When someone with dementia should no longer be left alone

Capabilities that determine safe alone time

• Can they recognize and respond appropriately to an emergency, including calling for help?
• Can they use the phone reliably to reach someone?
• Do they consistently avoid unsafe use of the stove, heaters, or other appliances?
• Do they remain in the home, or have they left and become disoriented?
• Can they manage toileting and mobility without assistance?
• Do they take medications correctly without prompting?
• Do they open the door to strangers or respond to scam calls?

Signals that alone time needs to shrink now

Certain events should change the arrangement immediately rather than at the next review: leaving the home and becoming lost, a fire or near-fire, a fall that was not reported, a significant financial scam, or a medication error with real consequences.

One occurrence is enough. Waiting for a pattern accepts unnecessary risk.

Intermediate options before full-time supervision

• Shortening the alone window rather than eliminating it
• Scheduled check-in calls or video calls at fixed times
• A neighbor or friend who stops by during the gap
• Adult day programs for structured hours
• Meal delivery to remove cooking from the equation
• Automatic shut-off devices and door chimes
• In-home paid help for the highest-risk hours

Having the conversation

Frame changes around specific risks rather than general capability, and involve the person wherever possible. "I worry about the stove when no one is here" lands differently than "you can't be alone anymore."

Where the person disagrees and the risk is serious, prioritize safety while preserving as much autonomy as the situation genuinely allows.