Understanding dementia at home: what changes and what stays possible

Living with dementia at home can be both comforting and challenging. Home is familiar. The photos on the wall, the favourite chair, the morning cup of tea in the same spot, these things help many people living with dementia feel grounded.

At the same time, dementia affects memory, thinking, problem-solving, and behaviour in ways that gradually interfere with everyday life. Global health organisations describe dementia as a decline in cognitive functioning that eventually means a person needs support with daily activities such as cooking, dressing, managing medication, and moving safely around the home.

The hopeful part is this: many risks at home can be reduced. You don’t need to overhaul everything at once. As an occupational therapist, I’ve seen again and again that steady, practical tweaks make more difference than big, overwhelming changes. Think in small, realistic steps:

• One routine made easier (for example, laying clothes out in order or keeping the shower at the same time each day)
• One trip hazard removed
• One piece of equipment or support service added

Over time, these small adjustments can reduce falls risk, prevent hospital admissions, and protect both safety and independence. Most importantly, they help the person with dementia keep doing the things that matter to them, for as long as possible.

Who this guide is for: NDIS, Support at Home (SAH) and families

This article is written for people in Australia who are:

• Living with dementia at home
• Caring for a parent, partner, or family member living with dementia
• Receiving aged care supports under the Support at Home program (Australia’s reformed in-home aged care system that replaced Home Care Packages and Short-Term Restorative Care on 1 November 2025)
• People receiving NDIS with a diagnosis of dementia.

If you are looking for official information or extra support, two helpful starting points are:

• My Aged Care – information about Support at Home and how to access an aged care assessment
• Dementia Australia – information, Helpline, “At Home with Dementia” and dementia-friendly home resources

Caring for a parent with dementia at home: start with a realistic plan

When you’re caring for a parent with dementia at home, the goal isn’t perfection. It’s:

• Safety
• Dignity
• Calmer, more predictable days

Step 1: Map daily routines and “pressure points”

As an occupational therapist, I often suggest families keep a brief behaviour diary for a few days, and dementia organisations and Australian government-backed tools recommend the same because these notes help reveal patterns and triggers that are easy to miss:

• Times of day when confusion or agitation is worse (e.g. late afternoon “sundowning”)
• Activities that cause conflict (bathing, changing clothes, medication times, getting into or out of the shower)
• Triggers that seem to increase distress (noise, rushing, multiple people talking at once, cluttered spaces)
• What helped settle things – for example, a quiet room, a favourite song, a cup of tea, or stepping away for a few minutes

A simple week of notes can make GP and OT appointments far more useful, shifting the conversation from “They’re just not coping at home” to specific routines, environments, and supports we can actually problem-solve.

Step 2: Involve the GP and care team early

A GP can:

• Check for medical issues that can worsen confusion (e.g. infection, pain, medication side effects, dehydration, sleep problems)
• Review current medications and refer to specialists if needed

Allied health professionals, especially Occupational Therapists, physiotherapists, and psychologists—can then help turn these issues into practical plans (e.g. safer bathing routine, mobility supports, memory prompts, or strategies for distress).

Functional capacity assessments and dementia: why they matter

A strong support plan starts with a clear picture of what the person can do, what’s becoming harder, and what support would make the biggest difference.

In the NDIS and aged care context, this is often done through a functional capacity assessment. In dementia, an OT will typically look at:

• Activities of Daily Living (ADLs): showering, dressing, toileting, eating
• Instrumental ADLs (IADLs): cooking, shopping, transport, managing money, medication routines
• Mobility and balance: getting in and out of bed or a chair, using stairs, moving around the home
• Cognition in action: memory, attention, problem-solving, insight and safety awareness during real tasks
• Communication and behaviour: how the person understands information and expresses needs

A well-written functional capacity assessment for dementia can:

• Provide clear, plain-language goals (for example, “safer showering with supervision and grab rails”)
• Support requests for home modifications, assistive technology, and support hours under the NDIS or Support at Home
• Give family members a shared understanding of current abilities and risks

It doesn’t guarantee funding, but it can provide the evidence and clinical reasoning decision-makers need to understand why supports are reasonable and necessary.

Support at Home occupational therapy and dementia: how OT helps in real life

As an occupational therapist, I focus on practical, hands-on strategies that make day-to-day life at home safer, calmer, and easier for someone living with dementia and for the people supporting them.

An OT can help to:

• Simplify task into smaller steps (“pick up toothbrush”, “put toothpaste on”, “brush top teeth”)
• Remove unnecessary steps that create confusion
• Build predictable routines
  • Consistent wake-up, meal, and bedtime routines
  • Regular shower days and times
  • Familiar prompts (the same words, in the same order, used by all carers)
• Add cues and supports
  • Labels and pictures on cupboards and doors
  • Large-font calendars, clocks, and whiteboards
  • Colour contrast to help people see edges, steps, or plates more clearly
• Recommend equipment and modifications
  • Shower chairs, grab rails, and non-slip mats
  • Bed rails or hospital-style beds if needed
  • Simple mobility aids to reduce falls risk

The focus is not on “taking over”, but on keeping the person involved in their own life for as long as safely possible.

Dementia vs Alzheimer’s: What’s the difference?

Dementia is an umbrella term that describes a group of symptoms affecting memory, thinking, behaviour and the ability to perform everyday activities. Alzheimer’s disease is the most common cause of dementia. In other words, all Alzheimer’s is dementia, but not all dementia is Alzheimer’s. There are several different types of dementia, including vascular dementia, Lewy body dementia, and frontotemporal dementia, and each has slightly different underlying causes and patterns of symptoms. Understanding the difference matters because diagnosis, progression, and management strategies can vary depending on the type. Learn more at: https://www.who.int/news-room/fact-sheets/detail/dementia

Home safety for people with dementia: a room-by-room checklist

Home safety for people with dementia is about balancing freedom and safety. The aim is to remove obvious hazards while keeping things familiar and comfortable. Dementia-specific services and government health sites highlight similar themes: good lighting, clear pathways, and reducing confusing patterns or clutter.

Kitchen and medications

• Lock away or closely supervise:
  • Sharp knives and scissors
  • Cleaning products and insect sprays
  • Matches and lighters
• Use appliance safety features where possible (e.g. automatic shut-off)
• Create one medication station a single tray or container, in one location
• Consider reminder systems or supervised dosing as memory declines

Bathroom and falls

• Install grab rails beside the toilet and in the shower
• Use non-slip mats and remove small loose rugs
• Improve lighting and reduce glare (frosted bulbs, night-lights, blinds that reduce harsh contrast)
• Set hot water temperature at a safer level to reduce burn risk

Wandering risk and outdoor safety

• Consider simple door alarms or motion sensors if wandering is a concern
• Keep car keys out of sight if driving is no longer safe
• Use a medical ID bracelet or card with emergency contacts
• Keep a recent photo of the person available in case police assistance is needed

For more detailed, dementia-specific home-safety ideas, Dementia Australia and government health resources such as Healthdirect Australia offer room-by-room guides and interactive tools.

Dementia caregiving: everyday skills that protect everyone

Dementia caregiving is demanding. It is also a skill that can be learned and supported.

Caregivers often find it helpful to:

• Speak slowly, using short sentences and one instruction at a time
• Offer two choices, not ten (Would you like tea or water?)
• Reduce background noise (TV, radio, multiple people talking at once)
• Focus on the emotion behind the words (You seem worried, let’s sit together for a minute.)

And importantly, carers need care too. Carer burnout is common and that practical and emotional support are essential, not optional. Read more on this blog:

Ageing carer Burnout: Ways to Recharge and Reduce Carer Burden

10 tips for dementia caregivers

1. Keep routines steady – similar wake, meal, shower and bedtime routines each day.
2. Use visual cues – labels, pictures, calendars and whiteboards to support memory.
3. Make the home brighter – increase lighting and reduce shadows that can cause confusion.
4. Remove trip hazards – loose rugs, cluttered walkways, trailing cords.
5. Communicate calmly – one instruction at a time, with a gentle tone.
6. Choose dignity over debate – avoid arguing about facts; focus on comfort and reassurance.
7. Simplify meals – foods that are easy to see and handle; good contrast between plate and table.
8. Build in movement – short walks, light household tasks, simple exercises appropriate to the person’s ability.
9. Use respite early– don’t wait until you are completely exhausted to ask for a break.
10. Get OT input – small environmental changes or equipment can significantly reduce falls and care stress over time.

How to reduce dementia risk: what families can do now

Many families also ask how to prevent dementia. Not all dementia is preventable, and it is important not to blame yourself or others. However, large international reviews suggest that a significant proportion of dementia risk is linked to modifiable factors such as high blood pressure, physical inactivity, smoking, hearing loss, depression, diabetes and social isolation.

For brain health across the lifespan, focus on:

• Managing blood pressure, diabetes and cholesterol with your GP
• Regular physical activity
• Not smoking and limiting alcohol
• Staying socially connected (family, community, hobbies, groups)
• Keeping mentally engaged (learning, reading, puzzles, meaningful tasks)
• Good sleep and treating hearing loss early

Even if dementia is already present, these habits can still support overall wellbeing and day-to-day function.

FAQs

Conclusion: small changes add up

Dementia at home can be tough for the person living with it and for the people who love them. But, you are not powerless. With:

• A realistic plan
• Thoughtful home-safety upgrades
• Support from services like OT, NDIS and Support at Home
• And a focus on looking after carers as well as the person living with dementia many families are able to create calmer, safer routines that support dignity and reduce crises over time.

If you’re in Melbourne and would like a home-based support, Cas Health’s mobile OT can visit you at home. We can complete functional assessments and work with you to make tailored recommendations for safety and independence.

You don’t have to do this alone, even one small change is a valid place to start.

reference:
https://www.dementia.org.au/living-dementia/care-options/home-care

https://www.dementia.org.au/get-support/home-dementia

https://www.myagedcare.gov.au/aged-care-programs/support-at-home-program

https://www.ndis.gov.au/applying-access-ndis/how-apply/information-support-your-request/providing-evidence-your-disability

https://www.alzheimers.gov/life-with-dementia/tips-caregivers

Related blogs:

• Occupational therapist in aged care: what OT’s actually do, falls safety, and when to call one
• Still Looking for an Occupational Therapist Near You?
• Ageing carer Burnout: Ways to Recharge and Reduce Carer Burden
• Top 5 Reasons support coordinators love working with Cas Health
• NDIS Price Guide 2026: Critical OT Pricing Changes, Release Timing & What It Means