Question: When is it no longer safe to leave my wife with Alzheimer’s disease home alone?
Answer: If you are asking the question, it’s probably no longer safe.
This is another one of the questions that invariably come up over the course of the illness. Unfortunately, it can also be a life-changing event for spouses and child-caregivers who are still working. It’s also another one of those questions that cannot be answered definitively by a medical professional because it is so dependent on individual characteristics of the patient.
In general, once a patient enters the moderate phase of dementia (the phase in which they require some help with their basic activities of daily living like dressing, bathing and grooming), it is unsafe to leave them alone for even short periods of time. Caregivers often say to me, “but my wife is perfectly content to sit and watch TV for an hour or two!” To this I generally respond that while that may be the case, they need to assure themselves that their spouse is also capable of handling emergencies. What would happen if there was a fire in the home? How would they deal with a stranger who comes to the door? By the time patients are in the moderate stage of dementia, they will often no longer have the insight and judgement to deal with emergencies, nor will they have the communication skills necessary.
At times, even patients with mild dementia may not be safe to stay alone, especially if they have demonstrated anxious, agitated, or impulsive behaviours. Patients who have experienced paranoia, delusions (false fixed beliefs, usually of a persecutory nature) or hallucinations, are also probably unsafe to leave alone. Finally, patients who have wandered should not be left alone.
Because of the serious implications for caregivers, this is a stage that I begin to talk about very early in my care of the patient, and ask caregivers to begin to plan for this eventuality. Some of this planning generally includes thinking about alternatives to the caregiver themselves providing the supervision. For example, are there friends or family who can provide some of the supervision? Are there community resources that can be used? Can home care through government service providers be utilized? Can the caregiver afford private care or even a full-time professional caregiver? Can a day program be used? While all these options will be helpful, in the end, the burden of care often falls on the spouse or one of the children, seriously affecting their work and social life. This is often a time when the caregiver might begin to think of institutionalization.