Using equipment and making adaptations at home
Most people with dementia wish to remain in their own homes for as long as possible, but as a person’s dementia progresses they may find everyday tasks more difficult. These can range from using the stairs to taking medication. Using equipment and making adaptations to the home environment can help someone to continue to do things for themselves for longer. This can help the person with dementia to stay independent, and can offer family and carers the reassurance of the person’s safety and security.
This factsheet looks at various pieces of equipment, and how different parts of the home can be adapted. It also looks at sources of support and advice, and explains how you can get hold of equipment, including help from the NHS and social services, as well as financial support that may be available.
Much of what is covered in this factsheet – for example, supporting a person with bathing or someone who has restricted movement – is also often relevant to older people who might not have dementia. In this factsheet, ‘equipment’ refers to things like walking sticks and frames, bath steps and non-spill cups – more low-tech items designed to assist people with mainly physical difficulties.
Technological and often electronic items that are designed to help people with cognitive or memory problems are classed as ‘assistive technology’ and are not discussed in this factsheet. For more information on these see factsheet 437, Assistive technology – devices to help with everyday living. It may help to read both factsheets together.
Everyone with dementia experiences the condition differently. What may be useful for one person may not be appropriate for another. The needs of each person will also change as their dementia progresses. Not everything included in this factsheet will be of use to everyone, but it can help to know what is available.
Keep in mind that equipment will not be the answer to every problem. You might find that changing the way you do something is enough and works for you and the person with dementia. For example, someone who has trouble sitting in the bath may find it easier to have a shower in a standing position. It is also important to recognise that a piece of equipment may help the person to be safer and more independent, but it is not a guarantee of their safety.
Types of equipment
Types of equipment designed to help older people with problems in general are often very useful for people with dementia. These include mobility aids and equipment for maintaining continence. There are also many products available specifically designed to address the needs of people with dementia, such as memory aids.
To find out who can offer advice on these various pieces of equipment see ‘How to get hold of equipment’, below.
Difficulty remembering things
There are a range of different types of memory aids for helping people to remember the date, appointments, shopping lists and other things. These include noticeboards where people can write messages and reminders, and clocks with large faces that are easier to read. (For more high-tech solutions, see factsheet 437, Assistive technology – devices to help with everyday living.)
Dementia may cause someone to forget when to take medication. Equipment such as dosette boxes – boxes with a pill compartment for each day of the week – can help. Dosette boxes are more suitable for people in the earlier stages of dementia because the person needs to know what day of the week it is. Automatic pill dispensers, which are electronic and pre-programmable, may be more suitable for those with more advanced memory difficulties.
Difficulty washing and bathing
Some people may have difficulty getting into and out of baths, or problems sitting down or standing up from the bottom of the bath tub. Transfer benches, grab rails or bath steps may be useful in this situation. There are also various hoists available which use pulleys to lower and raise a person into and out of a bath. If adapting an existing bath is not suitable, a walk-in bath can also be fitted. Bath seats and bath boards (which lie across the top of the bathtub, allowing a person to sit) can help someone to wash inside the bath tub.
Toilet problems and continence
Many people find that a raised toilet seat and grab rails make the toilet more accessible. Some people with dementia may lose continence, which can be distressing and embarrassing. Equipment such as commodes, bedpans, and waterproof mattresses and pillows can help people to manage incontinence. Pads and pull-up incontinence pants are also widely used. For more on incontinence aids see factsheet 502, Managing toilet problems and incontinence.
Difficulties eating and drinking
Dementia may affect a person’s co-ordination or swallowing and, as a result, their ability to use cutlery and to eat and drink as before.
The person may benefit from equipment such as cutlery with large, contoured handles that are easier to grip, and non-spill cups with (often two) large handles or fittings for long or non-return straws. (These are straws that do not let liquid travel back down, making it easier to drink.)
Difficulties performing household tasks (eg cooking)
Difficulties with movement and co-ordination may impair a person’s ability to cook for themselves. There is kitchen equipment available to make cooking easier and safer. One example is a kettle tipper – a frame which allows hot water to be poured safely, at a constant rate and without the need to lift the kettle. Other kitchen equipment includes grip extensions for controls on ovens and other appliances (which ordinarily may be hard for a person with dementia to adjust), height-adjustable cupboards and other adapted kitchen tools.
Other household activities such as cleaning, ironing and washing-up may be made easier with perching stools. These are special seats that allow someone to sit while performing household tasks.
Difficulties walking and moving
There are lots of different walking sticks, walking frames and wheelchairs to help people keep mobile and independent. People with limited mobility may often encounter difficulties moving position or place, for example from a bed to a chair. Equipment collectively known as ‘transfer aids’ can help here. An example of a transfer aid is a transfer turntable. This is a base that rotates, on which a person can stand and be swivelled. Chairs and beds can be adapted to make them height-adjustable. Hoists use pulleys and slings to help raise or lower people (for example, from or into bed). Many hoists are mobile so that they can be moved and used in different rooms.
Adaptations and improvements
Adaptations and improvements are changes made to a person’s home to make it easier, safer and more comfortable to live in. The home set-up also supports them to cope better with the difficulties they experience, makes them more independent, and improves their orientation. Adaptations range from putting up grab rails or adding ramps or wide doors for wheelchairs, to installing specially designed shower and toilet facilities, or changing the design of the home to make it more dementia friendly. Improvements or repairs could also include draught-proofing or improving heating systems.
Who will pay for these changes depends on how extensive any required work is. Equipment such as walking frames and minor adaptations such as grab rails may be provided free by social services. Bigger adaptations such as accessible toilet facilities are arranged through the council and are provided on a means-tested basis, meaning you may have to pay, depending on your income or savings.
As well as helping with mobility, adaptations can also make the person’s home more ‘dementia friendly’. For example, handrails, signage (eg signs for the toilet or bathroom) and extra lighting can make it easier for the person to find their way around the house.
Lighting is particularly important. Lots of light is needed in the kitchen or bathroom to keep these rooms safe. Lights that come on automatically may help prevent falls if the person gets out of bed and walks about at night.
Designs and patterns can affect people with dementia, particularly those who have problems with perception.
Using contrasting colours around the home is a good way of making doorways, furniture and other items clearer and easier for people with dementia to locate and identify. In the same way, using contrasting colours for the items below make them easier to use:
- cutlery, crockery and tablecloths
- toilet seats in a different colour to the bowl
- handrails, towels and soap that contrast with the rest of the bathroom.
Contrasting colours for doors and door frames can be particularly helpful for a person with dementia, as can labelling cupboard doors with a picture of what is kept inside.
Some patterns and surfaces can cause problems for people with dementia, and should be avoided. Patterned carpets, for example, can be mistaken for uneven ground. Shiny surfaces and mirrors can also be confusing as someone may not realise that what they are seeing is a reflection. Removing these types of surfaces and patterns will help to make a place more dementia friendly.
For more on these topics see Alzheimer’s Society free booklet 819, Making your home dementia friendly.
Where to get advice
Anyone considering getting equipment for themselves, or someone they know, should seek advice from professionals as soon as possible. The same applies to anyone who is making adaptations to their home. The following people should be able to help.
- An occupational therapist can advise on equipment and strategies to help someone with dementia with everyday activities, from washing and dressing to leisure activities. As the dementia progresses, they can also advise on appropriate ways to cope with the changes in mental and physical abilities caused by the condition. Occupational therapists work in health and social services and in private and voluntary organisations. You can contact an occupational therapist through the GP or hospital consultant, or through social services. For independent occupational therapists, contact the College of Occupational Therapists (see ‘Other useful organisations’).
- A qualified physiotherapist (known as a ‘chartered physiotherapist’) can advise on mobility aids, such as walking frames and wheelchairs, and on ways of helping someone with dementia to move safely. If the person attends hospital, they can ask to speak to a physiotherapist based there. Otherwise, they can 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. Someone can contact the district nurse through their 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 – the GP can advise.
How to get hold of equipment
What social services can provide
If a person is considered to have ‘eligible needs’, they are entitled to receive support from social services. This may include aids and adaptations, if they are needed. A social worker can assess someone to see if they have eligible 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. The occupational therapist will advise on whether or not a particular adaptation or piece of equipment may be helpful to meet someone’s individual needs. They can arrange minor adaptations such as handrails, adapted cutlery and special chairs through social services. The equipment that is available will vary from one local authority to another.
Social services have a duty to fund aids and minor adaptations up to the value of £1,000, regardless of your income and savings. More expensive equipment can also be arranged but this will be means-tested, meaning it will depend on your financial situation. However, each local authority social services will have its own criteria for which daily living aids and adaptations it will provide.
Some people will be given a personal budget by social services, which they can use to hire or buy their own equipment. After a financial assessment, the person may have to contribute to the personal budget amount themselves, depending on their financial situation. For more information see factsheet 473, Personal budgets.
If major adaptations are needed, 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 someone is applying for a grant from the local authority to help meet the cost of any adaptation needed because of disability. Carers can also ask the local authority for an independent assessment of their needs if they are providing care. These needs may include adaptations to help them to provide care.
What the NHS can provide
The NHS can provide certain types of equipment to aid mobility, such as walking sticks, walking frames and wheelchairs. These are provided on long-term loans, for as long as the item is needed, and can be arranged through the GP, hospital consultant or physiotherapist. There is no charge for the equipment, but a refundable deposit may be needed. Community equipment for home nursing, such as commodes, is usually provided through the NHS. Depending on the area, equipment for daily living, such as shower chairs and raised toilet seats, might be provided by the local authority.
Wheelchairs, which are available from the local NHS wheelchair service, are usually standard models. Some health authorities offer voucher schemes towards the cost of a more expensive chair. The wheelchair service can supply details. The NHS will pay for servicing and repairs, as long as these are not needed because of 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 the local NHS community health service. The most appropriate team member will assess whether this equipment is needed.
Grants and assistance available from local authorities
Some pieces of equipment will be provided directly by local authority social services – see ‘What social services can provide’ above.
For other pieces of equipment or adaptations, the local authority may be able to supply a grant or some other assistance. The various types of support that may be available are outlined below.
Disabled facilities grants
Disabled facilities grants are designed to help meet the cost of adapting a home for the needs of a disabled person. These are mandatory, meaning that if a person is eligible and needs the adaptation, the grant must be available to them. They can be awarded for:
- improving a disabled person’s access to and from their home
- improving a disabled person’s access to:
– the main family room in their home
– their bedroom (or providing a new bedroom)
– the bathroom (or providing a new bathroom, and making it easier for the person to use the facilities)
- making the home safe for a disabled occupant and anyone else living with them
- 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 their home to enable them to care for someone who is dependent on them and also lives there
- improving or moving controls for heating, lighting and plug sockets.
Disabled facilities grants are means-tested. The 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.
The maximum amount available as a disabled facilities grant is £30,000 in England, £36,000 in Wales and £25,000 in Northern Ireland. The local authority will not consider the grant application if the work has already started, so it is important to apply before any work begins.
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.
Local authority assistance with housing repairs
Local housing authorities now have wide powers to help people with repairs, adaptations and improvements to their home. They can set their own conditions for this, such as whether to perform a means test, and under what circumstances 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 (securing a loan against the value of the house), if they own it.
What help is available to owner-occupiers, tenants or landlords will depend on each local authority’s policy. They must have a published policy that sets out the type of assistance they are willing to provide and under what circumstances. For more information, ask your local authority for a copy.
Other sources of funding
Some people may be eligible for a budgeting loan from the Social Fund to help with the cost of minor repairs or improvements to their home. This may include people receiving income support, income-based Jobseeker’s allowance or Pension credit guarantee. For people in the Universal credit system, a budgeting advance may be possible. Information about the Social Fund is available at local Jobcentre Plus offices. The local authority will also have information about any local welfare scheme which replaced Social Fund community care grants.
Some charities and trusts may offer help towards the cost of minor adaptations or repairs. Information is available at a local library, advice centre, Citizens Advice Bureau or other local agency, such as a housing advice agency. Alternatively, contact Charity Search, who can direct you to other charities that may be able to help (see ‘Other useful organisations’).
Getting hold of equipment yourself
When looking for a piece of equipment, it is important to ask for a product demonstration and seek professional advice. You can get advice from the Disabled Living Foundation (see ‘Other useful organisations’), independent or disabled living centres (ask your local council) and ‘assisted living’ shops on the high street. Equipment specially designed to help with disability, such as a wheelchair, should be exempt from VAT.
It may be possible to hire equipment that is only needed on a short-term basis. The local British Red Cross centre may hire or lend wheelchairs and other items free of charge. How long you can hire them for will depend on whether you have a medical referral from a GP or occupational therapist. Alternatively, a specialist hire company, or the manufacturer or supplier, may be able to lend it out temporarily. Ask the Disabled Living Foundation or your nearest disabled living centre for details (see ‘Other useful organisations’ for details).
Tips for buying equipment
If you are thinking of buying equipment, it may help to 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. Many suppliers have mail order services or an online shop, and some items may be available from local shops, such as pharmacies. It is also worth noting that sometimes the best ‘equipment’ may just be a simple household item from an ordinary shop, such as a noticeboard for reminders or Velcro fastenings for clothes.
To see a range of products, including equipment and adaptations, go to Alzheimer’s Society’s online shop or see the Daily living aids catalogue.
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).
Other useful organisations
1–6 Tavistock Square
London WC1H 9NA
Age Cymru (in Wales)
Tŷ John Pathy
13/14 Neptune Court
Cardiff CF24 5PJ
Age NI (in Northern Ireland)
3 Lower Crescent
Belfast BT7 1NR
Provides information and advice for older people.
British Red Cross
London EC2Y 9AL
Offers a range of services – including care in the home, wheelchair loan and transport assistance – to help those with health issues lead a full life.
25 Portview Road
Bristol BS11 9LD
College of Occupational Therapists
106–114 Borough High Street
London SE1 1LB
Provides details of independent occupational therapists in your local area.
Disabled Living Foundation
4th floor, Jessica House
Red Lion Square
191 Wandsworth High Street
Provides information about finding some simple solutions, such as mobility aids. Includes a web tool offering advice on health, home and daily activities (asksara.dlf.org.uk). You can also arrange to visit the DLF centre to look at equipment and talk to staff.
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:
Care and Repair Cymru
Staying Put Department
Fold Housing Trust
Last reviewed: January 2016
Next review due: January 2019
Reviewed by: Stephen Wey, Senior Lecturer – Occupational Therapy, Faculty of Health & Life Sciences, York St John University, York and Professor Gail Mountain, Professor of Health Services Research, University of Sheffield
This factsheet has also been reviewed by people affected by dementia.
A list of sources is available on request.