Dementia Home Safety Assessment in Washington State

Your parent's home — the place they have lived for decades — becomes a hazard map when dementia progresses. Stairs they climbed without thinking become fall risks. The stove becomes a fire starter. The front door becomes an escape route at 3 AM. A structured home safety assessment identifies the specific dangers in your parent's environment and tells you what to fix, what to add, and what state-funded technology is available to help.

When to Do the Assessment

Do not wait for the first fall or the first wandering incident. The right time is immediately after diagnosis, and then again every 6 months as cognitive and physical abilities decline. What was safe at the mild stage — a gas stove, unlocked exterior doors, a second-floor bedroom — may be dangerous at the moderate stage.

If your parent recently had a CARE assessment through DSHS and was approved for Community First Choice (CFC) services, your case manager can coordinate an occupational therapy evaluation that includes a home safety component. But you do not need to wait for a formal evaluation to start the audit yourself.

Room-by-Room Safety Checklist

Kitchen

The kitchen is the highest-risk room for someone with dementia. Priorities:

• Stove controls. Install stove knob covers or a stove guard that automatically shuts off the burner after a set time. Consider switching from gas to electric if your parent has forgotten to light the pilot or left gas running.
• Sharp objects. Lock knives, scissors, and kitchen tools in a drawer with a childproof latch. Leave out only blunt utensils.
• Cleaning chemicals. Move all chemicals, dishwasher pods, and medications under the sink to a locked cabinet. People with moderate-to-severe dementia may mistake brightly colored pods for candy.
• Water temperature. Set the water heater to 120 degrees Fahrenheit or lower. Dementia impairs the ability to judge water temperature, increasing scald risk.
• Appliance access. Unplug the toaster, coffee maker, and microwave when not in active use — or install smart plugs you can control remotely.

Bathroom

• Grab bars. Install at the toilet, inside the shower or tub, and next to the sink. Use wall-mounted bars rated for at least 250 pounds — suction cup bars fail under load.
• Non-slip surfaces. Apply textured adhesive strips inside the tub and shower. Add a non-slip bath mat with suction cups on the floor outside the tub.
• Raised toilet seat. Reduces the distance your parent needs to lower themselves, cutting fall risk during transfers.
• Remove locks. Take the lock off the bathroom door (or reverse it so it locks from the outside). A parent with dementia who locks themselves in may panic and be unable to figure out how to unlock it.
• Medication storage. Move all medications out of the bathroom to a centrally monitored location. A locked pill organizer with timed alarms helps prevent double-dosing.

Bedroom

• Bed height. The bed should be low enough that your parent's feet touch the floor when sitting on the edge. If they are falling out of bed, add a padded bed rail or move the mattress to the floor.
• Nighttime visibility. Install motion-activated nightlights along the path from bed to bathroom. Total darkness disorients someone with dementia; bright overhead lights at night cause agitation. Soft, automatic lighting is the balance.
• Floor clutter. Remove area rugs, power cords, and any furniture that is not fixed in place. A clear, wide path from the bed to the door.
• Bed and chair sensors. Pressure-sensitive pads under the mattress or seat cushion alert you when your parent gets up — critical for nighttime wandering prevention.

Stairs and Hallways

• Gate the stairs. If your parent does not need to use the second floor, install a locking gate at the top and bottom. Choose a gate that does not have a step-over bar at the base — that is a tripping hazard.
• Handrails. Install on both sides of every stairway, extending past the top and bottom steps.
• Contrast strips. Apply high-contrast tape to the edge of each step. Dementia impairs depth perception, and uniform-colored stairs look flat.
• Remove throw rugs. Every loose rug in a hallway is a fall waiting to happen.

Exterior and Exits

• Door alarms and locks. Covered in detail in the wandering safety plan — magnetic alarms on every exterior door, locks positioned above or below eye level, visual camouflage techniques.
• Outdoor lighting. Motion-activated floodlights at all exits and along walkways.
• Fence the yard. If your parent has a history of exit-seeking behavior, a locked fence gate prevents them from reaching the street.
• Vehicle access. Remove car keys from anywhere your parent can find them. If they know where the spare is hidden, move it. A parent with dementia who gets behind the wheel is a danger to themselves and others — see Washington's driving rules for dementia.

State-Funded Assistive Technology

Washington's CFC program covers assistive technology designed for safety and independence. Through your DSHS case manager, you can request:

• Personal Emergency Response Systems (PERS) — wearable alert buttons connected to 24/7 monitoring
• GPS locator devices — real-time tracking with geofence alerts when your parent leaves the property
• Fall detectors — automatic alert dispatch without requiring your parent to press a button
• Medication dispensing systems — locked, timed pill dispensers that only release the correct dose at the correct time

These are CFC-covered benefits for Medicaid-eligible individuals who meet Nursing Facility Level of Care on the CARE assessment. The technology is provided at no cost to the family.

For families not yet on Medicaid, the TSOA program (administered through your Area Agency on Aging) may cover home modification and safety technology even when the care receiver exceeds Medicaid income limits.

Professional Home Safety Evaluations

Your local Area Agency on Aging can refer you to occupational therapists who specialize in home safety for people with dementia. A professional evaluation goes beyond the checklist — they assess your parent's specific movement patterns, identify fall-risk hotspots based on how your parent actually uses the space, and recommend modifications tailored to the home's layout.

The Washington Dementia & Memory Care Guide includes a printable room-by-room safety audit checklist, a CFC assistive technology request guide, and a home modification priority worksheet — so you can systematically work through the assessment and track what has been completed.

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