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My mom knows how to push her button and walk out the front door if there's a fire . But how do I know she understands that and she verbalizes back to me ... She has dementia and we have been over it but I'm not sure what to do to be sure she can verbalizes this to a dr ? I want to be sure she's safe for the few hours a day she's alone ...,any help would be appreciated

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I've thought about this a bit. My mother walks so slowly that it would take her a while to get out of the house if there was a fire. Then I thought about what I would do. Would I save myself and the rabbit, or would I let the both of us get burned with her trying to help? That is a huge question. I hope that I am never faced with it.

My mother also occasionally sets off the fire alarm when she cooks bacon or toast. She doesn't pay any mind to it.
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I was at my mother's doing her laundry and she was upstairs in the kitchen and put a piece of bread in the toaster, which caught on fire (the bread) setting off the smoke detector in the hallway of her tiny house. I came up and unplugged the toaster, and she was sitting in front of her tv with the sound cranked all the way up so she could hear over 'that annoying noise'! So, I 'hid' the toaster, to be brought out only when someone was there. The oven knobs were long ago taken off. The microwave was iffy, but when something burned in there, it got unplugged (she didn't think to plug it back in, just pressed buttons willy nilly with no result.)
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Babalou, she couldn't find APS number in the phone book (small print), but she would know how to call 911.

My three brothers know about this key issue. I vaguely remember her response when one of them asked about it a few years back. (Someone could break the sidelite glass and reach in and unlatch the deadbolt was her reasoning.)

The brothers are all out of state. One is probably going to visit in the next month or so, and I will discuss this with him. If he lets the entire issue drop, then so will I.
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That's true. The trouble with fire drills is that they rely on a person remembering what they did in the drill. A person with dementia normally lacks memory skills. And the problem with signs is that they rely on a person being able to read and follow the direction. And people with dementia often lose the ability to read and follow directions on their own initiative.

I've seen this example. If you write down on a peace of paper, touch your nose and have a person with dementia read it. They may say the words, but will they follow the instruction? I suppose that some patients with certain levels can still do that, but after a certain point, it's not possible.
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I think fire drills are an excellent idea to practice in case of a fire. Leaving a person with dementia alone, even for a little while, is questionable. Depending on the severity of the stage of dementia, their minds are more on the cognitive level of a small child. No responsible adult would ever leave a small child alone, even for a minute.
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What would your mom do if you changed the locks to keep her safe? Would she call APS to report you for abuse? Call 911?

If she's competent enough to do those things ON HER OWN then you probably don't have to worry about her competence in an emergency. But if she can't, then i think you have a responsibility to keep her safe.

Mental competency testing goes beyond a simple mental status exam. I'm sorry that you're going through this, and sorrier still that I'm being a nudge. But the
" what if there is a fire" question has long been my criteria in both my personal and professional life for safety standards.
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Grandma1954, interesting that others have dealt with the key-needed-on-interior-deadbolt issue. I like your solution. I might bring this idea up with my mother, but I doubt she'll go for it.

Babalou, my mother would pass any mental competency exam, so I can't just go and change her lock without her permission. Her reasoning is flawed, she doesn't hear, process or remember things correctly, but she would not be declared incompetent. I think she's in the gray area. I think this is a case where she has to be allowed to make her own mistakes and suffer the consequences, as is often suggested on this site with stubborn elders.
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Another thought: get "EMERGENCY EXIT" signs like commercial places have, and find out how to use battery operated lights so the signs are still visible in the event a fire cuts off the electricity. I imagine it would be somewhat expensive, but perhaps it's possible to install one way locks on them - locks that would open outward for escape but not inward for unwanted people.
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Thank,you so much for the great idea , I actually thought the signs were a great idea .. Thank you so much for your input every suggestion is greatly appreciated
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CT, i know you know this....but your mom's brain is broken. She can't be the ones calling the shots anymore. You just change the lock and let her pout, or scream or cry.
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CTTN55, I had to put a keyed deadbolt inside as well. I wore the keys around my neck at all times.
My husband when he was able to walk could find a way out of the house so I changed the deadbolts to keyed on both sides. So for 4 years I wore keys around my neck. Now that he is no longer walking I have been able to change the locks again so they are a thumb lock inside and keyed on only the outside. Much safer for both of us.
But knowing the keys were around my neck so even waking up at 2 in the morning and half asleep I could have unlocked the doors.
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I've been thinking about this situation; it's an unsettling situation for anyone caring for someone. While I can't think of anything sophisticated, perhaps something very basic would work.

I might create large signs and fix them to the walls with directions from every point in the house to the door. Keep it simple - maybe just something like:

FIRE- GO THIS WAY. Have large arrows pointing the direction. Place them along all the routes from all the rooms.

The question I wouldn't have answers to is if the smoke alarms activate - that loud sound alone can be disorienting. Maybe there's a way to have them connected so that one of them alarms outside and the neighbors could hear it?
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Just my two cents as everything else has been covered. We have a security system with fired alarms hard wired to it. When there is a fire i.e. when dinner o the stove burns., it lets out huge noise that anyone can hear then the phone rings. If the phone is not answered the call center immediately notifies local emergency services. If you press the pendent same thing happens but they know the difference between a medical emergency and a fire.
You have to work and 12 hour shifts are normal these days for nurses so be comforted in that you are doing the best you know how.
If you can afford a smart phone you could install a camera so you could check on Mom from time to time
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Seriously? That is your question? Rethink that question. How about, how do I keep this person safe when she has dementia and is not able to make logical decisions and follow through, especially in a crisis?
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cwillie, she has the Great Call system (and I have the phone app so I can see her whereabouts during the day if she drives somewhere). Thanks for reminding me about that!!!

Babalou, yes, we know that having the deadbolt key in another location is dangerous. She's had that explained to her. We couldn't replace the lock, as she would not allow it. I doubt she would believe a fireman...
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When i had a house with a lock like that on one of our wrought iron doors, we kept the key in the latch at all times in the winter (when the wooden interior door was closed, or hanging on a nail next to the door jamb in the summer when it was open. Having the latchkey in another location is extremely dangerous. How about having your local fireman come out and explain this to her? Or just replace the lock.
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CTTN, if she has an alarm pendant system like Lifeline she could at least summon help. My mom had it for years when she could still live independently. One thing I liked about Philips Lifeline was mom had to check in every month to test the system, being forced to use the system routinely makes them more likely to push the button when needed.
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Ooops...wish there was an edit feature on this board. I meant "she'd have to get herself down the hall," NOT "down to the hall," as she has a one-story.
Oh, and I didn't mention that she doesn't see well in the dark, and only has vision on one eye. At least I talked her into using a nightlight in the hall (but, again, that wouldn't work if the power was out).
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Interesting topic. My mother (90 next month, starting to slip cognitively) has a key to her deadbolt (key on interior side instead of latch) that she keeps in the kitchen. She is unsteady on her feet (uses cane, sometimes walker). So if she were in her bedroom, she'd have to get herself down to the hall, remember to stop in the kitchen to get her deadbolt key (or remember to get her purse where there is a set of keys), unlock the front door and get out. Maybe she would remember to go out the garage door instead (assuming the power worked for the automatic garage door opener). She won't let anyone tell her anything, though, so this is the situation she will have.
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omeowzer...Forget about perfect..we (none of us) will ever get it PERFECT! What sets us apart is that what we do we do with LOVE and that more than makes up for not being perfect.
We get angry
We are hurt
We are tired
But
We love
We care
We try
That is all anyone can ask, that is all anyone can expect.
If at the end of the day when your loved one is in bed and you can lay down and honestly say "we both survived another day, I did the best I could" then you can sleep easy.
There are days when I wonder how I am going to do it but that day becomes the next and that day is better.
I have always said my worst day now will be one of my better days in 6 months.
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Unfortunately, you can't teach dementia patients anything because they simply don't remember after a short period of time, and this gets progressively worse. Even writing instructions down, either on paper or a whiteboard does not guarantee they will follow them. (In my mother's case, first we wrote instructions on paper (which she threw out), then hung a white board (half the time she erased it and the other half, forgot to look at it). They simply can't help it - memory, self care, routines just drain right out of their heads. You would be better off hiring someone for the three hours, or maybe ask a neighbor to check on her.
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You learn with your brain. The brain of a person with dementia is broken. If her safety relies on her learning something, you need to find another way to keep her safe.
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I think that's a good way to look at it. If something does happen, like a fire, and she is harmed, the authorities are going to ask about her and when they discover that she has dementia and was left alone....that would be very upsetting for me.

Also, what if a stranger rings the bell? Can you be sure she won't answer it?

There are many things to consider.
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Cwillie, your words about the risk we're willing to take was what I always ask myself. I usually ask, "If something happens, and they die inside the house while I went for a quick drive to the Post Office or to the grocery store, will the police or prosecutor find me guilty of elderly endangerment/neglect?"... "If they die while I'm away, can I live with it, the guilt?".. 99.9% of the time, I decided that it's not worth it. I'll wait until my work lunch hour to do whatever errands need to be done.

Changing pampers 3 times a day, over and over - is a set routine. Yet, dad has finally reached the point that he can no longer turn or lift or sit up automatically. He's forgotten the routine. Now I have to say, "Up, lift butt, turn - no not to me - turn away from me, okay, turn to your back..." It's true that they can change and forget so quickly what used to be normal routine.

If you're worried - then take it seriously. Listen to your gut feelings. What I'm worried about is - If there's a fire, her main concern will be getting the cats out. And if the cats run into the closet and under the bed, she's going to be in there with them, trying to catch them. The cats will be in terror and refusing to come out, your mom will spend valuable time trying to get them out - until it's too late. Just be careful. And go with your guts.
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Cwillie
This phrase "be at peace with the level of risk you are willing to accept" is like tragic chilling poetry.
Thank you ohme for the question. I feel foolish for not having considered it before.
Thank all of you for the excellent advice. I don't think I could ever " be at peace " if my ignorant negligence were the reason for harm coming to a loved one.
I'm sorry for the loss of your sister. I'm sure she would be proud of how well you are caring for your mother.
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Very very good ideas I'll call the alarm company Tommrow , I agree about down the line , about her memory . I'm glad you all are here to help me I'm doing life alone since my sister died 3 years ago aug 10 , 2013 .. Life has become so hard and Geri ( my sister) always helped me .. I try so hard to get moms care as perfect as I can .. But I'm never sure ( even though I am a RN) I'm doing enough ... I'm not sure about much anymore ...since mom has declined I'm getting more confused when I should call hospice ... Is she eating enough .. Ectra ..when it's your own mom it's so difficult . Gosh I miss my sister ,. I'm so alone in all this
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And she may do well now but what happens in a month or two when her memory has declined more?
Is it possible to have the smoke detector wired in so that the fire department would be notified right away . I think many of the alarm companies have this service.
Also notify the Fire Department and Police Department that you do have an older person with dementia living in the house so that they are aware and can do a search for her should the need arise. Like a child she probably would not call out or answer if they called to her.
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That is a awesome idea that is great ! Yes I will do that thank you
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A couple near me did not see "fire". They smelled smoke and called their son 300 miles away. He called both 911 and his sister who lived just across the street from her parents. She got them out, both landed in the ER and the house was a total loss. That is reality. You want to experience reality, go to her kitchen, press the test button on the smoke detector and watch what she does. Don't yell fire, just push the button and wait.
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She is home alone 3 hours a day , I have a are giver 8 hours a day , well we actually had a fire drill pretending she is alone and she really did awesome . I said mom what do you do if there is a fire she stated " I get out " I said which exit " she said the closest " she said I'll leave the door open so the cats will get out ... She sits by the brown door her chair is 3 steps away,,,, I told her Tommrow we do a full fire drill , she is a retired nurse so she really was able to reason out what to do ..... I was shocked ... I think she's teachable .. I'm gonna video tape her we will renew it weekly .. She said once I get outside I'm gonna yell Fire fire ... I was shocked .. And she's gonna push her button her life alert ..... I will see how it goes .. I'm a RN so I work 12 hour shifts but yesi j do have a caregiver most of the day .... I think her dementia is getting worse.. But I'm a teaching nurse so I'm hoping I can make it second nature ... I appreciate all your help and advice , I need to figure out teaching methods ... I worry about everything ... Ugh God Bless us ... It's coming up to my sisters 3 years since her death. So I am highly emotional and sad ... Thank you for listening ... I love all your advice
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