Working in the Home of a Customer With Dementia

Why this matters

Sooner or later every residential tech works in a house where the customer has dementia, and often nobody tells them in advance. The work itself is ordinary. What goes wrong is everything around it: a customer who does not remember agreeing to the visit and becomes frightened, a tech who argues with someone who cannot follow the argument, and most seriously, a door or gate the tech opened and did not close, through which a person who wanders walks out into January or into traffic. The Alzheimer's Association estimates that six in ten people living with dementia will wander at some point. This article is organized by the moments of the visit where those things happen, because that is where you need the answer.

Before the visit: the call that matters most

Most of the risk is settled before anyone drives out, by the office or the tech talking to whoever arranged the visit.

• Find out who booked it and who decides. A daughter, a spouse, a care manager. That person approves the work and the price. Whether the customer can still agree to work and payment themselves is a separate question with its own signs; see related: Capacity to Contract: The Signs and What to Do, and Working With a Power of Attorney or Guardian.
• Ask whether that person, or another adult, will be home. A family member on site changes everything below. If nobody will be, agree how to reach them during the visit and get a backup number.
• Ask four specific questions. Does she tend to wander, and which doors does the family keep locked or alarmed? Is there anything that upsets her (strangers in uniform, men, loud tools, someone going into the bedroom)? What should we call her? Is there anyone she will expect, so we can mention them?
• Write the answers in the customer record as practical site notes ("keep back gate latched, front door chime must stay on, prefers Mrs. Alvarez"), not as a diagnosis.

What breaks if skipped: the tech arrives cold, the customer does not remember the booking, and the first five minutes are spent persuading a confused person to let a stranger in, which is exactly the conversation a family would never want a stranger to have.

At the door

• Introduce yourself the same way every time, short and plain: your first name, the company, what you are there to fix, and the name of the family member who booked. "Hi Mrs. Alvarez, I'm Dan from the heating company. Your daughter Maria asked me to look at the furnace."
• Show your ID and point to the truck. Visual cues help when words are not landing.
• If she does not remember and will not let you in, do not push. Step back, call the family member from the porch, and let them talk to her or come over. A visit that starts with a frightened customer letting you in under pressure is a visit she will describe to her family later as a stranger who forced his way in.

When the same question comes back

Repeated questions are not a test of your patience; the customer genuinely does not have the last answer. The rules are few:

• Answer every time as if it is the first time, with the same short words. Changing the wording each time reads as a new and confusing answer.
• Do not correct, do not argue, do not quiz. "I already told you" and "Don't you remember?" make a person with dementia feel caught out, and agitation follows.
• Do not tell hard truths that are not yours to tell. If she says her late husband will be home soon, the correction is a fresh bereavement for her every time it is heard. Acknowledge, and redirect.
• Give her something to do if she wants to help, like holding the flashlight or showing you the thermostat. It turns hovering anxiety into company.

CUSTOMER: Who are you again?
TECH:     I'm Dan, from the heating company. Maria
          asked me to look at your furnace.
CUSTOMER: My husband deals with all that. He'll be
          back at four.
TECH:     That's good. I'll leave him a note on the
          counter about what I did.
CUSTOMER: Did Maria send you?
TECH:     She did. I'm Dan, fixing the furnace.
          Want to show me where the thermostat is?
CUSTOMER: It's in the hall. Who did you say you were?
TECH:     Dan, from the heating company. Right here,
          this one?

Notice the tech never says "you asked me that." Each answer is the same sentence, and twice it ends by giving her something to do. The note for "her husband" is a note for Maria.

Doors, gates and the exits you opened

This is the part of the visit with the highest stakes, and the rule is simple: every exit you open, you close and latch, and you check them all again before you drive away.

• Count your openings as you make them. Front door, garage door, back slider, side gate, the basement bulkhead. Say the count to yourself, or jot it on the work order.
• Never leave an exit open while you go to the truck. Close the front door behind you every trip. If the garage door has to stay up while you carry a part in, she is in sight or you close it.
• Restore anything you disabled. A door chime unplugged, a deadbolt the family keeps locked, a child-safety knob on a door handle, a stove knob cover moved to reach a gas valve. Put each back exactly as found.
• Secure tools and chemicals. Refrigerant cylinders, drain cleaner, sharp blades, an open electrical panel: nothing dangerous is left where she can reach it while you are in the attic.
• Leave controls as the family set them. A thermostat behind a locked cover or set to a fixed temperature was set that way deliberately.

If she goes missing, call 911 at once and then the family, rather than searching alone for half an hour. Search and rescue guidance for people with dementia stresses speed: most are found close to home, and the first minutes matter. Tell the dispatcher she has dementia, what she was wearing, and which door was open.

When she becomes upset or accuses you

Distress can come suddenly: an accusation that you have taken something, a belief that you are an intruder, anger at the noise. Do not defend yourself point by point and do not touch her to reassure. Stop work, put the tools down, step into another room or onto the porch so she is not cornered, and call the family member. If she is becoming physically aggressive, leave the house and wait outside for the family; your safety comes first, and so does hers, and a struggle harms both. Afterwards, write down plainly what was said and done, so the family has the facts and the shop has a record. See related: The Hostile or Impaired Customer: A Decision Tree.

The work and the money

Explain findings and options to the family member who authorized the visit, by phone or in person, not to the customer alone. Do not take a signature or a payment from the customer if the family arranged the visit, and do not offer extras on site. A customer with dementia who agrees to an upgrade has not, in any meaningful sense, agreed. The pricing ethics around vulnerable customers have their own article; see related: The Vulnerable Customer and Doing Right.

Worked example: the furnace tune-up and the garage door

Booking. Maria books an annual furnace tune-up for her mother, 83, who lives alone with daily visits from Maria. Maria will not be home but answers her phone. Site notes: wanders, front door chime must stay on, back gate kept latched, call her "Mrs. Alvarez."

Arrival, 10:00 am. Mrs. Alvarez does not remember the appointment. The tech introduces himself with Maria's name; she still hesitates. He calls Maria from the porch, puts her on speaker, and Mrs. Alvarez lets him in. Two minutes, no pressure.

The work. The furnace is in the garage. Exits opened: (1) front door, closed behind him; (2) the internal door to the garage; (3) the overhead garage door, raised to bring the vacuum and a filter in from the truck. Three openings, jotted on the work order. She asks the same "who are you" question four times in 50 minutes and he answers it the same way four times.

The near miss. Halfway through, he realizes he needs a part from the truck. He walks out through the raised garage door. At the truck he looks back and sees Mrs. Alvarez standing at the end of the driveway, in slippers, 30 F outside, looking down the street. He walks her back in calmly, talking about the furnace, closes the overhead door, and from then on carries the part through the front door and closes it behind him. The mistake was walking out of sight with opening 3 still up. The count on the work order kept track of it, but only the rule of never leaving an exit open while you are away from it would have prevented the walk down the driveway.

Departure, 11:05 am. He checks all three openings against the work order: front door closed and the chime sounds when it opens, internal garage door closed, overhead door down and locked. Back gate latched, checked even though he never used it. Thermostat set back to the 70 F Maria's note specified.

The call. He calls Maria from the truck: tune-up done, filter changed, one recommendation (a slightly worn blower belt, not urgent), and the driveway incident described plainly with the time it happened. Maria thanks him and asks that future visits be booked when she is home. The record is updated with that request and with "do not raise garage door unless someone is with her."

What would have changed it. With Maria home, the driveway moment does not happen, because someone else's eyes are on her. With no one reachable by phone at the door, the right move was to rebook rather than talk his way in.

References

• Alzheimer's Association, guidance on wandering and on communicating with a person living with dementia.
• National Institute on Aging, home safety tips for people with Alzheimer's disease.
• See related: Capacity to Contract: The Signs and What to Do; Working With a Power of Attorney or Guardian; The Hostile or Impaired Customer: A Decision Tree; The Vulnerable Customer and Doing Right.