Why “person-centered at scale” matters
Person-centered dementia care is often described as a philosophy, but families and teams experience it as a daily operating system. When person-centered practices are not scaled reliably across shifts and roles, outcomes become dependent on “who is working today,” which increases distress for people living with dementia, frustration for care partners, and moral distress for staff.
Scaling person-centered care means designing routines, tools, and team expectations so that knowing the person, supporting autonomy, and responding to distress happen consistently—whether the setting is home care, assisted living, memory care, skilled nursing, or acute care (Fazio et al., 2018).
Turning principles into daily practice
- Know the person beyond the diagnosis: incorporate life story, roles, preferences, routines, cultural context, strengths, and what helps the person feel safe and respected (Fazio et al., 2018).
- Make engagement a core care process: plan meaningful roles and activities that match ability, interest, and purpose—not just “keeping busy.”
- Treat distress as communication: interpret behaviors as signals of unmet needs (pain, fear, overstimulation, boredom, hunger, loneliness, fatigue) and prioritize non-pharmacologic responses.
- Support autonomy with “enabled” choices: offer real options (what, when, where, with whom) while adapting the environment to make success more likely.
- Partner with families and other care partners: establish shared goals, communication preferences, and practical supports that reduce caregiver strain.
A practical way to operationalize these principles is to standardize a short set of “must capture” person-centered elements at admission and update them over time: what brings comfort, what triggers distress, preferred routines, meaningful roles, communication supports, sensory needs, and safety considerations. These elements should be visible in care plans, huddle sheets, and handoffs so they guide real-time decisions.
Montessori-informed approaches as a scalable engagement framework
Montessori-informed dementia care translates strengths-based education principles into dementia-supportive engagement—emphasizing prepared environments, purposeful activity, independence, and contribution. In dementia settings, Montessori-informed practices are commonly used to structure activities that are sequenced, concrete, and matched to remaining abilities (Camp, 2010).
A systematic review of Montessori-based programs in residential aged care found evidence suggesting benefits in engagement, function, and behavioral symptoms, while emphasizing the importance of tailoring activities to the person’s cognitive capacity and preferences (Yan et al., 2023).
To scale Montessori-informed engagement, organizations typically need: (a) role-based training, (b) activity “recipes” matched to ability levels, (c) ready-to-use materials, and (d) coaching so staff move from “activity as an event” to “engagement as part of care.”
Reducing distress without defaulting to restraint or medication
Person-centered systems reduce distress by making the easiest action the best action. That requires predictable processes for: rapid pain screening, sensory checks (hearing/vision), medication review for cognitive and behavioral side effects, sleep and delirium risk checks, and a structured non-pharmacologic response plan.
Scaling this work also depends on environmental design and team routines: quieter transitions, consistent assignments when possible, clear cueing and signage, and brief shift huddles that highlight what matters today for each person (Fazio et al., 2018).
Supporting autonomy and safety together
Autonomy and safety are not opposites—they are both care priorities. A person-centered approach emphasizes “dignity of risk” and practical mitigation: simplifying choices, optimizing lighting and contrast, using cueing rather than control, and building routines that reduce hazards (e.g., fall and wandering risks) without stripping independence.
At scale, organizations can clarify decision principles (what risks are acceptable, what supports are required, and how care partners are involved) so staff are not forced to improvise in high-stress moments.
Measuring quality beyond “no incidents”
A low incident count is not the same as a good life. Measuring person-centered quality at scale should include outcomes that matter to people living with dementia and care partners: comfort, connection, meaningful activity, quality of relationships, and perceived quality of life.
The International Consortium for Health Outcomes Measurement (ICHOM) Dementia Standard Set recommends core outcome domains, including quality of life and caregiver outcomes, to support benchmarking and improvement (ICHOM, 2017).
In practice, organizations may use validated measures such as QoL-AD (Logsdon et al., 2002) or DEMQOL (Brighton and Sussex Medical School, n.d.) alongside operational metrics like engagement participation, distress episodes, avoidable transfers, and staff retention/competency.
Implementation blueprint: what “scale” looks like on the ground
- Define role-based competencies (clinical and non-clinical) for communication, engagement, and distress response.
- Build a standard “know the person” workflow (admission, 7-day update, quarterly refresh, change-in-condition).
- Use micro-learning + coaching loops: brief refreshers, observation, feedback, and case review.
- Create engagement infrastructure: activity libraries, prepared environments, and material kits accessible on every unit.
- Hardwire communication: huddle sheets, handoff prompts, and family communication touchpoints.
- Measure and review what matters: quality of life, engagement, caregiver experience, and workforce outcomes—not only incidents.
How NCCDP can help
NCCDP supports person-centered care at scale by building workforce capability, standardizing expectations, and helping organizations sustain practice change.
- Build common competencies through recognized credentials: NCCDP’s certifications provide a shared language and expectations for dementia-capable practice across roles (National Council of Certified Dementia Practitioners, n.d.-a).
- Scale training internally: the Certified Alzheimer’s Disease and Dementia Care Trainer (CADDCT®) pathway supports train-the-trainer capacity so organizations can sustain onboarding and coaching (National Council of Certified Dementia Practitioners, n.d.-b).
- Strengthen Montessori-informed implementation: the CMDCP® and CMDCPT™ pathways support practical skills for meaningful engagement, autonomy, and purpose (National Council of Certified Dementia Practitioners, n.d.-c; n.d.-d).
- Operationalize quality through community standards: the Memory Care Excellence Network (MCEN) supports organizations committed to best-in-class memory care standards and continuous improvement (National Council of Certified Dementia Practitioners, n.d.-e).
- Reinforce person-centered language and practice: NCCDP’s person-centered care resources help teams align documentation and communication with dignity and respect (National Council of Certified Dementia Practitioners, n.d.-f).
Conclusion
Person-centered care becomes scalable when it is engineered into routines: how teams learn, how they communicate, how they plan engagement, and how they measure success. Montessori-informed approaches provide a practical engagement framework that can be taught, coached, and embedded across roles. When organizations measure quality beyond “no incidents” and build training capacity to sustain practice change, person-centered dementia care becomes a reliable standard—not a hopeful exception.
References
Brighton and Sussex Medical School. (n.d.). DEMQOL. https://www.bsms.ac.uk/research/clinical-neuroscience/cds/research/demqol.aspx
Camp, C. J. (2010). Origins of Montessori programming for dementia. *Non-Pharmacological Therapies in Dementia, 1*(2), 163–174. https://pmc.ncbi.nlm.nih.gov/articles/PMC3600589/
Fazio, S., Pace, D., Flinner, J., & Kallmyer, B. (2018). The fundamentals of person-centered care for individuals with dementia. *The Gerontologist, 58*(Suppl 1), S10–S19. https://doi.org/10.1093/geront/gnx183
Fazio, S., Pace, D., Maslow, K., Zimmerman, S., & Kallmyer, B. (2018). Alzheimer’s Association dementia care practice recommendations. *The Gerontologist, 58*(Suppl 1), S1–S9. https://doi.org/10.1093/geront/gnx182
International Consortium for Health Outcomes Measurement. (2017). *Dementia: Data collection reference guide (Version 1.0.1).* https://ichom.org/files/medical-conditions/dementia/dementia-reference-guide.pdf
Logsdon, R. G., Gibbons, L. E., McCurry, S. M., & Teri, L. (2002). Assessing quality of life in older adults with cognitive impairment. *Psychosomatic Medicine, 64*(3), 510–519. https://doi.org/10.1097/00006842-200205000-00016
National Council of Certified Dementia Practitioners. (n.d.-a). NCCDP: Alzheimer’s disease and dementia care education and certification. https://www.nccdp.org/
National Council of Certified Dementia Practitioners. (n.d.-b). Certified Alzheimer’s Disease and Dementia Care Trainer® (CADDCT®). https://www.nccdp.org/train/
National Council of Certified Dementia Practitioners. (n.d.-c). CMDCP® Certified Montessori Dementia Care Professional®. https://www.nccdp.org/cmdcp-certified-montessori-dementia-care-professional/
National Council of Certified Dementia Practitioners. (n.d.-d). CMDCPT® Certified Montessori Dementia Care Professional® Trainer. https://www.nccdp.org/cmdcp-certified-montessori-dementia-care-professional-trainer/
National Council of Certified Dementia Practitioners. (n.d.-e). NCCDP’s Memory Care Excellence Network. https://www.nccdp.org/certifications/nccdps-memory-care-excellence-network/
National Council of Certified Dementia Practitioners. (n.d.-f). Understanding person-centered dementia care. https://www.nccdp.org/understanding-person-centered-dementia-care/
Yan, Z., Traynor, V., & Chang, H.-C. (2023). The impact of Montessori-based programmes on individuals with dementia living in residential aged care: A systematic review. *Dementia, 22*(6), 1259–1291. https://doi.org/10.1177/14713012231173817
