Why Dementia Care Matters

An often overlooked, but vital element for successfully supporting and serving those living with dementia, is the “environment.” For this blog, we will define the environment as all the non-human things that surround the person. That is a very long list. Broadly, think of things such as supplies, furniture, lighting, flooring, interior and exterior finishes, room design, fixtures, appliances and general layout, and anything that creates sounds, and aromas. 

For quality dementia care, the environment should be much more than aesthetically pleasing. It must be a therapeutic tool, capable of optimizing functional independence, safety, health, security, wayfinding, emotional well-being, etc. Without a supportive environment, those with dementia are held back from achieving their potential, they may experience emotional distress and may have more falls and other accidents or injuries. 

Claudia Allen, a highly regarded occupational therapist specializing in cognitive theory, called the environment the “may do” performance factor in her Cognitive Disabilities Model. What a person “may do” refers to what is possible for someone with cognitive challenges based upon what surrounds them.  

Claudia believed a person “can do” activities and follow the routines they find meaningful (“will do”) to a certain
degree of independence and safety based upon their cognitive level. BUT this best ability to function is only
possible when the environment is appropriately supporting them. Allen believed “can do”, “will do”, and “may do” must coalesce for someone to engage in activities at their best ability and to live in emotional well-being.  

Understanding the Impact of Environment

Practically speaking, I always think of it this way… 

1. What do I want to do? (my Will do) 
2. How capable am I of doing it? (my Can do/cognitive level)  
3. Does the environment, which is everything that surrounds me, assist or impede me? (the May Do) 

Let’s normalize all of this to understand how powerful the environment is for all of us.  

• When you walk in a room, what the room looks and sounds like, helps you to know what to do there. If it is stark, you may feel confused about the way you should behave or function within it. 
• If you are in an unfamiliar place, a very noisy space, cluttered room, or low-lit environment, you may become agitated or unable to function as safely and independently as your capability level (this is called excess disability and a widespread problem in dementia care). 
•  If you navigate hallways, corridors or outside walkways that are devoid of signage or other wayfinding cues (environmental prosthetics), you may be lost, making it difficult to get to where or what you want or need (this is called wandering and a common problem in dementia care).

As this illustrates, the environment has immense impact on how we function and how we feel; calm, relaxed,
aware, and capable or stressed, confused, lost, or frightened. When someone has less cognitive capacity due to Alzheimer’s disease and other dementias, the impact of the environment and whether it is supporting or hindering, is even more significant because they have a lower stress threshold and are more reliant on others
for help.  

Therefore, creating and maintaining the right environment – one that is cognitively and physically supportive and offers surroundings that match interests and preferences - must be a top priority for those who aspire to deliver excellent memory care. Simply put, dementia specialized environments must be designed for and with the unique individuals that live there.  For organizations that want to develop or refresh their memory care environment and programs to achieve this level of specialization, our Dementia Care Specialists consulting team can help.
 

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A Memory Care Community Leading the Way with an Innovative Environment 

In January I had the pleasure to participate on the Society for the Advancement of Gerontological Environments (SAGE) Post Occupancy Evaluation (POE) team that visited LiveWell River Homes in Plantsville, CT. LiveWell River Homes was recognized by Environments for Aging (EFA) Magazine with the 2025 EFA Design Showcase Award of Merit. You can learn about the POE team's findings at the EFA Conference and Expo in Phoenix in March 2026 and in an upcoming white paper. 

As a part of the evaluation, our POE team visited LiveWell and toured the interior and exterior environment and
interviewed leadership, staff, and residents. 

From my observations, LiveWell appears to be that unique community that has the key elements required
for extraordinary memory care – a person-centered focus, cognitive level driven plans and programs, abilities
focused dementia care/programming, and a culture of well-being and innovation. And as it must be for sustainable success, they have integrated all of this masterfully into staff training, programming, and the environment.

I share some observations as to how LiveWell accomplished this: 

• Person-centered: Designing “with” individuals with dementia was their priority. It meant resident and prospect feedback was gathered and analyzed and expertly baked into the design. RLPS architects and designs, along with LiveWell leadership, did an exceptional job of learning what residents wanted and created spaces reflecting those preferences.
  
  As an example, this group valued “learning” and “the arts” therefore the adjacent LiveWell Resilient Living Center was designed with multiple spaces for classes. Each room clearly communicated its focus. As examples, finished art projects and supplies surrounded the Art Room central work area, the fitness center had a wall of large open cabinets with yoga supplies, and the movie room looked like a small theater with comfortable theater style chairs.
  
  Residents of the LiveWell River Homes attended classes for their enjoyment and as a part of their treatment for dementia. Those living outside LiveWell could also partake in classes designed to prevent (or treat) dementia.  
• Cognitive Level Driven and Abilities Focused: Designing an environment that properly supports certain cognitive ability levels (aka stages of dementia) was another design priority. This requires experts who know the characteristic abilities and deficits within each cognitive level/dementia stage and can translate this practically to the architects and interior designers.
  
  At LiveWell they employ occupational therapists including Dr. Kate Keefe, who uses the Allen Cognitive Levels and these levels inform the admission and discharge requirements for the LiveWell River Homes, and informed the design elements. The goal we always strive for is for a person’s cognitive capacity and features of the environment to be a fit.
  
  From my observations the LiveWell River Homes appear primarily designed to support those in Allen Cognitive Level 4 (Early-stage dementia) and Allen Cognitive Level 5 (Mild Cognitive Impairment), which means the program and environment are designed for higher functioning individuals.
  
  In each River Home designed for 16 residents, there was a functional kitchen, dining area, sunroom, living room and library of residential scale. Cognitively supportive design features included: 
  • The design choices in each room clearly reflected the purpose of the room and supplies were visible and available, encouraging residents to pick them up and use them; cooking supplies in the kitchen and games in the living room were also visibly available. As examples, some kitchen cabinets had glass doors to see what was inside, there was a glass door beverage refrigerator, and games and puzzles were placed on open shelves. This is a perfect design fit for those at higher cognitive levels as these visual cues and easy access prompt activity engagement.  
  • There were very few wayfinding cues and there was an elevator that residents were encouraged to use to get from the first to the second floor of the River Home. These design elements work for a higher functioning group (such as the one at River Homes) but wouldn’t properly support those in middle or lower stages of dementia.  
• A culture of Well-Being for All: One key element was to ensure the River Homes truly felt like being at home, for residents AND staff. I believe they accomplished this with the non-institutional, smaller scale environment of the two resident homes, and by the connections between staff and residents that the environment well supported. As examples: 
  • The feeling of home enveloped me as I watched residents do a puzzle in their living room. 
  •  I heard stories of residents and staff making a meal together in the household kitchen. Staff and residents reported repeatedly how this didn’t feel anything like an institution. It was home. 
  • Staff told us they use the library room (a smallish room with dark colored walls, a fireplace, and cozy furniture that created an intimate, warm space) to help calm a resident if relaxation was needed to prevent or deescalate emotional distress. I felt as if this was where I’d want to go if I needed to relax. 
  • Staff were encouraged to also use and enjoy the River Home spaces and the LiveWell Resilient Center. 

Summary

At LiveWell, not surprisingly, their leadership was passionate and uncompromising when it came to innovation to achieve their goals. As examples, they are pushing the edges when it comes to use of technology for safety such as using wrist devices with infrared technology to support freedom of movement as residents could “tap” in and out of the River Homes. They hired an exceptional transdisciplinary team that leads River Homes, with personnel from the fields of occupational therapy, nursing, social work, and activity engagement. It is not the typical one-person memory care director that heads those residences. It is a team, and that team was expert at using the environment as a therapeutic tool to optimize function and to minimize distress behavior.  

Quality care goals and positive outcomes are possible when (a) staff skill and a positive, enriching culture,
(b) programming that promotes health and socialization, and (c) the environment are all top notch and working collaboratively towards achieving the high priority goals. LiveWell delivered on each of these key points and they are demonstrating positive outcomes, such as exceptionally low staff turnover rates. I applaud their investment in the highest quality staff supported by an extraordinary, enriching environment. And, Claudia Allen would be proud of their integration of “can do”, “will do” and “may do.”  

As I demonstrated throughout this blog you can’t underestimate the importance of the environment on the ability to achieve success in memory care. And, while this blog focused on a senior living community, the same concepts apply at home. If someone with dementia lives at home, that environment must also be a supportive tool. 

Look around wherever you may be right now. Do you find yourself somewhere where the environment is enabling or disabling you? We know the difference and we feel the difference. While you may have the ability to shut off that distracting tv, or buy better lighting to work by, or move things around where they are easier to find, those with dementia are dependent upon us to create the environment that helps them to live well with dementia. If you aspire to specialize and succeed in memory care, I encourage you to make this a priority. 

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