Planning care for a person living with dementia involves more than just meeting medical needs. It means supporting routines, emotions, and well-being across changing stages. A dementia care plan serves as a structured approach that helps caregivers make daily tasks more manageable, monitor changes, and respond to needs as they evolve.
Throughout the progression of dementia families and professionals alike often feel overwhelmed. A well-organized plan removes the guesswork and provides direction by outlining routines, safety measures, communication styles, and care team coordination.
It acts as a shared reference, helping everyone support the person’s quality of life. Developing a care plan tailored to individual needs and grounded in consistency can improve the experience of both the caregiver and the person living with Alzheimer’s and related dementias
What Is a Dementia Care Plan?
A dementia care plan is a written or digital guide that outlines how to meet the daily and long-term care needs of someone diagnosed with dementia. It includes medical information, behavior support strategies, and daily activities. More than just a checklist, it serves as a flexible tool that can be adjusted as symptoms change.
While every plan looks different, they may include the following:
Personal history and preferences
- Daily routines
- Medication schedules
- Communication techniques
- Safety needs
- Nutritional preferences and needs
- Medical and therapy appointments
- Support strategies
- Involvement in meaningful activities
This documentation becomes especially helpful when multiple caregivers are involved. It keeps everyone aligned and supports continuity of care.
Why Personalization Matters
No two individuals experience dementia the same way. Some lose short-term memory quickly but remain physically active. Others may struggle more with communication or sensory overload. A person-centered care plan must consider lifestyle, beliefs, preferences, physical abilities, and emotional triggers.
Personalization improves comfort and decreases confusion. A favorite meal or song may ease agitation. Familiar routines build predictability. Involving the person in their care planning, when possible, also helps maintain dignity and a sense of control.
Establishing a Daily Routine for Someone Living with Dementia
Consistency is a powerful support for those living with dementia. Repeating tasks at the same time each day helps reduce anxiety and promotes cooperation. A structured daily routine for a person with dementia include waking times, meals, bathing, medication, physical activity, engagement in activities of interest, and rest periods based on their past routines and habits.
Here is a sample routine some care partners adapt.
Morning
- Wake up – Encourage natural waking and bedtimes vs. scheduled times.
- Take care of hygiene needs
- Dress in comfortable clothes
- Have a calm breakfast
- Take medications
- Engage in an activity of interest
Midday
- Enjoy lunch
- Hydrate regularly throughout the day
- Engage in an activity of interest
- Rest or take a short nap if needed.
Afternoon to Evening
- Light movement (short walk or stretches)
- Engage in activity of interest
- Dinner at a familiar hour
- Soothing wind-down activity
- Prepare for bed
This routine may need to shift depending on energy levels, health, needs, and preferences of the individual living with dementia. Let the person with dementia help guide the day’s routine. Honoring their preferences, what they want to do and when, can reduce conflict and help prevent distressing behaviors. Empowering choice supports dignity and promotes calmer, more positive interactions. Promote choice and flexibility wherever possible to support independence.
Still, even when flexibility is required, care partners can maintain the same sequence of events to support emotional balance.
Engaging Family and Support Networks
A dementia care plan thrives when the circle of care includes family members, friends, and community resources. The emotional and practical support from loved ones helps share caregiving responsibilities and enriches the person’s social environment.
Including family in the care planning process allows care partners to share observations, coordinate schedules, and create meaningful moments for the person living with dementia. Open communication among everyone involved prevents confusion and promotes a unified approach to challenges that may arise.
Families can contribute by sharing details about the individual’s past interests, values, and preferences. This information supports personalization and strengthens the connection during daily interactions.
Additionally, connecting with local support groups or counseling services provides care partners with emotional relief and valuable advice from those who understand the journey firsthand.
Tracking and Updating the Care Plan
Dementia is a progressive condition, and a care plan must reflect evolving needs as dementia progresses. Regular review and updating of the plan keep it relevant and practical. Care Partners should note any changes in cognition, mobility, mood, or health. This tracking can include written logs, digital apps, or communication notebooks used by all caregivers.
Documentation of changes helps identify patterns, such as increased confusion at certain times or new difficulties with self-care.
Sharing this information with healthcare providers informs medical decisions and may prompt adjustments in medications or therapies. It also helps care partners plan ahead for transitions, such as moving from home care to a memory care facility, if necessary.
By maintaining accurate records, care partners reduce stress caused by uncertainty and improve the consistency of support.
Encouraging Family Involvement in Dementia Care Planning
Why Family Involvement Matters
Family members—whether biological or chosen—bring critical insight to care planning for individuals living with dementia. They offer a deep understanding of the person’s history, values, preferences, cultural background, and routines that can’t be captured in charts or assessments alone. Their involvement helps ensure care plans are not just clinically appropriate, but personally meaningful.
What Families Bring to the Table
- Personal History & Life Story: Families can share valuable details about a person’s life, habits, likes, dislikes, and triggers—informing individualized approaches.
- Communication Preferences: Families often know how their loved one best expresses needs, discomfort, or joy—especially as verbal communication declines.
- Emotional Support: Simply seeing familiar faces can ease anxiety for residents and support emotional well-being.
- Consistency & Advocacy: Families can monitor care over time, raise concerns, and ensure that plans are followed or adjusted as needs change.
How Staff Can Encourage Collaboration
- Invite Early and Often: Actively invite family members to participate in care planning meetings and updates, not just at admission but regularly.
- Respect Their Role: Acknowledge families as partners in care, not outsiders. Listen without judgment, and avoid medical jargon that alienates.
- Build Trust: Keep communication open and honest. Share both positive updates and challenges. Reliability builds trust.
- Be Flexible: Offer meeting times that work for family schedules and allow virtual participation when needed.
- Highlight Their Impact: Reinforce how their input has shaped care decisions, so they see the value of their involvement.
Ways Families Can Advocate Effectively
- Be Prepared: Come to care planning meetings with notes, questions, and any observations from recent visits.
- Share What Works: Let the team know about successful approaches used at home or past care settings.
- Stay Informed: Understand the stages of dementia, possible care needs, and how the care plan is structured.
- Communicate Respectfully: Raise concerns constructively, and recognize the efforts and expertise of staff.
- Follow Up: If changes are discussed, check in to ensure follow-through and stay engaged in updates.
General Tips for Adapting to Different Stages of Dementia
Dementia progresses through several stages, from early mild symptoms to advanced impairment. A dementia care plan that works well in the beginning will require adjustments as the person’s abilities change. Early stages often focus on supporting memory and problem-solving, encouraging independence while assisting with organization and reminders.
In the middle stages, challenges like wandering, difficulty communicating, and changes in behavior become more common. The care plan should expand to include safety measures, behavioral support strategies, and more hands-on assistance with daily tasks. Familiar routines continue to offer comfort, but flexibility becomes necessary to accommodate fluctuating needs.
In the late stage, the focus shifts toward full-time assistance with personal care, mobility, and feeding. Communication may be limited to gestures or simple sounds. Comfort and pain management take precedence, along with preserving dignity and emotional connection.
Caregivers must be prepared to revise the care plan continually, seeking guidance from healthcare professionals and trained dementia care experts.
Nutrition and Physical Health
Proper nutrition plays a significant role in the well-being of persons living with dementia. A care plan nursing section often addresses meal planning, hydration, and monitoring for swallowing difficulties. Many individuals lose interest in food or forget to eat and drink regularly.
Caregivers can encourage small, frequent meals with familiar foods, focusing on nutrient-dense options that are easy to consume.
Physical health support includes encouraging gentle exercise to maintain mobility and reduce restlessness. Activities such as walking, stretching, or chair exercises help preserve muscle strength and contribute to better mood.
Coordinating with physical therapists or nutritionists through the care team ensures that health needs are addressed holistically.
The Importance of Professional Dementia Training
Caring for someone with dementia demands specialized knowledge. Training improves confidence, reduces caregiver burnout, and enhances the quality of care. At NCCDP, we offer a variety of certification programs designed for healthcare professionals and family caregivers alike.
Through completing the Alzheimer’s and dementia care training, caregivers gain tools grounded in research and real-world experience.
Our courses cover topics such as communication techniques, behavioral management, and ethical caregiving. In addition to individual certification, we provide organizational training options through our distributed training programs, which empower care teams to deliver consistent, high-quality care.
Supporting the Caregiver
Caring for a person with dementia can be emotionally and physically demanding. It is essential that caregivers include their own well-being in the care plan. Scheduling breaks, seeking respite care, and joining support groups help prevent burnout. Self-care allows caregivers to sustain the energy and patience needed for long-term care.
Sharing caregiving responsibilities with trained professionals, when possible, adds balance. Using resources like counseling, educational workshops, and peer networks can provide caregivers with strategies to cope with stress and emotional challenges.
Advance Your Dementia Care Skills with NCCDP Certification and Training
Creating and maintaining a dementia care plan is a dynamic process. It requires ongoing attention, compassion, and flexibility.
The National Council of Certified Dementia Practitioners (NCCDP) has supported caregivers and professionals since 2003, offering education that improves lives.
Becoming certified through our Alzheimer’s and dementia certifications affirms a commitment to compassionate, knowledgeable care for persons living with Alzheimer’s and related dementias. Together, we can build care plans that truly support both the person with dementia and those who care for them.
