Alzheimer’s disease and related dementias (AD/ADRD) are not only clinical diagnoses—they are long, complex, high-touch conditions that affect individuals, families, and every care setting. The scale of unpaid caregiving alone underscores the workforce reality: in 2024, 11.9 million family and other unpaid caregivers (care partners) provided an estimated 19.2 billion hours of care, valued at approximately $413.5 billion (Alzheimer’s Association, 2025). These demands expose a central truth for providers and communities: quality dementia care depends on workforce capacity and on systems that are built to support people living with dementia and the people who support them.
What is a dementia-capable system?
The term dementia-capable is often used, but it has a specific and practical meaning. In an issue brief developed through the Administration for Community Living, Tilly, Wiener, and Gould (2014) describe a model dementia-capable system as one that can consistently support people living with dementia and their care partners across a range of services—not as special exceptions, but as an expected part of routine operations.
In this model, a dementia-capable system would:
- Educate the public about brain health, dementia risk factors, and available supports.
- Identify people with possible dementia and support timely, accurate diagnosis (including ruling out reversible causes and conditions that resemble dementia).
- Ensure program eligibility and resource allocation account for cognitive changes and related support needs.
- Ensure staff communicate effectively and provide person- and family-centered, culturally appropriate services.
- Educate workers to recognize dementia, understand symptoms, and connect people to appropriate services.
- Implement quality assurance systems that measure how effectively providers serve people living with dementia and their care partners.
- Encourage dementia-friendly communities that include key parts of dementia capability.
This definition matters because it frames dementia care as a system property. Excellence cannot depend on a few “natural” caregivers or exceptional clinicians; it must be repeatable across roles, shifts, and settings.
The workforce capacity challenge is more than staffing levels
Workforce capacity is often discussed as a headcount problem, but dementia care capacity is shaped by demand, skill requirements, and job quality. The direct care workforce is projected to face an estimated 8.9 million total job openings from 2022 to 2032 when growth and replacement needs are combined (PHI, 2024). At the same time, wages remain a key constraint: PHI (2024) reports a median hourly wage of $16.72 for all direct care workers (2023), reflecting a persistent gap between the complexity of direct care work and the resources historically allocated to it.
Dementia care further amplifies these pressures because it requires specialized competencies that are teachable but must be supported through practice. These include communication strategies that reduce distress, recognizing behavior as an unmet need, non-pharmacologic approaches to agitation and sleep disruption, safety planning for wandering and falls, and care-partner coaching. Without consistent training, coaching, and leadership reinforcement, organizations often see higher stress, turnover, and avoidable emergencies and hospital visits.
Why systems must be designed to enable practice change
Even excellent training is not enough if the surrounding environment makes evidence-informed dementia care difficult to deliver. Dementia-capable systems convert knowledge into outcomes by embedding dementia-responsive processes and accountability into everyday operations. In practice, this means aligning workflows, roles, measurement, and community partnerships so that the right actions happen reliably—not only when a particular staff member is on duty.
Core building blocks of dementia-capable systems
1) Reliable identification, pathways, and transitions
Dementia-capable systems normalize early recognition and reduce delays by integrating cognitive concerns into routine workflows and strengthening referral and follow-up loops (Tilly et al., 2014). They also recognize that transitions—hospital to home, home to assisted living, assisted living to skilled nursing—are high-risk moments that require clear communication, medication reconciliation, and care-partner education.
2) Team-based models that bridge medical care and long-term services and supports
Because dementia affects cognition, function, behavior, and care-partner systems, effective care is inherently interdisciplinary. National policy is increasingly reflecting this reality. CMS’s GUIDE Model (Guiding an Improved Dementia Experience) provides Medicare coverage for a standardized package of care coordination and care management for people with dementia, alongside support services for qualifying caregivers (care partners) such as education and respite (Centers for Medicare & Medicaid Services, 2025). Dementia-capable organizations can mirror these principles—clear navigation, interdisciplinary access, and care-partner supports—even outside formal program participation.
3) Care-partner supports as a core service line
Given the scale of unpaid dementia caregiving (Alzheimer’s Association, 2025), care-partner support is workforce capacity. When care partners burn out, the formal system absorbs the impact through crises, avoidable emergency department use, and earlier institutionalization. Dementia-capable systems treat care-partner education, navigation, and respite linkage as essential services, not optional extras.
4) Quality assurance tied to dementia competencies
Tilly et al. (2014) emphasize quality assurance as a defining feature of dementia capability. Practically, this means measuring both outcomes (e.g., avoidable transfers, falls, unsupervised exits [exit-seeking events], distress-related events) and processes (e.g., staff competency by role, use of non-pharmacologic interventions, person-centered documentation elements such as preferences and triggers). Measurement enables targeted coaching, identifies variation across units or shifts, and supports continuous improvement.
5) Dementia-friendly communities and cross-sector readiness
A dementia-capable approach extends beyond facilities. Dementia-friendly communities strengthen the ability of everyday systems—businesses, faith communities, banks, libraries, and first responders—to interact effectively with people living with dementia (Tilly et al., 2014). This reduces stigma, improves safety, and makes it more feasible for people to remain engaged in community life.
Public health infrastructure is increasingly part of “dementia-capable”
In the United States, dementia capability is increasingly framed as a public health infrastructure priority. The CDC’s BOLD Infrastructure for Alzheimer’s Act program is designed to strengthen public health infrastructure to support dementia risk reduction, early detection and diagnosis, prevention of avoidable hospitalizations, and dementia caregiving (Centers for Disease Control and Prevention, 2024a).
Similarly, the National Healthy Brain Initiative (HBI) Road Map provides a state and local framework for public health action to promote brain health and strengthen community responses to cognitive decline (Centers for Disease Control and Prevention, 2024b). The Alzheimer’s Association also positions the HBI Road Map as a framework to help public health professionals act with urgency to improve brain health and support caregivers (care partners) (Alzheimer’s Association, n.d.-a).
Federal planning also continues to emphasize care and support capacity. The National Institute on Aging notes that the 2024 update to the National Plan to Address Alzheimer’s Disease prioritizes supports for people living with ADRD and their families, recognizing that many needs extend beyond formal medical settings (National Institute on Aging, 2024).
A practical implementation blueprint for providers and systems
Organizations can make meaningful progress by aligning workforce development with system design in a deliberate sequence:
- Define dementia care competencies by role (clinical and non-clinical), with clear expectations for communication, safety, and person-centered practice.
- Scale training through a train-the-trainer model to support onboarding, refreshers, and unit-level coaching.
- Standardize dementia-responsive workflows (admissions, behavior response, falls/wandering prevention, transitions, and family communication).
- Embed care-partner supports into routine operations (education touchpoints, navigation, community referrals, and crisis planning).
- Measure competency and outcomes, then coach to gaps using quality improvement methods.
- Strengthen retention through job-quality strategies (mentorship, recognition, scheduling stability, and realistic workload design).
- Partner locally across sectors (community organizations, public health, hospitals, and first responders) to extend dementia capability beyond one setting.
How NCCDP can help
NCCDP can serve as an enabling partner for organizations seeking to build dementia-capable systems by strengthening workforce competency, standardization, and scalability.
Build standardized competencies with recognized credentials
NCCDP offers multiple dementia care certifications that support role-based competency development across settings (National Council of Certified Dementia Practitioners, n.d.-b). Credentials provide a common language for expectations and can support recruitment, professional identity, and quality improvement efforts.
Scale capability through internal training capacity
Dementia-capable systems require training that is sustained and repeatable. NCCDP’s Certified Alzheimer’s Disease and Dementia Care Trainer (CADDCT) pathway is designed to create internal trainer capacity so organizations can deliver consistent education, onboarding, and reinforcement at scale (National Council of Certified Dementia Practitioners, n.d.-c).
Operationalize “dementia-capable” through MCEN and the Seal of Excellence
Training becomes most powerful when connected to operational standards and continuous improvement. NCCDP’s Memory Care Excellence Network (MCEN) is designed to recognize and support organizations committed to best-in-class memory care standards and improved staff competence (National Council of Certified Dementia Practitioners, n.d.-d). For many organizations, external recognition can also serve as a visible signal to families, referral partners, and internal teams that dementia care is a sustained priority.
Strengthen person-centered practice with Montessori-informed approaches
For organizations integrating strengths-based engagement and meaningful daily life into dementia care, NCCDP’s CMDCP credential focuses on applying Montessori methods in dementia care practice (National Council of Certified Dementia Practitioners, n.d.-e). This supports workforce skill-building that aligns with dignity, purpose, and person-centered care.
Conclusion
Workforce capacity and dementia-capable systems are inseparable. We cannot train our way out of a broken system, and we cannot system-design our way out of a workforce that is underprepared, unsupported, and rotating out. The path forward is integrated: invest in workforce development models that scale competency and retention, while building systems that make dementia-responsive, person- and family-centered care reliable across roles and settings. As dementia prevalence and caregiving demands grow, dementia capability must be treated as a core standard of care—not a specialty add-on.
References
Alzheimer’s Association. (2025). 2025 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 21(5). https://www.alz.org/getmedia/ef8f48f9-ad36-48ea-87f9-b74034635c1e/alzheimers-facts-and-figures.pdf
Alzheimer’s Association. (n.d.-a). Healthy Brain Initiative (HBI) Road Map. https://www.alz.org/professionals/public-health/models-frameworks/hbi-road-map
Centers for Disease Control and Prevention. (2024a, June 26). BOLD Infrastructure for Alzheimer’s Act. https://www.cdc.gov/aging-programs/php/bold/index.html
Centers for Disease Control and Prevention. (2024b, June 25). National Healthy Brain Initiative (HBI): State and local road map for public health. https://www.cdc.gov/aging-programs/php/nhbi/roadmap.html
Centers for Medicare & Medicaid Services. (2025, November 24). GUIDE (Guiding an Improved Dementia Experience) Model. https://www.cms.gov/priorities/innovation/innovation-models/guide
National Council of Certified Dementia Practitioners. (n.d.-b). National Council of Certified Dementia Practitioners. https://www.nccdp.org/
National Council of Certified Dementia Practitioners. (n.d.-c). Certified Alzheimer’s Disease and Dementia Care Trainer (CADDCT). https://www.nccdp.org/train/
National Council of Certified Dementia Practitioners. (n.d.-d). NCCDP’s Memory Care Excellence Network. https://www.nccdp.org/certifications/nccdps-memory-care-excellence-network/
National Council of Certified Dementia Practitioners. (n.d.-e). CMDCP Certified Montessori Dementia Care Professional. https://www.nccdp.org/cmdcp-certified-montessori-dementia-care-professional/
National Institute on Aging. (2024, December 19). HHS releases 2024 update to the National Plan to Address Alzheimer’s Disease. https://www.nia.nih.gov/news/hhs-releases-2024-update-national-plan-address-alzheimers-disease
PHI. (2024). Direct care workers in the United States: Key facts 2024. https://www.phinational.org/wp-content/uploads/2024/09/PHI_Key_Facts_Report_2024.pdf
Tilly, J., Wiener, J. M., & Gould, E. (2014). Dementia-capable states and communities: The basics. Administration for Community Living. https://acl.gov/sites/default/files/triage/bh-brief-dementia-capable-basics.pdf
