Care Playbook

Dementia Safety Is Getting Worse

Use this playbook to identify what has changed, reduce immediate safety risks, document patterns, and decide whether home care, memory care, or more support may be needed.

Use as a working checklist. Complete what is useful now and return when the situation changes.

Dementia safety note

If the person is missing, may have wandered, is in immediate danger, is newly severely confused, is threatening harm, has been harmed, or cannot be kept safe right now, call emergency services or urgent professional help immediately.

This playbook does not diagnose dementia, determine capacity, or replace medical or emergency care.

Who this playbook is for

Families seeing new or worsening dementia-related safety risks.
Caregivers trying to name whether wandering, nighttime risk, medication, or supervision has changed.
Decision-makers comparing home support, adult day care, respite, assisted living, memory care, or nursing home-level support.

Common triggers

WanderingGetting lostNighttime confusionMedication mistakesUnsafe cookingCaregiver cannot safely manage

Quick situation intake

These answers personalize the callouts and summary. They do not block access to the playbook.

What changed recently?

Wandering or trying to leaveGetting lostNighttime confusionMedication mistakesUnsafe cooking or appliancesFalls or near-fallsRefusing careAggression or fearPoor hygieneMissed mealsCaregiver cannot safely manageNot sure

Is the person missing or did they wander away?Can the person be safely left alone right now?Is nighttime becoming unsafe?Can the current caregiver safely continue the current plan?Where is the person living now?

What happened in the past 30 days?

FallWanderingHospitalizationMedication errorPolice/neighbors involvedCaregiver burnoutMissed mealsUnsafe drivingNoneNot sure

What to do now

Identify the specific safety riskDo not describe the problem only as "dementia is worse." Name the specific risk: wandering, medication mistakes, unsafe cooking, nighttime confusion, falls, refusal of care, aggression, or unsafe time alone.Care Plan

Check whether the person can be aloneAsk whether the person can safely be alone for one hour, half a day, overnight, or not at all. Supervision needs are often underestimated.Care Plan

Start Care Needs Checklist

Reduce immediate riskFor wandering risk, secure exits appropriately, prepare a recent photo, notify trusted local helpers, and create a response plan. For medication risk, remove old medications, update the medication list, and assign one medication owner. For nighttime risk, add lighting, remove trip hazards, plan bathroom support, and decide who is responsible overnight. For unsafe cooking, restrict unsafe appliance use, simplify meals, and consider meal delivery or supervised cooking.Emergency

What to do in the next 24 hours

Start a dementia pattern logTrack what happened, when it happened, what may have triggered it, what helped, and whether the caregiver could manage it safely. Include time of day, location, trigger, words used, safety risk, caregiver response, what helped, and what made it worse.Document

Review the home for dementia-specific safetyDementia can affect judgment, place orientation, behavior, balance, and sensory processing, so home safety should be reviewed through a dementia lens, not only a fall-prevention lens.Why it matters: Source note: Alzheimer's Association notes that dementia may affect judgment, sense of time/place, behavior, physical ability, and senses.Care Plan

Open Home Safety Checklist

Decide whether current care is still enoughIf the person cannot be safely alone, has wandered, is unsafe at night, or needs repeated redirection, the current care plan may need more supervision, home care, adult day care, respite, assisted living, memory care, or nursing home-level support.Care Plan

Start Plan Senior Care Track

What to do this week

Compare home safety support vs. memory careEstimate what it would take to keep the person safely at home: paid care hours, family supervision, nighttime coverage, home safety changes, adult day care, respite, and backup care.Cost

Use Memory Care Cost Calculator

Create a wandering response planIf wandering or exit-seeking has happened once, create a written response plan. Include who to call, recent photo, likely destinations, neighbors to notify, emergency contacts, and what to do first. Alzheimer's Association says wandering can happen at any stage of dementia and can be dangerous or life-threatening.Emergency

Create a care escalation ruleWrite the condition that will trigger a stronger care plan, such as wandering happening again, unsafe nighttime confusion more than three nights per week, or the caregiver being unable to sleep because of safety concerns.Care Plan

What to document

These fields feed the shareable Family Care Plan Summary.

Specific dementia-related safety risks(summary)Most unsafe times of dayWandering or exit-seeking detailsNighttime safety concernsCan the caregiver safely continue?(summary)Support neededFamily escalation rule

Safety threshold builder

Create a rule for when the family will change the care plan.

If ______ happens, we will ______.

If wandering happens again, we compare memory care.
If the caregiver cannot sleep safely, we add overnight backup.

Who to call

Emergency services

Call when

Call when the person is missing, has wandered away, is in immediate danger, is severely confused suddenly, or someone may be harmed.

Doctor or clinician

Call when

Call when confusion worsens suddenly, behavior changes quickly, falls increase, medication mistakes occur, or symptoms may reflect a medical change.

What to say

Normally, they can ____. Recently, we noticed ____. The biggest safety concerns are ____. We need help deciding what level of supervision or care is appropriate.

Dementia care specialist or geriatric care manager

Call when

Call when the family needs help deciding whether home care, adult day care, memory care, or another setting is appropriate.

Home care agency

Call when

Call when safety depends on supervision, bathing help, medication reminders, meals, or nighttime coverage.

Kefiw tools to use

Next best tool

Care Needs Checklist

Identify supervision, medication, mobility, and daily-care gaps.

guide

Home Safety Checklist

Review the home through a dementia safety lens.

guide

Dementia Wandering Guide

Create a response plan for wandering or exit-seeking.

calculator

Memory Care Cost Calculator

Compare higher-supervision care settings.

calculator

Caregiver Hours Calculator

Count supervision and nighttime worry as workload.

track

Plan Senior Care Track

Move from care needs to cost and care-setting decisions.

Family scripts

Family script

This is not about blaming the dementia or blaming the caregiver. We need to name the risks clearly and decide what support would make this safer.

Provider script

Normally, they can ____. Recently, we noticed ____. The biggest safety concerns are ____. We need help deciding what level of supervision or care is appropriate.

Red flags

Wandering or exit-seeking
Getting lost
Unsafe cooking
Medication mistakes
Nighttime confusion
Falls or near-falls
New aggression or fear
Caregiver cannot sleep
Person cannot safely be alone
Family relies on luck or constant vigilance

Escalation triggers

If wandering happens again, compare memory care immediately.
If nighttime confusion requires supervision more than three nights per week, add overnight support.
If the caregiver cannot sleep because of safety concerns, reassess the care setting.

Set a suggested review date

7 days, or sooner if wandering, sudden confusion, fall, or caregiver safety concern occurs

Review again in days

Suggested review date: June 3, 2026

Generate care summary

Dementia Safety Plan

Send the intake, documentation, checked actions, recommended tools, questions, and review date to the Family Care Plan Summary.

Kefiw Dementia Safety Plan
Date created: May 27, 2026
Suggested review date: June 3, 2026

Situation intake
What changed recently?: Not entered
Is the person missing or did they wander away?: Not entered
Can the person be safely left alone right now?: Not entered
Is nighttime becoming unsafe?: Not entered
Can the current caregiver safely continue the current plan?: Not entered
Where is the person living now?: Not entered
What happened in the past 30 days?: Not entered

Documentation
Specific dementia-related safety risks: Not entered
Most unsafe times of day: Not entered
Wandering or exit-seeking details: Not entered
Nighttime safety concerns: Not entered
Can the caregiver safely continue?: Not entered
Support needed: Not entered
Family escalation rule: Not entered

Completed actions
None checked yet

Recommended next steps
- Start the Care Needs Checklist.
- Open the Home Safety Checklist.
- Open the Dementia Wandering Guide if wandering or exit-seeking is involved.
- Use the Memory Care Cost Calculator if supervision needs are increasing.
- Generate a Dementia Safety Plan.

Questions to ask
- What changed from baseline in the past 30 days?
- Can the person safely be alone, and for how long?
- What level of supervision is appropriate now?
- What would trigger memory care or overnight support comparison?

Recommended Kefiw tools
- Care Needs Checklist: Identify supervision, medication, mobility, and daily-care gaps.
- Home Safety Checklist: Review the home through a dementia safety lens.
- Dementia Wandering Guide: Create a response plan for wandering or exit-seeking.
- Memory Care Cost Calculator: Compare higher-supervision care settings.
- Caregiver Hours Calculator: Count supervision and nighttime worry as workload.
- Plan Senior Care Track: Move from care needs to cost and care-setting decisions.

Family script
This is not about blaming the dementia or blaming the caregiver. We need to name the risks clearly and decide what support would make this safer.

You have a starting plan.

You documented what happened, identified the next care steps, and selected tools to continue planning.

Related guides

Dementia Daily Routine Guide

Build predictable routines around safety.

Dementia Wandering Guide

Plan for wandering response.

Memory Care Evaluation Scorecard

Evaluate memory care options.

Review and scope

Recommended reviewer type: Dementia care specialist, Clinician, Geriatric care manager. Last reviewed: April 30, 2026. Next scheduled review: annual update cycle or sooner when guidance changes.

Kefiw provides educational care-planning tools and guides. This playbook helps families organize decisions, estimate needs, prepare questions, and identify next steps. It does not replace medical, legal, tax, financial, insurance, Medicare, Medicaid, or emergency guidance. For urgent medical concerns or immediate danger, call emergency services.

How this guide is maintained

Written for family caregivers and care decision-makers.
Guide content is reviewed for clarity, safety, and practical usefulness.
Updated when Medicare, insurance, tax, legal, or care guidance changes.
Includes sources or reviewer notes where appropriate.
Designed to support, not replace, qualified professional advice.

Kefiw provides educational care-planning tools and guides. Content is designed to help families organize decisions, estimate costs, prepare questions, and identify next steps. Kefiw does not replace medical, legal, tax, financial, insurance, Medicare, Medicaid, or emergency guidance. For urgent medical concerns or immediate danger, call emergency services.

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Reviewed and approved by registered nurse and scientific reviewer.

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