# Chapter 5

## 

## Safety: 

## Issues and Tips

> *Initially, people with Alzheimer's disease or related dementias may
> compensate for their worsening memory by avoiding difficult activities
> or situations, by being extra cautious, or by using various memory
> aides such as notes and calendars to remind them of what they have
> already done or what they must do next. Eventually, however,
> problem-solving skills erode. With some care and creativity, however,
> steps can be taken to enhance the resident's safety and prolong their
> ability to live independently.*

### 

### 

### Why Is Safety A Concern?

As their memory worsens and judgment and thinking become impaired,
memory-impaired residents may fail to recognize safety risks to
themselves and others (e.g., eating spoiled food or forgetting to turn
burners off). They may wander away from home and get lost. They may
become targets for abuse or exploitation by others. This chapter
identifies common safety issues and suggests steps that housing staff
can recommend to the resident and/or family or paid caregivers.

### 

### Observable Signs That Safety Is Becoming A Problem

#### Concerns about self-care and protection

-   Neglects grooming and personal hygiene

-   Forgets to take medications or takes them improperly

-   Dresses in attire that is inappropriate for weather/season

-   Loses weight: doesn't seem to be shopping for food or eating

-   Suffers from vomiting or diarrhea as a result of eating spoiled food
    or inedible items

-   Has trouble with balance, shuffling gait

-   Seems fearful or uncertain when navigating steps, thresholds, dark
    or patterned floors

-   Becomes careless about locking door, letting strangers into building

-   Experiences trouble with money (overdue or overpaid rent, utilities
    shut off, etc.)

-   Ignores non-compliance or eviction notices.

#### Concerns in the home

-   Causes repeated fire safety issues---burns pans, sets off fire
    alarm, careless with cigarettes

-   Exhibits extreme clutter and hoarding

-   Disposes of odd or inappropriate items in the trash

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-   Lets water overflow in sinks or tub

#### Wandering

-   Frequently unable to find own apartment

-   Follows other people

-   Walks uninvited into other people's apartments

-   Rides on the bus for hours; forgets the right stop

-   Gets lost away from home and is returned by police.

#### Driving

-   Repeated fender benders

-   Can't find own car in parking lot

-   Gets lost in familiar surroundings.

### Possible Solutions

#### In General

-   Assess the environment. What are the potential hazards for the
    resident within her apartment? What can be made safer within the
    housing site and around the external environment if she regularly
    goes outside of the building?

-   Focus on adapting rather than teaching. Avoid re-teaching the
    resident about safety issues. Instead, identify potential risks and
    take the appropriate precautions.

#### 

#### Self-care

-   Encourage the resident to see a doctor for a complete checkup to
    rule out any medical conditions (e.g., medication reactions,
    infections) or sensory deficits (hearing or vision loss) that are
    creating an excess disability.

-   Ask the doctor for an in-home evaluation by an occupational
    therapist to assess the home, identify problem areas, and recommend
    solutions.

-   Home health nurses or family, if available, can set up pills for the
    resident. There are a wide variety of pill boxes available for this
    purpose, even ones that dispense medications at the proper times and
    give a verbal reminder to take them.

-   Consider the need for help with handling finances. Direct deposit
    and automatic bill paying arrangements assure that the rent and
    other bills get paid on time. Contact your local area agency on
    aging. Some have volunteer programs to assist older people with bill
    paying and other paperwork.

-   Eventually the resident will need someone else to take over the
    finances either through a power of attorney or a conservator legal
    arrangement. \[See Chapter 8.\]

#### In the home

-   Use the checklist on the following page to assess the home for
    risks.

-   A friend, family member or health professional working with the
    resident may be able to remove dangerous items and make simple
    modifications to the home to make it more dementia friendly for the
    resident. See the following checklist for suggestions.

##### 

##### Tips for Creating a Safe and 

##### Supportive Environment

###  Safety Checklist

###### Kitchen

1.  Lock up cleaning supplies

2.  Turn off electricity to garbage disposal

3.  Remove or hide knives and other dangerous utensils

4.  Consider automatic timers and shut-off devices for electrical
    appliances

5.  Shut off stove and arrange for home-delivered meals

6.  Clean out refrigerator regularly

####### Bathroom

1.  Set water temperature at 120 degrees

2.  Apply textured decals on slippery surfaces

3.  Supervise the use of electrical appliances

4.  Remove locks from the bathroom door

5.  Discard dangerous items from the medicine chest

6.  Install grab bars

####### Bedroom

1.  Avoid using electric blankets

2.  Install night lights between the bedroom and bathroom

######## Throughout the home

1.  Put away power tools, and limit access to large equipment such as
    lawnmowers and snowblowers

2.  Lock up poisonous products such as paints and fertilizers

3.  Remove all firearms

4.  Makes sure that there is a working smoke detector and fire
    extinguisher

5.  Remove or tape down throw rugs and carpeting

6.  Apply colored decals to large windows and sliding glass doors

7.  Remove poisonous plants

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1.  Create an even level of lighting near doorways, stairways and
    between rooms

2.  Remove objects that block walking paths

3.  Reduce clutter

###  

**Tips To Curb Wandering Wandering**

Wandering can be aimless or purposeful roaming that causes a resident to
become lost, leave a safe environment, or intrude in inappropriate
places. Either way, it is one of the most frequent and challenging
problems that caregivers face. **Seventy percent of people with dementia
will wander and become lost during the course of the disease, and most
will do so repeatedly.** Someone with Alzheimer's may not only wander by
foot but also by car or other mode of transportation.

-   Help the resident to locate his apartment by inviting him to post
    his name on the door or to display some other picture or object he
    will recognize.

-   Make sure that large-print floor numbers are prominently displayed
    at elevator entrances to help residents easily identify which floor
    is theirs.

-   Hold an educational program about memory loss and dementia for all
    residents. Provide information about what to do if they notice that
    one of their neighbors is missing or lost.

-   Hold a "Meet the Police" community policing event in the building.
    Encourage all residents to attend. Ask the police to offer free
    photo taking for emergency identification and notification cards to
    have on file at the police station and with the building manager.

-   Encourage the resident (or family, if available) to enroll the
    resident in Safe Return, a national, computerized data bank designed
    to identify, locate, and return to safety people who have wandered.
    Contact your local chapter of the Alzheimer's Association for
    information about scholarships for the one-time enrollment fee of
    \$40. \[See Appendix for enrollment form and additional
    information\].

 For more tips to prevent and/or respond to wandering see Appendix 4:
*Wandering: Plan Ahead Because it Happens More Often Than You Think*
(page 87).

### Tips for Restricting Driving

People with early stage Alzheimer's disease may still be able to drive
safely, but eventually they must stop driving. Alzheimer's disease
impairs judgment, reaction time, and the ability to solve problems. It
may also affect physical and sensory skills.

-   Co-piloting is not recommended. Caregivers and neighbors, especially
    those dependent upon the resident with dementia for transportation,
    may attempt to keep the resident driving longer by giving directions
    and instructions on how to drive from the passenger seat. Warn them
    that this is dangerous because in hazardous situations there is
    simply not enough time for the driver with dementia to comprehend
    the warning and respond appropriately. ^1^

-   Alert police when the resident drives away in a car and ask them to
    assess the resident's driving.

-   If there is evidence that the resident is no longer safe to drive,
    report the resident to the Division of Motor Vehicles for a driver
    evaluation.

-   An occupational therapist can also evaluate driving capacity.

-   Ask the doctor to write a prescription instructing the resident not
    to drive.

-   Meanwhile assess the resident's need to drive and introduce him to
    alternate modes of transportation.

-   For residents determined to drive, with or without a license, it may
    be necessary to ask family members to take away the keys and remove
    the car.

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-   For an excellent discussion of this topic and additional tips,
    please see *At the Crossroads; A Guide to Alzheimer's Disease,
    Dementia & Driving*. For copies, contact The Hartford, 200 Executive
    Blvd., Southington, CT 06489, or visit their web site at
    [www.thehartford.com/alzheimers](http://www.thehartford.com/alzheimers).

### 

### Sources

1.  *Steps to Enhancing Your Home,* Alzheimer's Disease and Related
    Dementias Association, Inc., 1999.

2.  *Steps to Ensuring Safety,* Alzheimer's Disease and Related
    Dementias Association, Inc., 1999.

**Resources And Further Reading**

1.  *The Do-Able Renewable Home: Making Your Home Fit Your Needs,* by
    John P.S. Salmen, American Association of Retired Persons, 2000.

2.  *At the Crossroads: A Guide to Alzheimer's Disease, Dementia and
    Driving,* published by The Hartford, Southington, CT 2000.

3.  *The Complete Guide to Alzheimer's-Proofing Your Home,* by Mark L.
    Warner, Purdue University Press, 1998.

4.  *Homes that Help: Advice from Caregivers for Creating a Supportive
    Home,* by Richard V. Olson, Ph.D., et al., New Jersey Institute of
    Technology, 1993.

5.  *The 36-Hour Day* (Third Edition), by Nancy L. Mace and Peter V.
    Rabins, The Johns Hopkins University Press, Baltimore, 1999.

-   You can also order the following brochures by calling the Maine
    Alzheimer's Association at 1-800-660-2871, or your local chapter.

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-   *Steps to Enhancing Your Home: Modifying the Environment*

-   *Steps to Ensuring Safety: Preventing Wandering and Getting Lost*

-   *Alzheimer's Association "Safe Return" Registration Brochure*

**Appendix 5.1**

**Medication:**

**[Tips for Families and Direct Care Providers]{.underline}**

As a caregiver you need to understand the use of medications, and be
alert to possible over-medication and to adverse reactions to drug
combinations. No medications prevent or cure Alzheimer\'s disease, but
physicians rely on several drugs to manage delusions and hallucinations,
as well as depression, agitation, or sleeplessness.

Although these medications may affect specific disease symptoms and
assist in managing them, they can also produce side effects such as
agitation, dry mouth, drowsiness, problems in walking, tremors, falling,
or constipation.

Even though a physician might prescribe a drug for a limited period of
time, it can sometimes take up to four weeks for a drug to leave the
patient\'s system after use is discontinued.

Some medications can contribute to the Alzheimer patient\'s problems and
make some symptoms even worse. For example, a resident who begins taking
drugs for high blood pressure or a heart problem might appear to be more
confused than before she began taking the drugs.

So-called anti-cholinergic drugs can also block the production of a
chemical within the brain called acetylcholine and further alter the
patient\'s memory.

To understand the effects of medications and how to manage their use,
consider the following tips:

### Action Steps

 **Get medical advice**

Be cautious about giving any medication --- whether it\'s an
over-the-counter or prescription variety. Begin by asking your physician
to review all medications, in order to check for any possible
interactions between drugs. Make sure that every physician involved in
the resident\'s care knows about all prescribed medications.

Find out as much as possible about every medication, including its name,
purpose, dosage, frequency, and possible side effects. If serious side
effects occur, report them

immediately to the resident's physician.

*Continued*

** Be prudent**

[Under no circumstances should you change the resident's dosages without
first consulting her physician.]{.underline} In addition, avoid the
temptation to exaggerate or over-report symptoms in order to persuade
the physician to prescribe a new drug or to increase the resident's
dosage. Do not share medications with other caregivers or keep
medication bottles from old prescriptions.

 **Rely on your pharmacist for information**

Pharmacists can be an important source of information. Your local
pharmacist can also check for interactions between drugs. Keep in mind
that pharmacists can neither prescribe drugs nor alter drug dosages.

Maintain accurate and ongoing records. Keep a written record of all
current medications, including the name of the medication, dosage, and
starting date. The resident should carry a copy of this list in their
wallet or purse at all times. This record will be invaluable in the
event of a serious drug interaction or overdose.

 **Develop a routine**

Giving medications in a specific way at specific times of the day or
evening will help to reduce conflicts. However, if the resident refuses
to take the medication, stop and try again at a later time. Never assume
that the resident will take medications her own. It may be necessary to
check to see whether the medicine has been swallowed. At some point in
the progression of the disease, someone other than the resident will
need to assume responsibility for giving medications.

 **Stay organized**

Helping the resident separate pills into a plastic container with small
compartments labeled "day" and "evening" or "Monday," "Tuesday,"
"Wednesday," etc., will help in tracking medications. Some people find
it useful to give medications in individual cups or envelopes, or to
keep a calendar and check off each dose as it's taken.

Adapt to the resident. If the resident has problems swallowing pills or
spits out the pills, you might try crushing pills and mixing them with
applesauce or cottage cheese. Some medications may be available in
liquid form.

 **Take safety precautions**

If necessary, put a lock on the medicine cabinet or place the
medications in a locked drawer. If the resident spits out pills, make
sure these pills aren't picked up and eaten by animals or anyone else.
Avoid leaving the resident alone with medication bottles in the room. Be
sure to throw out all old medicines.

*Continued*

 **Be prepared for emergencies**

Research the names and telephone numbers of pharmacies or taxi services
that deliver

medications. Also find out the names of pharmacies that are open on
Sundays and weekends. Keep the number of your local poison control
center or emergency room handy. If you suspect a medication overdose,
call the number before inducing vomiting or taking any other action.

**Appendix 5.2**

**Nutrition:**

**[Tips for Families and Direct Care Providers]{.underline}**

Providing the Alzheimer patient with nutritious meals and snacks is a
problem for many

caregivers. Often the patient can\'t sense or identify hunger or
fullness, or the need for fluids or foods with certain vitamins and
minerals.

**Predictability**

The resident\'s response to food is also difficult to predict. An
individual might like specific foods such as turkey or chicken and
then---without warning---turn away from these foods.

**Poor Nutrition**

The result of poor nutrition among Alzheimer patients is usually weight
loss or gain and a variety of other symptoms, including poor-fitting
dentures, listlessness, and fatigue.

A resident who snacks regularly on such foods as candy and pastries
often experiences a "sugar high" followed by complaints of being tired,
depressed, or hungry. "Junk foods" tend to make the resident more
restless and disoriented, and reduce the craving for regular meals and
more nutritious foods. The resident may also experience bowel or bladder
problems because of not drinking enough fluids or eating adequate fiber.

**Disease Progression**

As the disease progresses, providing the resident with proper nutrition
may become even more difficult.

The individual might not understand the timing of meals or the
difference between breakfast, lunch, dinner and snacks. In addition, you
may have to offer more coaching at mealtime to help the resident use
utensils, for chewing, swallowing, or identifying various foods. For
example, you may hand the resident a spoon only to discover that he
can\'t remember how to use it. In another situation, a resident who
feels no need for food may clench his jaw tightly and refuse to let you
put a utensil near his mouth. This resident may not understand or
remember what to do with food.

### ACTION STEPS

**** Look for early behavior changes such as increased snacking,
drastic shifts in food likes and dislikes, dramatic weight losses or
gains, or bowel problems. Experiment with changes in the resident\'s
diet to address these problems. You may need to allow for more time and
offer more assistance at mealtime.

*Continued*

** Monitor changes**

Check the resident\'s weight weekly and, on the advice of your doctor,
have regular blood work completed, as needed. Laboratory reports will
help to identify problems with cholesterol, anemia, dehydration, or
constipation.

** Prepare food for easier eating**

If the resident has problems with chewing, swallowing, or choking, try
chopping or cutting the food into bite-size pieces.

** Use food to trigger the patient\'s attention**

Use rough-textured foods such as toast or sandwiches made on toasted
bread to stimulate the resident\'s tongue and encourage chewing and
swallowing.

The resident with Alzheimer\'s sometimes has little sensation of food in
the mouth. By gently moving the resident\'s chin, you can remind them to
chew. Stimulate chewing by touching the resident\'s tongue with a fork
or spoon. By lightly stroking their throat, you can remind them to
swallow.

** Use soft foods to assist the resident**

A resident who has problems chewing or who has poor-fitting dentures
will benefit from foods of soft textures such as a peanut butter
sandwich rather than a sandwich made of sliced meat, or a mashed potato
rather than a fried potato.

You may want to serve mashed or steamed vegetables, bite-size pieces of
cooked meat,

or turkey or chicken salads instead of sliced meat. If swallowing
becomes a problem, put food into a food processor or blender before
serving it. Also remember that soups with two consistencies may confuse
the individual.

** Make knife-and-fork foods into finger foods**

If the resident\'s regular breakfast consists of scrambled eggs and
bacon, cut the food into small squares. Or combine cheese, meat and eggs
into an omelet so the resident can pick up the food with their fingers.

** Proceed with caution in using liquid supplements**

Liquid food supplements are often costly, high in sodium, and can
sometimes be prepared more economically at home. If the resident is
eating regular meals, use supplements as an occasional between-meal or
late-night snack or when the resident refuses to eat a regularly
scheduled meal. When considering supplements, consult with your
physician.

** Work to make mealtime calm and comfortable**

Keep the environment quiet and free from such distractions as the
television or radio.

Try to maintain regular meals with the family for as long as possible.
Social interaction and conversation are important. Feed the resident at
regular intervals. Many caregivers find it helpful to serve several
small meals rather than three large meals.

*Continued*

**** **Be consistent**

Feed the resident in the same area at every meal and at the same
approximate times each day.

**** **Keep the table setting simple**

-   Avoid placing objects on the table that might distract or confuse
    the individual.

-   Put condiments on food before serving it to the resident.

-   Set the table only with the utensils needed to eat the meal.

-   Avoid using plates or place mats with patterns that might confuse
    the resident.

-   Use a plate that\'s a different color from the place mat.

-   Offer one food item at a time. A full plate with a meat, potato, and
    vegetable might overwhelm and confuse the resident.

** Rely on nutritious finger foods as between-meal supplements**

> Encourage independence for as long as possible by allowing the
> resident to use utensils and eat finger foods. Holding a cup and
> drinking fluids through a straw will also give the resident a sense of
> accomplishment.

-   Serve thick fluids to prevent choking. If choking occurs, be
    prepared to use the abdominal thrust to dislodge the food.

-   Prepare the meal ahead of time so you can stay with the resident
    during the meal. He may mimic your eating behavior.

-   Reduce between-meal snacks to ensure that the resident eats at
    regular meals, or provide the resident with fruit or nutritious
    snacks.

**Appendix 5.3**

**Home Safety Checklist**

### 

### Throughout the home . . .

-   Place smoke detectors and fire extinquishers in hallways, at the top
    of stairwells, and in each room -- especially the bedrooms.

-   If the resident smokes, this activity must be supervised at all
    times.

-   Lock-up or hide medications, and supervise the administration of all
    prescription and over-the-counter medicines.

-   Place locks on doors and windows---high and low.

-   Consider adding a bell or an electronic door alarm on outside door.

-   Put away car keys.

-   Apply colored decals to large windows and all sliding glass doors.

-   Remove toxic plants.

-   Remove or secure throw rugs.

-   Order a Safe Return ID bracelet by calling Alzheimer's Association
    at 1-800-272-3900 if wandering is a concern.

-   Lock up poisonous or dangerous products, including cleaning supplies
    and tools.

-   Hide or remove firearms, knives or other weapons.

### 

### In the bathroom . . . 

-   Adjust the water temp to 120˚ degrees or less.

-   Install a hand-held shower and grab-bars in the tub.

-   Add a tub chair with a back.

-   Apply non-skid safety strips or a bath mat in tub or shower.

*Continued*

-   Install a raised toilet seat and a grab bar if mobility is a
    problem.

-   Remove bathroom door lock

-   Discard dangerous items in the medicine chest

-   Make sure there are nightlights along the route from the bedroom to
    the bathroom.

### In the kitchen . . .

-   Remove stove knobs or turn off circuit breaker, or hook up stove to
    a hidden gas valve or electric switch. Pay special attention to this
    if the resident is left alone for a while. Watch for burned-on or
    missing pots, pans, or teakettles.

-   Clean out refrigerator of spoiled food

-   Try auto shut-off appliances

**Appendix 5.4**

**Wandering: Plan Ahead Because**

**[It Happens More Often Than You Think]{.underline}**

Wandering is defined as either aimless or purposeful roaming that causes
problems such as getting lost, leaving a safe environment, or intruding
in inappropriate places. At least 70% of people with dementia will
wander at some point during the course of their disease, and most will
do so repeatedly. A person with Alzheimer's may not only wander by foot
but also by car or some other mode of transportation. He may end up
hundreds of miles from home. People with Alzheimer's disease typically
do not behave like most lost adults: they do not recognize that they are
lost, leave few physical clues, and are unlikely to call out for help or
respond to shouts from searchers. A missing resident with Alzheimer's
disease is always an emergency situation because he is at risk for
serious injury and possibly death. In fact, 46 percent of those who are
not located within 24 hours of the time last seen die, usually
succumbing to hypothermia and/or dehydration.

It is difficult to predict when a resident with Alzheimer's disease will
begin wandering. However, wandering incidents are prevalent in Maine as
evidenced by the experiences of the more than 600 law enforcement
officials, emergency medical crews, mall security staff, K-9 search and
rescue volunteers, and officers of the Maine Warden Service trained by
the Alzheimer's Association over the past two years. Participants
related numerous incidents including:

-   a woman who wandered into a neighbor's attic

-   a woman who was lost for five days in a remote wooded tract

-   a man in a cotton bathrobe found walking alone on a January night

-   a woman missing from a care facility found sleeping under someone
    else's bed

-   a man on foot in the middle of one of Portland's busiest streets,
    acting as if he were driving a car

-   a man who started out in New Hampshire and was found driving the
    wrong way down a one-way street in Auburn, Maine, looking for his
    daughter's home.

Most of these stories had happy endings. Some, sadly, did not.

** The best advice is to assume that the resident with Alzheimer's or
dementia will wander at some point and plan accordingly.** To help you
do this we have compiled some tips for understanding and preventing
wandering behavior. We have also asked the Maine Warden Service for
advice on what caregivers can do to prepare for and respond to a
wandering incident because collectively their 120 officers have vast
experience searching for people with Alzheimer's disease. The Maine
Wardens Service originated in

*Continued*

1880 as a law enforcement branch of the Department of Inland Fisheries
and Wildlife to protect inland fish and wildlife resources. Over the
years, their mission expanded to include primary responsibility for the
search and rescue of lost persons in all but the most urban areas of the
state. They will also search in city environs if the possibility exists
that weather conditions will endanger the victim. Wardens frequently
work in cooperation with local law enforcement and rescue groups.

### 

### Understanding Wandering

Wandering may be triggered when a resident with Alzheimer's:

-   No longer recognizes familiar people, places, and objects

-   Feels lost in a new or changed environment

-   Tries to fulfill former obligations, such as going to work or taking
    care of a child

-   Takes medications that have side effects such as restlessness and
    confusion

-   Tries to relieve stress caused by noise, crowds, or isolation

-   Experiences confusion at certain times of the day or night

-   Is restless due to lack of physical activity

-   Is fearful of unfamiliar sights, sounds, or hallucinations

-   Searches for something specific such as food, drink, the bathroom,
    or companionship

-   Looks for a way out of the home.

### 

### 

### Tips To Prevent Wandering

-   Prevent unsafe exits from the house or backyard by placing door and
    window locks out of sight and reach, either very high or very low.
    Use a double-bolt lock, and keep the key handy in case there is an
    emergency.

-   Consider high-tech devices, such as electronic buzzers or bells to
    signal when a door is opened, or a pressure-sensitive mat at the
    door or resident's bedside that sounds an alarm to alert you to
    movement.

-   Try camouflaging doors by papering or painting them to match the
    walls, or labeling them in such a way as to be undesirable to the
    resident (e.g., to discourage a woman from entering, label the door
    "Men's Locker Room").

-   Check to see if the resident is hungry, needs to go to the bathroom,
    or feels uncomfortable.

-   Encourage movement and exercise to reduce anxiety and restlessness.

-   Involve the resident in daily activities such as folding laundry or
    preparing a meal.

-   Remind the resident that you know how to find him and that he is in
    the right place.

-   Reduce noise levels and confusion.

-   Observe if wandering behavior occurs at a regular time each day and
    try to find a cause. Try to distract the resident to another
    activity during that time.

-   If night wandering is a problem, try restricting fluids in the
    evening and make sure that the resident uses the bathroom before
    going to bed. If possible, limit naps during the day.

*Continued*

### Where To Call For Help

> ** Register the resident in the Safe Return program** sponsored by
> the Alzheimer's Association. This will help to provide information and
> identification if authorities find your loved one. Call
> **1-800-660-2871** for a registration form. There is a one-time
> enrollment fee of \$40; scholarships are available from the Maine
> Alzheimer's Association.
>
>  For additional tips or ones specific to your situation, call the
> Alzheimer's Association HELPLINE at **1-800-660-2871.**

### Advice From the Search and Rescue Experts

There are a number of things that caregivers can do to help law
enforcement and search and rescue personnel find missing persons. We are
grateful to Training Supervisor, Mark Warren, and Game Warden
Specialist, Deborah Palman, from the Maine Warden Service for the
following insights:

** Plan Ahead**

**1. Before you need their help, introduce yourself and the resident to
the local law** **enforcement officers**, game wardens, fire chief, and
search and rescue group leader if such a group exists near your town.
This will help them to recognize the resident and keep special watch if
they see him or her in their travels, and help your loved one to
understand that these people may be trying to help him or her find their
way home.

**2. Talk to neighbors about the resident's condition.** Give them names
and numbers of whom to call if they see the resident outdoors without
supervision. Ask them to pay special attention to the time and place
they saw the resident.

**3. Keep a log of the resident's behavior patterns,** especially places
she likes to walk or travel. Encourage the resident to tell you where
she is going if she goes out alone. Often people become lost when they
make a small deviation from their usual route. Knowing the route gives
searchers a place to start from. Rick Davis, Chief of the York County
Emergency Rescue Team, also encourages caregivers to make note of what
the resident liked to do in the past, since they may be trying to
re-enact those earlier memories. One woman, for instance, walked 8
miles, bushwhacking her way through an overgrown mountain trail because
that had been her favorite place to play as a child. Other important
information from the resident's past includes former neighborhoods,
places of worship, workplaces or favorite places to spend time. In
addition to the above information, the search and rescue leader will
also ask you the specific time and place your loved one was last seen,

*Continued*

information about any previous wandering incidents, and what the
resident was doing and talking about just prior to her disappearance.

**4. Note what the resident is wearing each day.** An accurate
description of what the resident is wearing is essential during a
search.

**5. Provide brightly colored clothing for the resident to wear.**
Bright colors are much easier to spot in thick vegetation or from an
airplane and help motorists to see the wearer.

**6. Make rubbings, prints or drawings of the soles of the footwear the
residen wears.** Footprints are vital clues for search and rescue
personnel, and having an exact duplicate of the footwear pattern is very
valuable information.

**7. Keep an updated list of the resident's identifying information:**
height, weight, hair color, blood type, eye color, identifying marks,
medical condition, dental work, jewelry, allergies, and complexion.

**8. Make multiple copies of a recent photograph.**

**9. Keep scented clothing on hand** in the event that rescue dogs are
involved in the search. Wearing plastic gloves or using tongs or pliers,
store a piece of the resident's unwashed clothing in a bag where it will
not be disturbed. Replace it monthly to retain the scent. It is critical
that the article contains only the scent of the lost person. For this
reason, be sure that you do not touch the item directly, and avoid
taking clothing from the family clothes hamper or from areas that every
one uses.

**11. Identify dangerous areas near the home,** such as bodies of water,
swimming pools, dense foliage, tunnels, bus stops, steep stairways, high
balconies, and heavy traffic roadways. Check these places first if
someone becomes lost.

**12. Keep a list of emergency phone numbers.** In Maine, this list
should include the local law enforcement agency; the emergency number of
local Maine State Police Office, which can contact the Maine Warden
Service (the agency in charge of search and rescue in the woods and
waters); and telephone numbers of relatives, friends and/or neighbors
who live nearby who can assist in the search if the resident becomes
lost.

** If The Resident Is Missing**

**1. Call your local law enforcement agency.** **Do this first!** The
biggest single problem hampering a search is the delay in calling for
help. Let the dispatcher know that a person with dementia may be missing
and that you are going to conduct a search of the premises. You can
always call back if the resident is found right away. If not,
professional helpers have already been alerted and are getting ready to
respond.

*Continued*

**2. Call friends, relatives or neighbors to come help you.** Someone
will need to stay near the phone while others search. Often a caregiver
panics or becomes distraught and doesn't search areas well. The search
and rescue rule for small children is: "Search the house, search the
house, search the house again," because small children often hide in
places their parents never think of. The same is true of people with
dementia because they often panic and hide in unlikely places such as
closets or small crawlways. Search the property and buildings and have
nearby neighbors check their houses and yards. Be aware that
professional searchers will go over these locations again when they
arrive on the scene just to be sure that nothing has been overlooked.

**3. If the resident is not found within** **a short time,** call your
local law enforcement agency again. Be sure to stress that the resident
has Alzheimer's and may be confused and vulnerable if she is lost. The
resident may become endangered if not found soon. This is especially
crucial if the weather is bad. Ask the agency to contact a K-9 (dog)
team to help. Many law enforcement agencies have their own K-9 teams, or
trained teams are available from the Maine State Police, Maine Warden
Service, and Maine Search and Rescue Dogs, which can be contacted
through the Maine Warden Service.

**4. Notify the Maine Warden Service.** If your local law enforcement
agency does not contact them, contact the Warden Service yourself
through the nearest State Police office. If it still seems like no one
will be responding, keep trying.

**5. Make sure someone stays near the phone** once an emergency response
agency has been called. Because those who answer the phone during the
search will need to answer questions about the lost resident, it should
be someone who is familiar with the resident's dress and habits. If the
Resident Coordinator is designated as the best person to stay near the
phone, get help from others to search the local area and perform other
tasks. Use a cell phone or another phone line so that the number you
gave to emergency personnel remains free for incoming calls.

**6. Tell local searchers to be alert for clues like footprints and
litter.** Often, these clues are ruined by people who are unaware that
they are destroying signs that can be used to help find the lost
resident. Unless those searching are trained woodsmen who can recognize
the sign of the lost resident, it is best if the family or friends stay
out of the woods and check local buildings, yards and other areas the
lost resident may be. Trained search and rescue personnel who can read
signs and track the person in the woods or in the dirt beside the road
will be responding. Keeping people out of uninhabited areas also makes
it easier for dog teams to search these areas. Keep in mind that the
lost person may also be moving and move into areas that have already
been searched.

**7. Have someone ride the local roads to watch for the lost resident**
who may find his way to a road. Make sure these persons look for
footprints if they are driving on dirt roads, and have them preserve any
footprints they find which might belong to the lost person.

*Continued*

**8. Don't clean up the house or the lost resident's room.** A K-9
handler will want to obtain a scented article that has only the
resident's scent on it. The handler or another trained person should be
the one to retrieve the article. Often a pillowcase from an unmade bed
is best. Investigators will also want to look around for clues that may
tell where the person went.

**9. Stay calm.** Most lost persons are found unharmed within a few
hours of being missing. Lost persons, even those with dementia, have
surprising resilience when lost.

**Emergency Phone Numbers**

Maine State Police: Augusta 1-800-452-4664

Houlton 1-800-924-2261

Orono 1-800-432-7381

Scarborough 1-800-482-0730

Local search and rescue groups: call the Dept. of Inland Fisheries and
Wildlife Safety Office at 207-287-5222 (Business Hours Only).

Maine Search and Rescue Dogs: call the pager number at 207-471-DOGS
(207-471-3647).

# Appendix 5.5

> On the following page is a registration brochure from the Alzheimer's
> Association **Safe Return** program. To order additional copies, call
> the Maine Alzheimer's Association
>
> toll-free at 1-800-660-2871, or contact your local chapter.
>
> You can also print out additional forms from the national Alzheimer's
> Association web site at [www.alz.org](http://www.alz.org/).

# Appendix 5.6

> On the following pages we have provided a photocopy of the **Driver
> Medical Evaluation** form from the Maine Secretary of State,
> Department of Motor Vehicles. This form should be provided to the
> resident's physician if you become concerned that he or she may not be
> able to safely operate a vehicle.
>
> **For Housing Staff In Other States:** Contact the Department of Motor
> Vehicles in the Office of the Secretary of State to request procedures
> for driver medical evaluation for your state.

# Appendix 5.7

**Sample Letter**

**[To Report An Unsafe Driver]{.underline}**

On the following page we have provided a sample letter you may wish to
use if you feel that a resident with Alzheimer's or dementia can no
longer safely operate a vehicle. Of course, in addition to filing this
letter with the Secretary of State, you should also notify the
resident's family or caregivers of any driving-related mishaps or
accidents involving the resident. For more information, you can also
call the Medical Review Coordinator for the Bureau of Motor Vehicles at
(207) 624-9000, ext. 52125.

**SAMPLE LETTER**

Secretary of State

Medical Records Review

State House Station 29

Augusta, ME 04335

Re: Mr/Mrs. John Doe

Name of Residential Facility

Address

City, State Zip code

Dear Sir or Madam:

This letter is a formal request for a medical review of the driver's
license of \[name of resident\] whose date of birth is
\[month/date/year\].

As the \[Resident Coordinator/other title\] at \[insert name of
residential facility\], I have become concerned about the ability of one
of our residents, \[Name of resident\], to safely operate a motor
vehicle. Recently, \[Mr./Mrs./Ms. Name of resident\] has been involved
in several mishaps while driving \[his/her\] car. \[You may wish to
describe an incident here.\]

Although no summons was issued in any of these incidents, I have told
\[Mr./Mrs./Ms. Name of resident\] that I would be contacting your
office. I \[know/believe\] that \[Mr./Mrs./Ms. Name of resident\]
\[is/may be\] suffering from a form of cognitive impairment associated
with Alzheimer's disease or a related dementia that makes it
increasingly difficult for \[him/her\] to drive safely.

According to our records, this resident's primary physician is:

Name of Doctor

Name of Hospital or Practice

Address

City, State and Zip Code

Phone number

Thank you for your review of this matter.

Sincerely,

Your name

Title