“Admitting my mother to a nursing home was the most guilt-ridden and traumatic experience of my life -- including my divorce and the death of my father,” says Betsy Brawley, a Sausalito interior designer whose mother and grandmother both suffered from Alzheimer’s disease. “Although it was the best thing for her, I didn’t feel good about it.”

Brawley’s journey through the labyrinth of AD inspired her to switch the focus of her business, Design Concepts Unlimited, to designing environments for the elderly that enhance their quality of life. She also became a public policy advocate and a board member of the Alzheimer’s Association.

“We don’t have a cure for AD, so the difference we can make in people’s lives is the quality of care we deliver,” says Brawley. “The environment is part of what it takes to support giving good care. If we’re dealing with people who can’t express what’s going on, it becomes frustrating for the person with dementia and for the caregiver, who can’ figure out what’s going on.

“And yet, caregivers must deal with behaviors like crying and anger. Too often we decide that’s what the disease is about because we’re not looking at what’s causing these kinds of reactions. If we can create safe places where people can move about comfortably without being frustrated, it makes it easier to care for them.”

An Emerging Field

Although designing for disability is not a new concept -- barrier-free construction is a federal mandate -- designing specifically for the elderly is an emerging response to the oncoming age wave. It is not an easy sale, however: “There is definite resistance among the general public because people don’t want to contemplate aging, illness or disability,” says San Francisco interior designer Mary Lou D’Auray, [cq] who observes that, nevertheless, more professional attention is being paid to the environmental needs of an aging population.

Home modifications are on the rise as Baby Boomers increasingly find themselves caring for aging parents and other relatives. Too often, the elderly leave their lifelong homes and neighborhoods prematurely because standard housing of the past was not designed to allow them to live independently. With a prediction of 14 million cases of AD in the United States by the year 2050 -- compared with 4 million today -- and the desire of most older people to age in place, more families are looking at modifications as a way to keep their loved ones at home.

Experts say that home modifications are only now becoming mainstream because families either haven’t known what to do, or they thought projects would be too expensive. Today, however, this decision may not require major renovation but rather easy basics like adding brighter lights and installing hand rails and grab bars strategically -- products now available in most home-product stores.

“Designing for disabled adults is not the same as designing for older adults,” notes Mark Warner, a Florida architect and gerontologist who has written the definitive guide to adapting the home for Alzheimer’s disease. “The Complete Guide to Alzheimer’s-Proofing Your Home” (Purdue University Press, 1998, $29.95, 470 pages) translates the concepts of universal and accessible design, traditionally applied to buildings, into home use by addressing the demands imposed by specific age-related conditions such as AD, stroke, diabetes, Parkinson’s disease and macular degeneration. In great but accessible detail, it explains both the why and the how of removing triggers for unsafe behaviors such as wandering. It also suggests myriad ways to simplify the home to deal with problems such as memory loss, agitation, hoarding, repetitive behavior, fear of bathing, incontinence, dressing and instability. At the end is an extensive guide to products and resources.

Rezoning the Home

Warner proposes establishing perimeters for wandering and finding tactful ways to discourage entry into dangerous areas. He lays out how to divide the home into three strategic areas:

* The Storage Zone. Two areas of the house are out of bounds to the person with AD. One is dangerous rooms like the garage and basement with their stairs and tools, or closets where breakable items are stored. Doors leading to these restricted areas and to the outside should be locked, alarmed or controlled by wander-prevention devices.

* The Respite Zone. The second area off-limits to loved ones with AD is dedicated to the caregiver, who may be on-call 24 hours a day. This zone allows a caregiver private time to reduce stress and avoid burnout, which in the worst cases can lead to institutionalization of the loved one.

* The Safe Zone. This is the remainder of the home, where the person with AD may freely roam, rummage and hide things. Warner recommends plugging up or disguising electrical outlets, removing medicines, dangerous tools, appliances and chemicals, as well as important documents, bills and valuables.

Warner suggests approaching home modifications so that all family members will feel safe and comfortable. Other ideas include:

* Securing windows and balcony doors on upper floors.

* Lowering the thermostat on the water heater to its lowest setting, or no higher than 120 degrees, to prevent accidental burns.

* Installing a hand-held showerhead in the bath or shower, as well as grab bars and nonslip bath/shower mats.

* Removing all electrical appliances from counters and the control knobs from the stove and oven.

* For doors that lock from the inside, such as the bathroom, either removing the lock or keeping an emergency key nearby.

* Identifying and removing toxic plants both indoors and outdoors.

* If necessary, installing a wheelchair ramp to entry doors and widening doorways inside the home.

San Francisco architect Karen Thomas, a senior vice president and partner at Stone Marraccini Patterson [cq] who does extensive designing, planning and international research on housing trends for the elderly, offers the following principles for modifying a home to accommodate the progressive stages of Alzheimer’s disease:

* “Simplify the house. Get rid of the clutter and junk that invites confusion. You can still have wonderful memories around, but only the things you need for a comfortable life.”

* “Clarify the purpose or function of each room so your loved one doesn’t become disoriented. Use visual clues -- pictures or signs --that say, ‘This is the room that I sleep in, or sit in, or make my food in.’ ”

* “Use color-coding and lighting as ‘wayfinding’ cues. As we age, our eyesight requires additional illumination without glare to aid depth perception, especially down a dark corridor that may seem frightening. For example, getting to the restroom in a timely manner is probably one of the most important things. If the hallway has a brighter light right outside the bathroom, or if the door is painted a brighter color, your loved one is reminded that this is the toilet, and he or she may need to use it.”

Basic modifications such as these, Thomas says, can mitigate the expense of larger renovations. “Most people don’t need to modify a home extensively because at some point, the loved one will need so much additional care that either someone is going to be there with them full time, or they will need to be moved to a setting where there’s assistance.”

Architect Warner concurs. “Caring for someone with AD need not be an overwhelming burden,” he says. “The more planning, thinking, and constructive action you take early in caregiving, the easier it will be for the entire family to cope. If you have the sense that what you are doing is not just worthwhile but also achievable, then you have the most valuable thing of all: hope.”

This article first appeared on Consumer Health Interactive.

Beth Witrogen (www.witrogen.com), a double Pulitzer Prize nominated writer, was most recently recognized for her book, “Caregiving: The Spiritual Journey of Love, Loss, and Renewal,” a uniquely inspired blend of advice based on personal growth and spiritually profound wisdom. A former newspaper journalist, she has written for magazines including Good Housekeeping, Self, and Family Circle and online sites such as WebMD, Consumer Health Interactive, and ThirdAge.com. She is currently at work on a book about women's renewal and sexuality at midlife. Ms. Witrogen resides in Northern California, and pursues her other passion as a professional photographer (www.witrogenphoto.com) and rock climbing. Send your questions to Beth@smartnow.com.