A therapeutic environment is an important factor in every person’s quality of life. A thoughtfully designed environment supports the well-being of a person living with dementia and can be an effective non-pharmacological factor in reducing challenging behaviors (Siegelaar et al., 2025). It is a key component of person-centered care.

A therapeutic environment is especially important for people living with dementia because, as their cognitive skills decline, they become more dependent on the physical space. Brain changes make it harder for a person to create and retain a mental image of their physical space. A well-designed therapeutic environment can compensate for these losses (Buuren et al., 2025).

A therapeutic environment should help a person easily and safely find their way around. People living with dementia use objects and signs to find their way. Although some objects, such as a microwave or care equipment are not meant for the wayfinding*, people still use these objects to orient themselves to the environment (Buuren et al., 2025).

*Wayfinding: a person’s ability to navigate spaces using signs, maps, and environmental cues.

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, and improve independence (Siegelaar et al., 2025).

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. Good 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 prevent overstimulation, reducing agitation and restraint use (Siegelaar et al., 2025).

Dementia-friendly indoor design includes:

• Private space in a person’s room with a private bathroom.
• Easy-to-access public spaces.
• 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
• improved quality of sleep
• decreased use of medication (Lygum et al., 2025)

Spending time in a garden or outdoor area can reduce agitation, aggression, drug use, and falls. Green care farms, which include the presence of animals and gardens provides opportunities for attractive outdoor activities and is associated with improved psychological well-being. Outdoor and garden areas and participation in outdoor activities can also reduce drug-use (Siegelaar et al., 2025).

Many people living with dementia prefer to spend their final days at home because the familiarity, stability, and predictability of the environment is important to them. As cognitive functions decline, being at home can protect them from the distress and confusion associated with environmental changes and avoid the feelings of powerlessness and displacement that arise when they are transported to a care facility (Yin et al., 2024).

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 (CANHR, 2025):

• Is the organization’s philosophy consistent with your beliefs?
• What conditions or behaviors determine whether an organization will admit or retain someone living with dementia?
• Is the organization’s philosophy and practice of handling "difficult behaviors" compatible with your views?
• What is the organization’s philosophy in using physical restraints to deal with certain behaviors?
• Does the organization recommend the use of psychoactive drugs to treat challenging behaviors?

Dementia Friends is a global movement that is changing the way people think, act, and talk about dementia. Dementia Friends USA helps everyone in a community understand what dementia is and how it affects people, each of us can make a difference for people touched by dementia.

7.3 Safety and Security

My mom has severe dementia. She can still walk around the house using a walker. Last month, she went into the bathroom, swung her hips around and landed heavily on the toilet. Unfortunately, when she turned, she grazed the corner of the tile sink cabinet and broke a rib. To prevent this from happening again, we installed a transfer pole next to the cabinet, which blocked the corner of the cabinet. My mom was able to grasp the pole and sit on the toilet more safely.

Family Caregiver, West Palm Beach, FL

7.3.1 Elements of a Safe Environment

Safety is 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, and consistent communication with healthcare providers.

For a person nearing the end of their life, muscle weakness, injuries from falls, hearing loss, and visual changes increase the risk of accidents and injuries. Safety focuses on reducing clutter, and removing hazards such as 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 come into contact with 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).

7.3.2 Elements of a Secure Environment

Physical security involves measures such as exit control, lighting and surveillance, facility and room access, and control of the facility’s perimeter (fencing, gates). Security also involves caregiver and staff training, emergency preparedness, and addressing patient abuse.

On a personal level, support from healthcare providers provides a sense of security for clients and family caregivers. Family caregivers feel insecure when they don’t know what to expect or have unrealistic expectations of what it means to provide care at home. A lack of information can cause caregivers to feel useless and helpless, which contributes to a sense of insecurity (Barlund et al., 2021).

The table below illustrates some common safety and security 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. There are many proprietary companies now offering similar location services.

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.

7.3.3 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 safely continue to wander. 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 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 Smart Technology Related to Safety and Autonomy

Smart technologies can be used to increase safety, security, and autonomy. Remotely controlled environmental monitoring systems can be used by family caregivers to regulate temperature, humidity, and air quality. Health and safety monitoring systems can detect falls and send an emergency alert. Automated lighting controls, voice-activated assistants, and GPS trackers can provide a sense of security (Hu et al., 2024).

Safety sensors can also detect 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 via two-way audio. These tools can provide peace of mind for caregivers and reduce risk while supporting independence.

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 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 a person living with dementia at the center of our care and planning. When done right, task-centered care recedes into the background, replaced by care and activities that focus on the needs and well-being of hospice clients.

The person-centered approach was developed nearly 3 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

Being part of a client’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.

Many factors make it difficult to effectively blend staff into the environment. 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 significantly 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 clients 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.
• Allow staff to control lighting and environmental levels.
• Keep staff consistent.
• Encourage staff to collaborate with one another.

7.6 Staff Adjusting to Patient Routines

Forget dementia, remember the person!

Alzheimer’s Disease International

At the end of life, medical aspects of care are deemphasized and the focus shifts to comfort-oriented care. Daily tasks such as bathing, grooming, and eating must consider a client’s energy level and personal preferences. Caregiver tasks such as cleaning, vacuuming, and cooking must consider a client’s need for rest and quiet.

For medical staff, the client’s care plan must be adjusted according to the client’s needs. Clients, staff, and family caregivers must work as a consistent unit. The nursing care plan must shift as needed to prioritize comfort and the client nears the end.

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).

A thoughtful schedule accounts for physical issues that might disrupt routines such as hunger, pain, fatigue, or illness. This is especially important for a person nearing the end of their life.

Caregivers and healthcare workers responsible for maintaining a schedule need to be flexible while helping maintain 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 with dementia often causes aggressive behaviors that frustrate both parties.

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. As a result, the person living with dementia experiences a lack of input and control.