Caring for Someone with Dementia at Home: A Philadelphia Guide
Caring for Someone with Dementia at Home: A Philadelphia Guide
Short answer: Caring for a loved one with dementia at home means adjusting to new behaviors, ensuring safety, and planning ahead. This guide explains what to expect as the disease progresses and connects you to Philadelphia resources to help you manage daily care.
- Dementia progresses through early, middle, and late stages, each requiring different levels of care and planning.
- Establishing daily routines, clear communication, and home safety upgrades reduce confusion and fall risks.
- Legal and financial planning should happen in the early stages while your loved one can participate in decisions.
- Philadelphia offers local support through the Alzheimer’s Association, Penn Memory Center, and the Philadelphia Corporation for Aging.
- Caregiver stress is common; use respite care, support groups, and state programs to protect your own health.
What changes over time
Dementia progresses differently for everyone. On average, people live four to eight years after a diagnosis, though some live up to 20 years. The Alzheimer’s Association groups the disease into three main stages. Understanding these stages helps you prepare for the care your loved one will need.
| Stage | Common Changes | What Help Looks Like |
|---|---|---|
| Early (Mild) | Trouble finding words or names, forgetting what was just read, misplacing valuables, and trouble planning or organizing. | The person may still function independently, drive, work, and socialize. This is a good time to make legal and financial plans while they can take part. |
| Middle (Moderate) | Typically the longest stage. Forgetting personal history, confusion about place or date, mood changes, sleep disruption, wandering, and bladder or bowel problems. | The person can still do daily activities but needs help. Caregivers often use respite care, adult day health, or in-home support. Read more about the dementia stages. |
| Late (Severe) | Loses the ability to converse and eventually to control movement. Changes in walking, sitting, and swallowing. Highly vulnerable to infections, especially pneumonia. | Needs around-the-clock help with personal care. Hospice may step in to focus on comfort. |
Stages often overlap. Because symptoms can change, tell the doctor if you notice sudden differences in behavior or physical ability.
Daily care basics
Caring for someone with dementia requires adapting your home and your approach. Small changes to your daily habits can reduce frustration for both of you.
Establishing routines and communication
Keep a regular routine for waking, meals, and bed. Schedule demanding tasks like bathing and medical appointments in the morning or early afternoon when the person has more energy. Adapt how you speak based on their stage. In the early stages, do not assume abilities based on the diagnosis. Speak directly to the person and give them time to respond.
During the middle stages, talk one-on-one in a quiet space with few distractions. Ask simple yes or no questions and avoid arguing. Focus on the meaning behind their words rather than the exact facts. In late stages, always approach from the front and identify yourself. Consider the feelings behind their words or sounds. Treat them with dignity and respect, and do not talk about them as if they are not present. Learn more communication tips.
Modifying the home for safety
A few changes at home lower the risk of accidents. Start in the kitchen by using appliances with automatic shut-offs and installing stove knob covers. You can also remove the stove knobs or turn off the gas when not in use. In the bathroom, place a non-slip mat or self-stick strips in the tub or shower. Install grab bars inside and next to the tub, and next to the toilet.
Throughout the house, clear paths around furniture and remove throw rugs to prevent falls. Coil or tape cords next to the wall. Keep medications in a locked drawer or cabinet, and remove guns or weapons entirely, or keep them in a locked cabinet. Place latch or deadbolt locks above or below eye level on exterior doors. Consider an automatic thermometer for water temperature to prevent burns. Never lock a person inside the home. Review our full home safety checklist for more details.
Preventing wandering
Six in 10 people living with dementia will wander at least once. Warning signs include returning late from a walk or drive, pacing, restlessness, or wanting to “go home” while already at home. You can prevent wandering by maintaining structured daily activities, especially at the time of day wandering is likely. Ensure you meet basic needs like toileting, food, and fluids.
Install door alarms and night lights, and remove car keys if the person no longer drives. Keep a recent close-up photo and a list of places the person may go. If they go missing, search immediately. If they are not found within 15 minutes, call 911 and tell the dispatcher the person has dementia. Many are found within 1.5 miles of where they were last seen. Learn more about wandering prevention.
Managing sundowning
Sundowning causes increased confusion, trouble sleeping, anxiety, pacing, and disorientation from dusk through the night. Contributors include end-of-day exhaustion, unfamiliar surroundings, a disrupted body clock, shadows in dim light, and picking up on others’ stress.
To reduce symptoms, encourage daytime sunlight and limit long naps. Avoid alcohol, caffeine, and nicotine, and serve the main meal at lunch. Keep the home well lit in the evening and use calming activities like music, looking at photos, or a gentle walk. Ask the doctor about medication timing. Always stay calm, do not argue, and never use physical restraint. Find more strategies for managing sundowning.
Need extra support at home? New Century Home Care provides non-medical personal care and companion services in Philadelphia. Call 215-974-0000 or contact us online (choose “I am a client” then “I need services”). Our office staff speaks English, Russian, and Ukrainian.
Plan early: legal and financial steps
The early stage of dementia is the best time to make legal, financial, and end-of-life plans. Your loved one can still take part in these decisions and express their wishes.
Legal documents
Set up a Pennsylvania financial power of attorney. This must be dated and signed by the principal, acknowledged before a notary, and witnessed by two adults. The agent and the notary cannot be witnesses. You should also complete a health care power of attorney and a living will. These require signatures and two adult witnesses, but no notary is required. These documents ensure someone is legally authorized to manage affairs and medical choices when your loved one no longer can. Read our legal documents guide for state rules.
Medicaid and waiver programs
If your loved one needs long-term services and supports, they may qualify for the Community HealthChoices (CHC) waiver. The CHC waiver covers Personal Assistance Services, home adaptations, assistive technology, and Personal Emergency Response Systems (PERS). To qualify, applicants must meet financial and functional rules. The 2026 income limit is $2,982 per month.
The local Area Agency on Aging handles the Functional Eligibility Determination (FED). People with dementia may qualify under FED Group 2, which requires at least three items from a list. For example, the assessor looks for mild to severe cognitive impairment, memory problems, confused or disorganized thinking, behavioral symptoms like wandering, or needing hands-on help with two activities of daily living. Need for supervision or cueing is ignored by the FED, so people with cognitive impairment may be wrongly denied and should consider an appeal. Learn more at our Medicaid home care hub.
Getting help in Philadelphia
You do not have to manage dementia care alone. Philadelphia offers several local resources for education, support, and services.
| Organization | Contact Information | Services Provided |
|---|---|---|
| Alzheimer’s Association Delaware Valley Chapter | 24/7 Helpline: 800-272-3900 | Free local caregiver support groups by phone, video, or in person. |
| Penn Memory Center | Visit their website for schedules | Runs virtual caregiver support groups, a seven-week skills program for dementia caregivers, and The Caring Collective peer-matching program. |
| Philadelphia Corporation for Aging (PCA) | 24/7 Helpline: 215-765-9040 | The Area Agency on Aging for Philadelphia. Conducts FED assessments for waiver programs and runs the PA Caregiver Support Program. |
| New Century Home Care | 215-974-0000 | Licensed non-medical home care agency offering specialized dementia support, personal care, and respite care. |
Caring for yourself
Caregiving takes a physical and emotional toll. You must protect your own health to continue providing care safely.
Recognizing caregiver stress
Watch for signs of caregiver stress. These include denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability, and lack of concentration. If you experience regular health problems, talk to your doctor. Protect your health by taking breaks. Use respite care to get relief, share duties using a care-team calendar, eat well, exercise, and join a local support group. Learn more about preventing caregiver burnout.
Workplace and financial support
If you work, you may be eligible for the Family and Medical Leave Act (FMLA). FMLA provides up to 12 workweeks of unpaid, job-protected leave in a 12-month period to care for a parent or spouse with a serious health condition. Ask your employer about your eligibility and any paid leave options.
You may also qualify for the PA Caregiver Support Program, run locally by PCA. This program offers education, planning help, and reimbursement for approved caregiving supplies, personal care, respite services, and adult day care. The maximum monthly reimbursement is up to $600, based on your reimbursement percentage. You apply through PCA at 215-765-9040.
If you need help caring for a loved one with dementia, New Century Home Care is here for you. We are a licensed non-medical home care agency serving Philadelphia and surrounding counties. Call 215-974-0000 or fill out our contact form and select “I am a client” then “I need services”.
Frequently asked questions
How quickly does dementia progress?
Dementia progression varies by person. On average, people live four to eight years after a diagnosis, but some can live up to 20 years. The disease moves through early, middle, and late stages, with the middle stage typically lasting the longest.
When should a person with dementia stop living alone?
There’s no set point; talk to the person’s doctor. Signs that daily help is needed include wandering, forgetting personal history, confusion about place and time, or needing help with daily activities like dressing and toileting.
How do you communicate with a family member who has dementia?
Adapt your communication to their stage. In the middle stages, talk one-on-one in a quiet space, ask simple yes or no questions, and avoid arguing. Focus on the meaning behind their words. In late stages, approach from the front, identify yourself, and always treat them with dignity.
Non-medical home care in Philadelphia, Bucks, Montgomery, Delaware and Chester counties. Medicaid CHC (Keystone First), VA programs and private pay. We speak English, Russian and Ukrainian.
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