Is it safe to leave a parent with dementia alone? The questions to walk through honestly

Nobody asks "is it safe to leave a parent with dementia alone" on a good day. You ask it after the neighbor walked her home, or after you came back from the store and the burner was on, or at midnight when you cannot sleep for wondering. There is no test on this page and no score. There is a set of questions, each tied to what the Alzheimer's Association and the National Institute on Aging publish, and next to each answer, what it points to.

The honest starting point

The Alzheimer's Association's page on middle-stage caregiving says plainly that early in the middle stages, it will become too difficult or dangerous for a person with Alzheimer's to be left alone, and that preventing wandering becomes a crucial part of care, with safety precautions needed throughout the person's living environment. Its wandering page adds that six in 10 people living with dementia will wander at least once, and many do so repeatedly.

That does not tell you which stage your mother is in, and neither can we. It tells you the question is the right one, and that "she's fine for a few hours" is a claim to test.

Can she use the stove safely?

The stove is the first question because it is the one with the least room for error. The Alzheimer's Association's home safety page says to prevent unsafe stove usage by applying stove knob covers, removing knobs or turning off the gas. The NIA's home safety page says to use smoke detectors and natural gas detectors and check them often, because people with Alzheimer's may not be able to smell smoke or an unlit gas stove. If your answer is "she still cooks, and I have not checked," the knob covers go on this week regardless of anything else on this page.

Would she know what to do if the smoke alarm went off?

Not "does she know the number for 911." Would she, with the alarm going and the smoke, get herself out of the house? Watch her respond to a loud unexpected sound and you will have your answer. If she freezes, hides, or tries to silence the alarm rather than leave, the NIA's advice to list emergency phone numbers and the person's address near all phones is necessary but not sufficient, because a list only helps someone who reaches for it.

Does she know how to call for help?

Hand her a phone and ask her to call you. Then ask her to call you from the phone she would actually have if she fell in the bathroom; a landline in the kitchen does not help a woman on the bedroom floor. The NIA's falls guide wants night lights and light switches close to the bed and a lit path to the bathroom. A charged phone by the bed, with your number as the only button, is the rest of it.

Has she ever tried to leave?

If the answer is yes, even once, even "just to the mailbox and she seemed confused," this question outweighs the others. The Alzheimer's Association says to identify the time of day the person is most likely to wander, and it says never to lock a person in at home. Put those together and the conclusion is uncomfortable but honest: a person who has wandered cannot be left alone during her wandering hours, and the answer cannot be a lock. It has to be a person. The safe-exit checklist slows the door; it does not replace someone hearing it.

Does the late-day window happen when you are not there?

The NIA describes sundowning as restlessness, agitation, irritability, and confusion as daylight begins to fade. If your mother's hard hours are four to eight and you leave at three, she is alone for the exact stretch when she is most likely to be frightened, most likely to head for the door, and least able to use the phone. Many families discover that the honest answer is not "she cannot be alone" but "she cannot be alone after four."

Her medicines, her money, the front door

Three smaller questions. The Alzheimer's Association says to place medications in a locked drawer or cabinet, and the NIA says to store prescription and over-the-counter medicines, alcohol and cleaning products in a locked area or remove them from the home. Whether she takes the right tablets when nobody is there is a question for her doctor, not the kitchen counter. Who answers the door to a stranger, and whether she would hand over a checkbook, is a front-door question too; the NIA suggests a "NO SOLICITING" sign for the front gate or door.

The car is a door too

A daughter searching "dementia and driving how to take the keys" is asking the alone question about the road. The NIA's driving page lists what families notice first, including getting lost and comments from neighbors or friends about unsafe driving, and says you can ask the person's doctor to tell them to stop driving; the doctor can write "Do not drive" on a prescription pad. If necessary, the NIA says, hide the car keys, disable the car, move it out of sight, or consider selling it. The Alzheimer's Association suggests a comprehensive driving evaluation by an occupational therapy driving rehabilitation specialist in the early stages. Whether she should still drive is her doctor's decision. Where the keys live tonight is yours.

What each answer points to

None of this is a diagnosis. It sorts the hours of her day into ones that are fine, ones that are risky, and ones that need a person:

1. a few hours
   Safe with the stove disabled and the phone by her chair, but the house goes quiet and the mail goes unopened. This points to company for part of the day: a relative, a neighbor, a senior center, or a non-medical caregiver for a morning or an afternoon.
2. the window
   Fine until four and not fine after. This points to a person in the house from mid-afternoon through bedtime on the days you cannot be there.
3. overnight
   She has wandered, or the night is when the door matters. This points to someone awake in the house at night; the night-shift page lays out the family rotation and what an overnight caregiver does.
4. all the time
   The stove, the phone, the door and the car all came back with the wrong answer. This points to someone there at all times, and to a conversation with her doctor and the Alzheimer's Association's 24/7 Helpline, 800-272-3900.

How do I know when she can't be alone anymore?

You will not get a memo. You will get a burner left on, a walk that ended two streets over, a phone she could not work. The rule most families land on: the first time one of the questions above comes back with a frightening answer, that hour of the day is no longer an hour she spends alone, starting tonight. The rest of the day can stay as it was until it tells you otherwise.

If it is your father who is alone now, in a house where your mother did everything, the questions change shape a little. Since Mom Died walks through them for that house: eating, the pill organizer she used to fill, driving, and what a companion a few hours a week actually does.