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Fire Safety, the Elderly and Caregivers
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Fire Safety, the Elderly and Caregivers

Fire safety is extremely important. And providing that safety is more difficult than it may seem.

The primary problem with elderly patients is mild dementia, lack of situational awareness, lack of judgement, the desire to "control", and paranoia, All of the fancy pamphlets with photos of seniors in fire helmets won't change this. To impose reasonable rules of fire safety often involves a battle. A psychological battle. This involves everything from the cost of an extinguisher, to enforcing a "no-excessive-trash" rule.

Case in point. There is an eighty-year old I look in on. He broke a hip and went to a rehab nursing home for two months and his phone bill went up. He returned and had his phone disconnected because of the "high bills". He has no cell phone (he can't "understand" the buttons). He is paranoid and installed a lock that requires a key to open the door from the inside. Which he usually can't find. He cooks alone. His kitchen has trash on the counter next to the stove. His girlfriend, who lives nearby, encourages him. Now he isn't my responsibility, but he is an accident waiting for a place to happen. Adult protective services visited and decided he seems to be rational and not in need of a guardian.

When I hire aides I give them a list of "Rules of the Road". One of those rules is to do a "walk-around" the apartment at the beginning of each shift for fire hazards and make a notation in the daily log.. You would think this simple common sense instruction would be sufficient. Right? The answer is "no". They complained to the service that hired them and their R.N. nursing supervisor who backed them up and told me "they're health aides - not fire inspectors". Arghhhh!

The lack of situational awareness means that a person with mild dementia will not recognize danger. Not the blare of a smoke alarm or smoke from an outlet box. And yet they are rational enough to speak coherently with a representative from adult protective services. Dealing with such a person requires tact.

Let's say there are newspapers all over and the secondary means of egress is blocked. You don't want to have them evicted, so you don't necessarily want to involve the landlord. My solution was to arrange a "fire inspection" and give them a ticket. Not a real inspection. First I tried to hire an off-duty fireman. "Oh no...that would be unauthorized". So I got a blue shirt for a friend to wear, put on fire insignia and a borrowed shield, and a name plate that said "fire inspector" and had him visit the senior, make-believe this was a mandatory inspection, give the senior a "ticket" I printed up on the computer and read him the riot act. This registered. The house got cleaned. The senior called me and said "Give me a hand cleaning up. The Fire Department was here! I don't want to get arrested". That cost me two six-packs of cold beer.

In another case the senior was always forgetting she left a pot on the stove. Result - burning food. I got an old-fashioned wind-up alarm clock and established a routine that whenever she put something on the stove, she would set the alarm clock to ring in thirty minutes.

Toasters are a problem. If you put in a large slice of bread they won't shut off. Didn't know that, did you?  The bread chars and then turns into a flame. If the toaster is under as wood cabinet with paper frills for decoration under the edge that's all the wrote. So a toaster is never placed under a wooden cabinet and you have to monitor the shopping by an aide so that only thinly sliced bread ends up in the kitchen.

Candles are another problem. They should be banned. But many elderly patients like them. They burn them in the bathroom to end the smells, form example. I took care of one patient with Lewy's body dementia who fashioned himself a Budhist, who needed the candles for his religious ceremonies. He had Parkinson's and would fall down and knock over the candles. I threw out the candles. His girlfriend snuck them back. He called up the "family attorney" who informed me "her client had rights". Yes. This was from a person who actually was practicing law. Common sense is not that common. I swiped some official fire department stationary and envelopes, made up a non-existent regulation prohibiting candles in certain buildings, and mailed it to him. I suppose I was violating some law or regulation by doing so. "Oh." he said to me. "I just got a notice from the fire department. Candles are no longer allowed!"

"Really" I said.
The danger from an oil fire in a frying pan cannot be overemphasized. A few drops of water on such a fire will literally cause an explosion of fire, scattering flaming droplets flying ten foot in every direction, and igniting whatever they land on. The solution is to immediately put a lid on the pot.

IF a lid is readily available. And if you don't have to reach over the burning oil to retrieve it.

Bicarbonate of soda will work, but the best way to control a fire is with an extinguisher. A dry chemical extinguisher UL (Underwriters Labs) rated a minimum of 2A 10 BC. A "1A" rating or a "1BC" is unacceptable.

The extinguisher should be mounted low enough so a senior can take it off the wall and not next to the stove where they will have to reach over a flaming pot.

As a caregiver, one project is to always insure that the area next to the stove is free from pasta boxes, bread, and newspapers. And to make sure that these items are never left on a burner.

One thing I did in a patient's home was to disconnect all the burners except one, in the far left hand corner. She would always get confused as to which burner was on. Which button to push. Then I spray painted the control for that burner bright red.

Another very serious problem is electrical extension cords running under rugs of across the floor, especially when they are under newspapers. In my own personal experience I had a small fan (negligible amps) running off an extension cord. I left the Sunday papers over the extension plug while I lounged on the floor reading another section. To my amazement the plug underneath the newspapers exploded! There was a small "bang" and the newspaper rose and caught fire! The wire was not warm or overloaded. The extension cord and plug were inexpensive dime-store products. If I had not been present there would have been an apartment fire. So there is a lesson to be learned here. I certainly learned one.

Multiple plug outlets are another no-no.

And large wattage bulbs in sockets for small wattage bulbs.

And heaters that don't have tip-switches to cut them off that are less than three foot from anything that can be ignited.

If you have aides, one of the "Rules of the Road" should be the NEVER EVER hesitate to call the fire department and evacuate the patient if they smell something burning. They should do so before calling you, their superior, or anyone else. FIRE DEPARTMENT FIRST. There is no penalty for making such a call. The words to use with the dispatcher is: "I have to report a CONDITION. I smell smoke and can't tell where it is coming from."
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