A therapeutic environment is increasingly recognized as an important factor for a person living with dementia. A therapeutic environment for individuals living with dementia is guided by a specific, person-centered philosophy of care, a framework that identifies an organization’s goals and values.

People living with dementia rely on environmental cues to support them physically, cognitively, and emotionally. Unfamiliar, chaotic, or disorganized environments cause stress, anxiety, disorientation, and contribute to behavioral problems.

Interior environments that are “homelike” are associated with reduced behavioral disturbances and increase social interaction. Family-style dining in small groups can improve food and fluid intake. Higher light levels during the day can reduce functional decline, while improving the circadian rhythm and quality of sleep (Siegelaar et al., 2025).

Indoor features such as bright-light therapy (1,000–2,500 Lux) have been shown to positively influence clients’ agitation and disruptive behaviors and improve daytime wakefulness. In general, moderate or low levels of sensory stimulation prevents overstimulation, reducing agitation and restraint use (Siegelaar et al., 2025).

Additional elements of a therapeutic environment include providing:

• common areas such as a music room, crafts room, and garden areas
• links to the community
• areas that encourage activities and socialization

Emphasizing the experience of living with dementia rather than focusing on symptoms and impairments creates an environment that allows people living with dementia to actively participate in everyday life rather than just passively receiving care (Gramegna, 2021).

7.1 Physical Environment

A supportive physical environment means treatment and care are offered in a manner that is tailored for people living with dementia (Lygum et al., 2025). A well-designed physical environment supports engagement in activities, can decrease psychotropic drug use, has a positive effect on behavior, and improve independence (Siegelaar et al., 2025).

The overall architecture of a nursing home can provide residents with a sense of freedom and mobility. For example, unique bedroom door designs with a range features, such as door knockers or letterboxes, can help residents with wayfinding and visual recognition. The building structure and floor plan can support a resident’s orientation, and windows provide views of the outside. When there are children or animals outside the window, these views can provide a sense of freedom and contribute to the quality of life of residents (Sturge et al., 2024).

A thoughtfully designed physical environment can reduce challenging behaviors by having clear, uncluttered pathways, place markers, safe outdoor spaces, ample lighting, and interesting destinations. These features serve as an important “non-pharmacological treatment modality” helping people compensate for sensory and cognitive changes (Gramegna, 2021).

For people living with dementia, indoor design should include:

• private space in a person’s room with a private bathroom
• public spaces that are easy to access
• rooms personalized with furniture, memorabilia, and personal possessions
• absence of smelly odors
• sunlight, ventilation, and elimination of dark nooks and crannies
• areas that cue specific behaviors (kitchen, art and music area, rummaging room, library, coffee shop, quiet areas, living room, family visiting area)

Dementia-friendly outdoor design should allow a person to connect with nature. Certain health benefits are associated with this approach:

• decreased agitation
• improved well-being and affect
• improved attention
• decreased use of medication (Lygum et al., 2025)

Green care farms, which include the presence of animals and gardens provide opportunities for attractive outdoor activities and are associated with improved psychological well-being. Outdoor and garden areas and participation in outdoor activities can also reduce drug-use and improve quality of sleep (Siegelaar et al., 2025).

7.2 How an Organization’s Philosophy of Care Affects the Environment

An organization’s philosophy of care is a framework that identifies its goals and values. The family, and the person receiving services, has the right to know—and should feel free to question—a center’s philosophy of care. Key questions include (California Advocates for Nursing Home Reform, 2024):

• Is the center’s philosophy consistent with your beliefs?
• Does the center provide services to persons at all stages of dementia?
• What conditions or behaviors determine whether a center will admit or retain someone living with dementia?
• Is dementia care provided in a separate unit or as an integrated part of center’s services?
• Is the center’s philosophy and practice of handling "difficult behaviors" compatible with your views?
• What is the center’s philosophy in using physical restraints to deal with certain behaviors?
• Does the center recommend the use of psychoactive drugs to treat challenging behaviors?

Person-centered care is the philosophy of care encouraged for individuals living with ADRD. An organization’s philosophy should support a resident’s rights. People living with dementia have the right to have their own clothes and other personal items. They must have unrestricted private communication, be able to send and receive unopened correspondence, and have access to a telephone. If both spouses are residents, they have the right to share a room.

Residents have the right to visit with any person of their choice, manage their own financial affairs (if able), exercise their civil and religious liberties, and access appropriate healthcare. The living environment must be safe and clean, and residents must be free from chemical and physical restraints and free from abuse and neglect.

7.3 Safety and Security

However, changes to the physical environment intended to increase security may decrease a resident’s autonomy and attempts to enhance autonomy can lead to decreased security. Providing autonomy without compromising security is a considerable challenge, particularly for residents who are living with dementia (Sandberg et al., 2021).

7.3.1 Elements of a Safe Environment

Safetyis freedom from accidental or preventable injuries or harm. People living with dementia need to feel safe (and be safe). A safe and secure environment should include proper assistive equipment, dementia-trained caregivers, the absence of abuse, and consistent communication with caregivers and healthcare providers.

Muscle weakness, injuries from falls, hearing loss, and visual changes increase the risk of accidents and injuries. Environmental safety focuses on reducing clutter, and removing hazards such as steps, poisonous plants, household chemicals, firearms, and alcohol.

Each room must be assessed for safety—especially bedrooms, bathrooms, and kitchens. Electrical outlets should be covered, and electrical appliances placed so they cannot encounter water. Monitoring devices can be installed in each room and medications must be safely stored out of reach of the client. Alarms or locks can be helpful to prevent wandering into unsafe places.

Elements related to client safety also include error reporting, infection prevention, medication safety, compliance with safety procedures, and personal safety awareness (Moran et al., 2024).

The table below illustrates some common safety issues, consequences, and suggestions that help make the environment safe and secure. Interventions should be tailored to match the specific circumstances.

*The Alzheimer’s Association has a product called Comfort Zone that uses GPS technology to locate a person who has wandered and become lost.

Measures to Promote Resident Safety and Security
Safety issue	Possible consequence	Elements of a Safe Environment
Wandering	Getting lost, exposure to environmental hazards.	Use technology such as the Alzheimer Association’s Comfort Zone.* Provide short, looping indoor corridors without dead ends. Create open, common areas of interest. Create safe, outdoor wandering areas that are accessible from indoor wandering paths. Paint the inner surfaces of doors so that they are not readily recognizable as an exit. Place locks where they are not visible.
Cooking without supervision	Fire, injury	Install a shut-off valve on the stove. Remove burner on-off handles. Keep a working fire extinguisher. Create a work area with an activity kitchen.
Falls	Injury	Rule out medical conditions. Reduce clutter. Install handrails in showers and hallways. Wipe up spills promptly. Maintain physical activity. Supervise walking and use assistive devices. Remove throw rugs or tape edges down. Maintain good vision and hearing. Provide many places to sit.
Poisoning	Sickness or death	Remove toxic plants from the facility. Lock up chemicals and medications.

7.3.2 Elements of a Secure Environment

Security includes physical security measures such as exit control, lighting and surveillance, facility and room access, and control of the facility’s perimeter (fencing, gates). Security also involves staff training, emergency preparedness, and addressing resident abuse. Security measures must consider the privacy and autonomy of the resident. 

For a person living with dementia who likes to wander, doors are often perceived as an attraction, inviting a person to go out. Facility exits need to be monitored or controlled to avoid a person exiting the facility (Gramegna, 2021).

Exit doors that are less visible and more camouflaged, with no obvious hardware, can reduce or even prevent a person from trying to open them. Increasing the visibility of “safe doors”—ones that encourage a resident to enter indoor safe areas of a facility—can distract them from exit doors. Alarmed exit doors should be discreet and should not disturb residents with loud sounds or strong lights. These precautions help a facility maintain a quiet atmosphere and support independence for residents (Gramegna, 2021).

7.3.3 Wandering and Safety

Although it is easy to identify the risks associated with wandering, it is often difficult to know how to allow a person to continue to wander safely. A regular review of medications ensures that wandering is not the result of medication side effects, overmedication, or drug interactions.

As a person nears the end of their life, weakness can make walking and wandering unsafe. Nevertheless, the same practices used in earlier stages of dementia still apply in hospice:

• Redirect to a purposeful activity.
• Provide safe places to wander.
• Install rails and grab bars.
• Encourage the use of a walker or cane.
• Provide close assistance.

Electronic devices attached to the person’s ankle or wrist alert caregivers when a person has wandered out of a safe area. Subjective barriers such as grid patterns on the floor in front of exit doors, camouflage, and concealment of doors and doorknobs discourages a wanderer from exiting a building.

The Alzheimer’s Association has partnered with MedicAlert through the Alzheimer’s Association Safe Return Program to provide 24-hour assistance for those who wander. They maintain an emergency response line and immediately activate local chapters and local law enforcement to assist with the search for someone who has wandered off. The program includes an ID bracelet and a medical alert necklace. For more information call 800 625 3780 or visit the Alzheimer’s Association website (Alz.org).

7.3.4 Technology Related to Safety

The use of technology and electronic devices can reduce risk and increase independence. Safety technologies include GPS trackers to monitor wandering, smart home devices (sensors and automated lighting), medication reminders, and wearable devices for fall detection and emergency calls.

Smart plugs allow caregivers to remotely monitor and control electrical appliances, such as stoves, irons, heating, and cooling. Smart safety sensors can detect smoke, carbon monoxide, flood, and fire and send early warnings and alerts to a caregiver’s phone. Indoor cameras allow caregivers to remotely check on their loved one and communicate with them via two-way audio. These tools can provide peace of mind for caregivers while supporting the independence of the person living with dementia.

7.4 Task-Centered vs. Person-Centered Care

Many of us trained in the traditional medical model are familiar with task-centered care. In this model, we provide care to the best of our ability but generally do not consider the places we work as “homelike,” Our approach is often hierarchical, and we expect a facility to be designed to help us do our jobs.

Person-centered care turns this approach on its head by putting the person living with dementia at the center of care and planning. When done right, task-centered care recedes into the background, replaced by care that focuses on the needs and well-being of residents. Person-centered care is encouraged for people living with ADRD.

Person-centered dementia care is built on the understanding that a sense of belonging and opportunity for meaningful engagement are critical to the success of all human communities. Key principles for successfully implementing person-centered dementia care include (Gramegna, 2021):

• understanding the environment of the specific care setting for residents living with dementia
• creating a clear understanding of people living with dementia as unique individuals
• promoting access to meaningful engagement tailored to suit that person

The person-centered approach was developed nearly three decades ago and is now considered the gold standard in dementia care. Five essential psychological needs are emphasized (Scher, et al., 2025):

1. Comfort—the feeling of trust that comes from others.
2. Attachment—security and finding familiarity in unusual places.
3. Inclusion—being involved in the lives of others.
4. Meaningful occupation—being involved in the processes of normal life.
5. Identity—what distinguishes a person from others and makes them unique.

Person-centered care can lead to positive outcomes for people living with dementia, including a reduced risk of behavioral problems, neuropsychiatric symptoms, and improved quality of life. Person-centered care can also have a positive impact on the caregivers, influencing staff behavior, and job satisfaction of professional caregivers, as well as family satisfaction of informal caregivers (Wittmann et al., 2024).

7.5 Staff as Part of the Environment

Studies indicate that nurse staffing levels are a “critical factor” in determining nursing home quality of care. Nursing homes with higher staff-to-resident ratios provide better care (White and Olsho, 2023).

Many factors make it difficult to blend staff into the environment effectively. These can include high staff turnover, insufficient education, lack of resources, heavy workload, burnout, and difficult ethical issues. Training programs that enable formal and informal caregivers to acquire knowledge, empathy, and care skills are considered crucial for treating individuals with dementia adequately and effectively (Wittmann et al., 2024).

Consistent staffing, good pay, career advancement opportunities, and education can reduce staff turnover and support person-centered care. Small, fixed teams of trained caregivers and activities that are organized completely, or in large part, by residents and caregivers encourage cooperation and participation.

To encourage integration of the staff into a home-like environment:

• Hire staff with the emotional skill, training, and desire to interact with people with memory problems.
• Increase pay, training, and opportunities to advance.
• Eliminate institutional, centralized nursing stations.
• Locate nursing and work areas throughout the building.
• Allow staff to control lighting and environmental levels.
• Keep staff consistent.

Being part of a resident’s environment means being aware of the person’s routines and habits. It means respecting their needs, understanding the impact of cognitive and sensory changes (vision, hearing), and respecting cultural and language differences.

7.6 Staff Adjusting to Resident Routines

Forget dementia, remember the person!

Alzheimer’s Disease International

When a nursing home is organized around dementia-friendly care, resident routines are a priority. This means the medical aspects of care are deemphasized. Residents, staff, and family caregivers work as a unit and daily tasks, such as cooking and cleaning, are shared and organized by residents, staff, and caregivers.

7.7 Schedules and Routines

For a person living with dementia, maintaining schedules and routines is important. A daily plan organized by the caregiver and the person they are caring for creates predictability and supports their well-being. A daily routine must be flexible, consider personal preferences, and include physical exercise and rest time.

Routine tasks such as bathing, dressing, and eating should be kept consistent each day. Keeping a to-do list with appointments, tasks, and events provides support and reminders for a person whose memory is impaired. Plan activities that the person enjoys and try to do them at the same time each day. Consider a system or reminders for helping those who must take medications regularly. Serve meals in a consistent, familiar place and give the person enough time to eat (Alzheimer’s.gov, 2026).

Unfortunately, schedules and routines are often organized around the convenience of caregivers and can change dramatically from day to day. This is difficult for people living with dementia because they rely on a predictable routine to know what to expect.

Caregivers and healthcare workers responsible for maintaining a schedule need to be flexible while maintaining familiar routines. People living with dementia tend to be slow, so caregivers must allow ample time for meals and activities. Attempting to rush a person often causes aggressive behaviors that frustrate both parties.

In the last decade, the average hours of care from registered nurses, licensed practical nurses, and nurse aides that nursing facility residents received declined by 8%. The decrease was driven by a 21% decline in registered nurse hours and an 8% decline in nurse aide hours (Chidambaram and Burns, 2024). In early 2025, a federal rule mandating minimal staffing requirements in nursing homes was struck down, leaving minimum staffing decisions to each state.