Equipment, adaptations and improvements to the home

There are many different types of equipment that may enable people with dementia to remain independent for longer or make it easier for others to give support. Adaptations and improvements to the home may also help a person to stay at home for longer. Of course, each person is different. What may be useful for one person at a particular stage may not be appropriate for another. This factsheet looks at where you can go for advice and suggests some equipment and adaptations to consider. It explains how you can get equipment and the help that the NHS and social services can provide. It then gives details of financial help that may be available.

People with dementia may find it harder to learn new skills or adjust to new ways of doing things due to gradual loss of memory or other abilities such as concentration. It can be helpful to introduce any equipment or make changes to the home in the earlier stage of the illness.

Where to get advice

If you are considering getting equipment for yourself, or someone you know, or are making adaptations to your home, seek advice from professionals as soon as possible. The following professionals should be able to help.

• An occupational therapist (OT) can advise on equipment and useful strategies to help someone with dementia with everyday activities, such as washing and dressing. As the dementia progresses, they can advise on appropriate ways to cope with the changes. OTs work in health and social services and in private and voluntary organisations. You can contact an occupational therapist through the GP or hospital consultant, through social services or, for independent OTs, contact the College of Occupational Therapists (see 'Useful organisations' at the end of this factsheet).
• A qualified physiotherapist (known as a 'chartered physiotherapist') can advise on mobility aids, such as walking frames and wheelchairs, and on safe ways of helping someone with dementia to move. If the person attends hospital, they can ask to speak to a physiotherapist based there. Otherwise, ask the GP for a referral to the hospital physiotherapy department.
• A district nurse can advise on the kind of equipment needed for nursing someone at home. Contact the district nurse through your GP surgery or health centre.
• A continence adviser can advise on problems relating to incontinence and give information on a range of aids. Most areas have a continence adviser - ask your GP.

Types of equipment to consider

Many of the devices designed to help with common problems experienced by older people are very useful for people with dementia. Examples include mobility aids and equipment for maintaining continence. Other devices are designed to address the specific needs of people with dementia. These include memory aids and equipment to help with taking medication.

Products that can help with the difficulties that people with dementia experience include:

• memory aids, such as clocks with large faces or notice boards for messages
• equipment for washing and for using the toilet, such as bath seats or raised toilet seats
• equipment for maintaining continence and personal dignity, including commodes, continence aids and dressing aids
• equipment for eating and drinking, such as specially adapted cutlery or non-spill cups
• equipment to help people to continue to participate in household activities such as cooking and cleaning, including kettle tippers and adapted kitchen tools
• mobility aids, including walking frames and wheelchairs
• transfer aids such as bed sticks, transfer turntables and hoists, which help people to move from a bed to a chair, for example
• adaptations to seating and beds, such as chair or bed raisers
• safety devices, such as gas detectors and water-level alerts
• equipment to help the person take medication, such as boxes with a pill compartment for each day of the week
• nursing equipment, including bedpans or pressure relief mattresses
• assistive technology - devices or systems to reduce risk and help with various tasks and activities (see factsheet 437, Assistive technology - devices to assist everyday living).

It is useful to keep in mind that equipment is not always the answer. It may be enough to make small changes in the way that daily activities are organised.

Adaptations and improvements to consider

Some people with dementia have difficulty moving around the home or managing daily activities, such as getting in or out of the bath. Changes to the person's home can help them to cope better with the difficulties they experience and maintain their independence. Adaptations to the home range from putting up grab rails to adding ramps or wide doors for wheelchairs, or installing specially designed shower and toilet facilities.

As well as helping with mobility problems, adaptations can also make the person's home more 'dementia friendly'. Handrails, signposting and extra lighting can make it easier for the person to find their way around the house.

Design changes, such as using contrasting colours around the home, are very useful in making items easier for people with dementia to identify. This includes using contrasting colours for cutlery, crockery and tablecloths, and toilet seats, handrails, towels and soap that contrast with the rest of the bathroom. It can also be helpful to label cupboard doors with a picture of what is kept in there.

Improvements or repairs could include draught-proofing or improving heating systems. They may help the person with dementia to remain at home.

Where to get equipment

Equipment may be available through health or social services, or through shops and other specialised sources.

Buying equipment privately

Some people are provided with funding (known as a 'personal budget') by health or social services, which they can use to buy or hire their own equipment. Others may choose to buy or hire equipment themselves when the equipment that they want is not available from health or social services, or if the wait is too long.

Before buying, ask for a product demonstration and seek professional advice. Sources of advice include the Disabled Living Foundation and AT Dementia (see 'Useful organisations'). If you are buying equipment specially designed to help with disability, such as a wheelchair, it should be exempt from VAT. Check before buying.

Ask yourself the following questions:

• Is it easy to use?
• Is it fit for purpose (ie, does it do what it says it does)?
• Are spare parts easily obtainable? Are they expensive?
• Does the equipment need regular servicing? Who pays for this?
• Is it safe? Equipment that conforms to European safety standards will have a CE kitemark. You may also see a BSI mark on some products. This means they have been tested and approved by the British Standards Institution.

You can buy equipment from many different sources, for example:

• many suppliers have mail order services or an online shop
• some items may be available from local shops, such as pharmacies
• sometimes the best 'equipment' may be a simple household item from an ordinary shop, such as a noticeboard for reminders or Velcro fastenings for clothes.

It is advisable to buy from businesses that are operating under an Office of Fair Trading (OFT) approved code (these will display the OFT approved code logo).

If you only need equipment on a short-term basis you may consider hiring it. Your local British Red Cross centre may hire or lend wheelchairs and other items. Alternatively, you might be able to hire the item from a specialist hire company or from the manufacturer or supplier. Ask the Disabled Living Foundation or your nearest Disabled Living Centre for details (see 'Useful organisations' for contact details).

What social services can provide

A social worker can assess a person to see if they qualify for support by having what is known as 'eligible needs'. The local authority is responsible for providing the person with any equipment for daily living that is required to meet these needs. An occupational therapist can also visit the home to assess if any equipment or adaptations are needed. This is called an occupational therapy home assessment. If you are unhappy with the length of time that you are having to wait for an assessment, or for equipment to be delivered, then use the social services complaints procedure. Social services will explain how to do this.

The occupational therapist (OT) will advise on whether or not a particular adaptation or piece of equipment may be helpful to meet the person's individual needs. The OT can arrange minor adaptations, such as handrails, adapted cutlery and special chairs through social services. Community equipment, aids and minor adaptations that assist with living at home or aiding daily living and cost under £1,000 should be provided free of charge in England. However, your local authority will have eligibility criteria for the daily living aids and adaptations it will fund.

If major adaptations are needed, the OT will explain what steps to you need take. Grants towards the cost may be available in some cases (see 'Grants and assistance available from local authorities' below, for more information).

An assessment is usually required if you are applying for a grant from the local authority to help meet the cost of any adaptation due to disability. Carers can also ask the local authority for an independent assessment of their needs if they are providing a substantial amount of care on a regular basis. These needs may include adaptations to help them to provide care.

What the NHS can provide

The NHS can provide certain types of equipment, such as walking sticks, walking frames and wheelchairs to aid mobility. These are provided on long-term loans. You can arrange this through the GP, hospital consultant or physiotherapist. There is no charge for equipment, but there may be a returnable deposit. Community equipment for home nursing, such as commodes, is usually provided through the NHS. Depending on where you live, equipment for daily living, such as shower chairs and raised toilet seats, might be provided by the local authority.

Wheelchairs, which are available from your local NHS wheelchair service, are usually standard models although some health authorities offer voucher schemes towards the cost of a more expensive chair. Ask your wheelchair service about this. The NHS will pay for servicing and repairs, as long as these are not due to misuse or neglect.

Equipment needed for nursing someone at home, such as bedpans, pressure relief mattresses, hoists or hospital beds should be available on free loan from your NHS community health service. The most appropriate team member will assess the need for such equipment.

If you have a complaint about equipment, contact your local health authority or health trust.

Grants and assistance available from local authorities

You may be able to get a grant or other assistance from your local authority to allow you to make adaptations or improvements to the home. The types of support outlined below may be available.

Disabled facilities grants

Mandatory disabled facilities grants are designed to help meet the cost of adapting a property for the needs of a disabled person. These can be awarded for:

• improving a disabled person's access to and from their home
• making the home safe for a disabled occupant and anyone else living with them
• improving a disabled person's access to the main family room in their home
• improving a disabled person's access to their bedroom or providing a new bedroom
• improving a disabled person's access to the bathroom or providing a new bathroom, and making it easier for the person to use the facilities
• making it easier for the disabled person to prepare and cook food
• improving the heating system or providing a suitable new heating system
• making it easier for the person to move around the home to enable them to care for someone dependent on them, who also lives there
• improving or moving controls for heating, lighting and plug sockets.

Disabled facilities grants depend on a person's financial situation (they are 'means tested'). The means test is applied to the person with disabilities and their partner, if they have one, even if the disabled person is not the applicant for the grant.

Disabled facilities grants are generally administered by the local housing authority rather than the social services department, although this may vary across different authorities. An application form should be available from the grants department of your local authority offices.

Discretionary powers to assist with housing repairs, adaptations and improvements

Legislation introduced in July 2003 brought about changes in the powers of local authorities to provide assistance with housing repairs, adaptations and improvements. Local housing authorities now have wide discretionary powers to provide these types of assistance. They have the power to set their own conditions for assistance, such as whether to perform a means test, and to set the circumstances under which financial assistance should be repaid. Assistance can be given in the form of a grant, a loan, labour, materials, advice, or any combination of these. Local authorities may also require some sort of security for any financial assistance they provide, including taking a charge on a person's home if they own it.

Local authorities can help owner-occupiers, tenants or landlords. They must have a published policy setting out the type of assistance they are willing to provide and under what circumstances. If you are interested, ask your local authority for a copy of its policy.

Grants for keeping the home warm

Keeping the home warm is important. Older people tend to feel the cold more easily, as do people with dementia who have become less active. Grants may be available to improve heating and insulation in the person's home. Local authority grants may be available (see above) or you may be able to receive a grant through one of the following government-funded schemes.

In England

Under the Warm Front Scheme, help towards improvements in insulation, room heating and water heating is available to people who receive a qualifying benefit. Warm Front provides a package of installing insulation and improving heating worth up to £3,500.

People who receive Income support, Pension credit, Housing benefit, income-based Jobseeker's allowance, income-related Employment and support allowance, certain pension or disability premiums, or council tax benefit may be eligible for a grant under the Warm Front Scheme. Contact Warm Front for details (see 'Useful organisations').

If you do not qualify for the Warm Front Scheme, you may be able to get a £300 rebate towards the cost of repairing your heating system or installing new central heating if you do not have it. You must be over 60 and own or privately rent your home.

In Wales

Nest is the Welsh Government's fuel poverty scheme, which replaced The Home Energy Efficiency Scheme (HEES) in April 2011. Nest provides a free home energy assessment and home improvements for people in receipt of means tested benefits and living in the hardest-to-heat homes.

In Northern Ireland

The Warm Homes Scheme offers grants of up to £850 towards insulation and heating improvements for people who receive a qualifying benefit. Some people who apply for the Warm Homes Scheme will be identified as needing extra help through Warm Homes Plus. They may be able to receive support up to the value of £4,300 to pay for improvements such as a new central heating system if they do not have one, or the conversion of an existing system.

Other sources of funding

Social fund

You may be eligible for a community care grant from the social fund to help with the cost of minor repairs or improvements if you are receiving income support, income-based Jobseeker's allowance or Pension credit. Ask about the social fund at your local Jobcentre Plus office.

Charities

Some charities and trusts may offer help towards the cost of minor adaptations or repairs. Ask at your local library, advice centre, Citizens Advice Bureau or other local agency, such as a housing advice agency. Alternatively you could contact Charity Search (see 'Useful organisations' at the end of this factsheet).

For details of Alzheimer's Society services in your area and information about a wide range of dementia-related topics, visit our website at alzheimers.org.uk

Useful organisations

Age UK

Tavis House
1-6 Tavistock Square
London WC1H 9NA
T 0800 169 8787 (general enquiries)
  0800 169 6565 (advice line)
E contact@ageuk.org.uk
W www.ageuk.org.uk

Age Cymru (in Wales)
T 029 2043 1555
E enquiries@agecymru.org.uk
W www.ageuk.org.uk/cymru

Age NI (in Northern Ireland)
T 028 9024 5729
E info@ageni.org
W www.ageuk.org.uk/northern-ireland

Provides information and advice for older people.

Anchor Staying Put

Burnbank House
Balliol Business Park
Benton Lane
Longbenton
Newcastle-upon-Tyne NE12 8EW
T 0845 140 2020
W www.anchor.org.uk

Provides a service to older and disabled homeowners across England, helping them with repairs, adaptations and improvements.

Assist UK

Redbank House
4 St Chad's Street
Cheetham
Manchester M8 8QA
T 0161 832 9757
E general.info@assist-uk.org
W www.assist-uk.org

Runs a number of disabled and independent living centres throughout the country, providing advice and information on a range of equipment. Some centres will also display and demonstrate equipment.

AT Dementia

Trent Dementia Services Development Centre
9 Newarke Street
Leicester LE1 5SN
T 0116 257 5017
E info@trentdsdc.org.uk
W www.atdementia.org.uk

A web-based information resource on assistive technologies (including telecare) for people with dementia. In addition to general information the website contains a database of products that may be appropriate for people with dementia.

British Red Cross

44 Moorfields
London EC2Y 9AL
T 0844 871 11 11
E information@redcross.org.uk
W www.redcross.org.uk

Offers a range of services - including care in the home and transport assistance - to help those with health issues lead a full life.

Charity Search

Freepost (BS 6610)
Avonmouth
Bristol BS11 9TW
T 0117 982 4060
E info@charitysearch.org.uk
W www.charitysearch.org.uk

National charity that signposts older people in financial need to support available from a range of charitable sources.

Citizens Advice Bureau (CAB)

Various locations
W www.citizensadvice.org.uk
www.adviceguide.org.uk

Your local CAB can provide information and advice in confidence or point you in the right direction. To find your nearest CAB look in the phone book, ask at your local library or look on the Citizens Advice website (above). Opening times vary.

College of Occupational Therapists

106-114 Borough High Street
London SE1 1LB
T 020 7357 6480
E info@cot.co.uk
W www.cot.co.uk

Provides details of independent occupational therapists in your local area.

DIAL UK (Disablement Information and Advice Line)

St Catherine's
Tickhill Road
Doncaster DN4 8QN
T 01302 310123
E enquiries@dialuk.org.uk
W dialuk.org.uk

Network of over 140 local groups throughout the UK providing information on a range of issues connected with disability, including equipment. DIAL centres are run by people with personal experience of disability and most advice workers are volunteers.

Disabled Living Foundation (DLF)

380-384 Harrow Road
London W9 2HU
T 0845 130 9177 (10am-4pm weekdays)
E info@dlf.org.uk
W www.dlf.org.uk

Provides information about finding some simple solutions, such as mobility aids. You can also arrange to visit the DLF centre to look at equipment and talk to staff.

Grants for keeping the home warm

England
Warm Front
T 0800 316 2805
E enquiry@carillionplc.com
W www.direct.gov.uk/warmfront

Provides a package of heating and insulation improvements to those who are eligible. You can apply by phone or online. The scheme is funded by the government and managed by Carillion Energy Services (formerly Eaga).

Wales
Nest
T 0800 512012
E advicewales@est.org.uk
W www.nestwales.org.uk

Provides a package of heating and insulation improvements.

Northern Ireland
Warm Homes
T 0800 988 0559
E via the website, below
W www.warm-homes.com

Provides heating and insulation improvements to those who qualify. You can apply by phone or online. Warm Homes is funded by the Department for Social Development and delivered by Bryson Charitable Group and H&A Mechanical Services.

Home improvement agencies

Home improvement agencies, also known by names such as Care and Repair or Staying Put, offer free advice and information to older and disabled homeowners who want to stay in their own homes but may need specialist equipment or adaptations in order to do so. There are over 200 home improvement agencies at present. To find out if there is one within your local authority, contact the following organisations:

England
Foundations
T 0845 864 5210
E foundations@foundations.uk.com
W www.foundations.uk.com

Wales
Care and Repair Cymru
T 029 2057 6286
E enquiries@careandrepair.org.uk
W www.careandrepair.org.uk

Northern Ireland
Staying Put Department
Fold Housing Trust
T 028 9042 8314
E info@foldgroup.co.uk
W www.foldgroup.co.uk

Factsheet 429

Last reviewed: January 2012
Next review due: January 2014

Reviewed by: Professor Gail Mountain, Professor of Health Services Research, University of Sheffield, Sheffield and Mr Stephen Wey, Senior Lecturer, York St John University, York