stages, the questions change. Hospice for dementia explains the signs families notice and what Medicare covers.