Dementia remains a progressive disease for which there is no cure, but the landscape of care of people with dementia has changed significantly. While there are still some rough roads and dark clouds, there are also spots of sunlight, bright clearings, and colorful scenery.
“Culture change has transformed dementia care from a task-focused model to one centered on person-centered care planning and quality of life,” said Gretchen Pace, CDP, CADDCT, CMDCP, director of memory care and activity support at Aperion Care.
There have been many advancements in dementia care in recent years, and while there are still challenges and barriers to overcome, the focus of this care is increasingly on individuals: what matters most to them, what they are capable of and what they can no longer do, and prioritizing nonpharmacological interventions to promote safety, comfort, and quality of life.
Key Paradigm Shift
As knowledge about dementia has grown, it has become increasingly apparent that the disease impacts everyone differently. As DeLon Canterbury, PharmD, BCGP, the Deprescribing Pharmacist® and founder of GeriatRx, Inc., said, “If you’ve seen one person with dementia, you’ve seen one person with dementia.”
Michelle Wallace, BSN RN, MEDSURG-BC, GERO-BC, and director of clinical services at Vetter Senior Living, agreed and noted, “There’s been a shift from a disease focus to prioritizing the resident’s goals and their abilities—that is, preserving what function they still have and what they are still able to do. It’s about creating meaningful moments for residents and allowing their families to be part of it, as well.”
She explained, “If you have someone who was a cook on a ranch, for example, they can still remember parts of cooking even as their cognitive function declines. We can recreate the cooking experience for them, let them do the parts they still can, and support them where they need help.”
There also is a growing focus on sensory engagement. Wallace said, “We use a great deal of music and memory equipment, utilizing earphones and personalized music lists for residents. This really helps prevent a lot of out-of-character behavioral responses, and it has helped reduce the use of psychotropic medications.”
Pace explained, “Sensory and multisensory approaches are increasingly incorporated with things like sensory rooms or areas, aromatherapy, fidget and tactile tools, and nature-based experiences. Such interventions help regulate emotions and provide meaningful stimulation.”
Freedom, Independence, and Measured Risks
Charles de Vilmorin, senior vice president of resident engagement at LifeLoop, observed that “a fundamental change in dementia care is happening worldwide, with a growing focus on freedom, autonomy, and enablement.” This means supporting people to live as fully as possible in environments that preserve choice and freedom of movement while thoughtfully managing risk.
The Hogeweyk®, a care neighborhood in the Netherlands, exemplifies this approach. Its twenty-seven small homes and its streets, open green spaces, grocery store, pub, theater, and many clubs create an everyday neighborhood setting rather than an institutional one.
“The idea is to balance freedom and safety—to create a supportive environment where people living with dementia can make choices, move freely within the community, and continue participating in everyday life,” de Vilmorin said.
Another focus receiving greater attention in the care of people with dementia is meaningful engagement and social connection. “The evidence is increasingly clear that social isolation and loneliness are serious health risks,” de Vilmorin explained. “Meaningful, personalized engagement and genuine human connection should be treated as essential components of care, not optional amenities.”
Montessori Makes Inroads
Montessori principles adapted for dementia care continue to grow, said Pace, because they focus on preserved abilities, meaningful roles, choice and independence, and success rather than failure. The Montessori Dementia Program was designed by geriatric medicine specialists and Montessori educators. Residents are encouraged to contribute, lead activities, and participate in purposeful daily tasks.
“I have seen some amazing benefits with this,” Pace said, adding, “By focusing on skills residents have, we can empower those individuals to perform tasks independently again and foster that sense of purpose and self-worth.”
The Montessori-inspired lifestyle training and credentialing program at the Center for Applied Research in Dementia is a system-level intervention for senior living communities to create environments that support people living with physical and cognitive disabilities. The center’s innovation officer, Evan Shelton, PhD, said, “We sometimes say that a Montessori community is a community that is led, to the extent possible, by the residents, so we start with remaining strengths rather than deficits. Then we build routines and opportunities for residents around those strengths and preferences.”
That might mean a prepared environment with clear visual cues, such as signage to let residents know what’s allowed and what’s not allowed or to help them know when something will be happening, such as mealtimes or activities.
Shelton noted, “A prepared environment is just one way of promoting independence, and it does so without involvement from any staff. We also think differently about activities. So rather than thinking about activities as a program of entertainment, much like a resort or a service model—a cruise ship, for example—we focus on activity with purpose.”
Montessori communities often include resident-led committees. A welcoming committee, for example, might include several residents who decide how to welcome a new resident. Shelton said this gives current residents a purposeful way to support someone through a stressful life transition.
Finally, he said, “we talk about twelve principles for how to engage with a resident who’s living with dementia.”
These are practical things that staff can practice every day, such as breaking down a task into steps and slowing down to match the resident’s pace. Each principle is meant to shift the dynamic from one person’s giving care and another’s receiving it to two active participants in the process. Residents are treated with respect and equality rather than having their day directed for them.
One additional aspect of the Montessori-inspired lifestyle that is unique, said Shelton, involves learning. “It’s a bit of a misconception that persons living with dementia are no longer able to learn,” he said. “Learning happens with repetition, and that’s a remaining strength for people with dementia. We can use that remaining ability to help persons with dementia learn routines and procedures that make everyday life easier and enable them to stay more independent.”
Age-Friendly Care and Dementia Go Hand in Hand
The Age-Friendly Health System model and 4Ms framework (what matters, mentation, mobility, and medication) align perfectly with dementia care because it keeps the focus on the whole person. Pace explained, “‘What matters’ ensures we honor the individual’s preferences and life story. ‘Mentation’ supports cognitive health and emotional well-being. ‘Mobility’ helps maintain independence, function, and quality of life. ‘Medication’ encourages careful use of medications to avoid side effects that can worsen cognition or increase fall risk. Together, the 4Ms provide a person-centered approach that promotes dignity, safety, and meaningful living for people with dementia.”
Pace further observed, “For a long time in dementia care, we had debates about the locked doors, and we realized that that wasn’t a good approach. But there were uncertainties about how to balance what matters to residents and what they want while keeping them safe. When you focus on the person first, safety just kind of automatically follows.” But she stressed, “We have security in place for a reason, and when secure units are necessary, it’s important to make them homey and inviting.”
The Evolution of Memory Care
According to the National Center for Assisted Living, 44 percent of assisted living residents have some form of cognitive impairment, so it is not surprising that memory care is the fastest-growing component of senior care.
Sarah Howd, MD, associate professor of medicine and geriatrics at the University of Rochester (UR) and medical director of Senior Living Practice at UR Medicine Geriatrics Group, said, “Memory care falls under the assisted living umbrella, but what we’re really seeing is that memory care is becoming an almost distinct level of care somewhere between assisted living and nursing homes.”
She added, “The main legislation for assisted living in the past five years has targeted memory care and dementia units, so I think there is a focus on protecting this vulnerable population.”
She noted that there are “more and more states that require specific staff training to work in memory care units to increase the level of care and the ability for people to age in place longer.” This shift to a greater emphasis on memory care is essential to fill a gap. While many assisted living residents with cognitive impairment are able to live independently, they need more support as the disease advances and as they become frailer over time. Increasingly, memory care programs are prioritizing this support to enable residents to stay in their homes or preferred settings longer.
Pace concluded, “Memory care has evolved from a primarily task-focused and safety-driven model to a more person-centered approach that emphasizes quality of life, dignity, and meaningful engagement. Today, we recognize that safety is important, but so is autonomy. The goal is to balance protection with choice by understanding each person’s abilities, preferences, and values. Through individualized care planning and measured risk-taking, we can support residents in maintaining as much independence and purpose as possible while still ensuring their well-being.”
Tech Talks . . . and Listens
As in other areas of health care, technology is enhancing and streamlining the care provided to people with dementia. These tools are among recent innovations:
- Telehealth. While this technology isn’t new, it is becoming more widespread, particularly in expanding access to care and specialist services in rural areas. “We use it in our rural areas for working with behavioral health specialists. This not only provides individuals with access to services they wouldn’t otherwise be able to secure, but it also helps reduce some of the
- Remote monitoring. Wearable devices and smart home systems that collect health data, such as mobility and medication management, are growing in use. These also can be used to create and maintain music playlists, enable family members to communicate and share photos and videos, offer memory support and other games, and provide reminders about medications and appointments.
- Sensory-engagement technology. Innovations such as interactive light projections to encourage movement, socialization, and cognitive engagement, and stimulating scents designed to improve memory, are gaining popularity.
Of course, it’s impossible to talk about technology without addressing artificial intelligence. Evan Shelton said, “With the emergence of AI, I think there are a few promising areas and a few areas where we need to be cautious. The most promising uses of AI, in my view, are tools that help staff better understand residents—their histories, strengths, preferences, needs, routines, and relationships. AI could help suggest who a resident might connect with, what activities may be meaningful to them, or how to adapt an activity to match their abilities.”
He also sees promise in using AI to help staff think through responsive behaviors. When residents exit-seek, call out, or resist care, staff don’t always know what to do beyond redirect them in the moment. A well-designed AI tool, Shelton said, could guide staff through a more thoughtful process—prompting them to consider what unmet need the behavior might be communicating—and then help them brainstorm ways to meet that need instead of simply trying to stop the behavior.
Shelton said he is more skeptical about AI as companionship. “We are starting to see technologies designed to simulate social connection, and we need to be very careful there. People living with dementia need real relationships, not just the appearance of a relationship. There are also ethical concerns around confusion, consent, and whether the person understands what the technology is and is not. Technology should support human connection, not replace it.”
Medication Matters
While there are ongoing advancements and trials for dementia-related medications, there also is a growing focus on nonpharmacological interventions and meeting people where they are. This aligns with the goals of the long term care and senior living profession to deliver person-centered care by getting to know individuals and understanding their stories and what matters most to them.
“It’s helpful to know that someone worked a night shift their entire life,” Howd offered, “so you understand why they’re not sleeping or why they’re up and walking around at night.”
She stressed that families need to be involved. She recalled one family who said their father would settle down if they put a western movie on TV. “We’re doing a better job of addressing potential nonpharmacologic interventions instead of jumping to medications,” she said.
Efforts to reduce antipsychotic use are significant, said Wallace. “When we add an antipsychotic medication for a resident with dementia, it increases the mortality risk, the risk of stroke, the risk of falls, and the risk of cognitive decline and aspiration pneumonia.” When knowledge of the resident is used to determine how to address the root causes of behaviors, solutions that benefit the resident and staff become apparent.
Holly Harmon, senior vice president of quality, regulatory, and clinical services at the American Health Care Association, has seen the impact nationwide. “Skilled nursing facilities have been leading the way for more than a decade, working with CMS [Centers for Medicare & Medicaid Services] and other stakeholders through the National Partnership to Improve Dementia Care in Nursing Homes to reduce the unnecessary use of antipsychotics, with remarkable results that improved the lives of tens of thousands of residents.” Between 2011 to 2024, federal data found that skilled nursing facilities reduced the off-label use of antipsychotic medications by nearly 40 percent.
Increased awareness and ongoing collaboration with policymakers, as well as other medical professionals and families, remain key, Harmon added. “We support continued education about the proper use of psychotropic drugs across all parts of the health care continuum.”
That’s because physicians and hospitals play a significant role in what medications residents may be prescribed prior to when they are admitted to a long term care facility. Even family members can sometimes urge their use when they are concerned about their loved one’s behavior and unaware of the side effects.
“Shared decision-making is crucial,” Harmon emphasized, and long term care providers consistently strive to work with physicians and families to develop the appropriate care plan for each resident.
In some cases, antipsychotic medications are necessary and beneficial to certain individuals; however, the long term care profession’s primary focus when it comes to care of people with dementia has been nonpharmacological interventions, enriching programming, and meaningful relationships with direct caregivers. “I continue to be amazed and inspired by our member providers who are constantly innovating how to provide better quality of care and quality of life for the people who live in our nation’s long term care communities,” Harmon said.
Hope Remains
The future of dementia care is bright. Pace noted, “One of the biggest lessons from dementia research in recent years is that quality of life can be improved even when we cannot cure the disease. Research has shown that person-centered care, meaningful engagement, social connection, personalized activities, and supportive environments can significantly reduce distress and enhance well-being. We’ve also learned that behavioral expressions are often a form of communication, and by understanding the person’s unmet needs, we can provide more compassionate and effective care.”
Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.