October 6, 2026
The Evolution of Memory Care
By Joanne Kaldy
Everything changes over time, and memory care is no exception. Today’s memory care units, programs, and philosophies show signs of evolution, fresh thinking, and innovative ideas, but more change is needed and likely to come in the years ahead.
Until about 50 years ago, people with dementia who could no longer live independently were frequently sent to nursing homes. However, as more organizations and practitioners embraced person-centered care and needs for dementia care grew, specialized units—often labeled as memory care—began to pop up. Over time, it became a popular care model for those living with varying levels of cognitive change.
The demand for memory care has grown and will continue to rise, as over 6.5 million Americans now live with dementia, and this number is expected to increase to 8.2 million by 2030. Currently, there are nearly 6,000 properties across the United States that offer memory care services, 76% of which involve combined properties (such as assisted living and memory care) and 13% freestanding memory care facilities.1
Move to Greater Understanding, Personalization
While Alzheimer’s disease, dementia, or cognitive change continue to cause challenges and concerns, there have been some important innovations in memory care over the years. There has been more research on the causes of dementia and how to prevent or at least delay the onset. “People are seeing that there are things they can do to slow the progression if they get a diagnosis,” says Maley Hunt, MHA, LNHA, chief operating officer and administrator at LiveWell.
Part of this is understanding that keeping people active with meaningless activities is not enough. “The beautiful thing is we’ve seen a move from keeping people busy to understanding what is meaningful for them, what matters to them, and what gives them joy and a sense of purpose,” says Denise Boudreau, founder and president of Drive. She stresses that while technology has done much to support family connections, personalized content, and documenting someone’s history and preferences, this cannot replace human relationships and interactions.
Increasingly, Ms. Hunt suggests, this means seeking ways to respect and embrace residents’ preferences and wishes. “I think getting to ‘yes’ on so many things is easier than we think. Part of this is understanding and acknowledging perceived barriers versus real ones.” She notes that more programs are utilizing connections in the community at-large. “There are so many people who want to contribute. For instance, engaging volunteers in different ways and even getting residents to contribute to the community helps expand teams and build purpose.”
Giving Residents a Voice
One significant memory care trend is the involvement of people living with cognitive change in solutions and innovation. “We are seeing more places involving the voice of people living with dementia,” says Ms. Hunt. “When you include people in that narrative of what living with dementia looks like for them, they're more likely to come forward and say, ‘I am experiencing cognitive change, and I'm doing something about it. I'm still here.’” When people living with cognitive change are engaged to share their stories, their insights are illuminating.
This is a significant development. As Philip Sloane, MD, MPH, professor of family medicine and geriatrics and co-director of the Program on Aging, Chronic Illness, and Long-Term Care, University of North Carolina at Chapel Hill, says, “Back in the 1990s, Tom Kitwood, a psychologist and former minister who began working in nursing homes, saw that individuals living with dementia weren't being treated as people.” They were labeled by their behaviors, and Kitwood’s insights really turned around how people think about individuals living with dementia. “It was really the start of the person-centered movement,” Dr. Sloane says.
Seeing the individual as who they were as a person took hold and expanded over time. In addition, talking about dementia has gone from taboo to commonplace. As Dr. Sloane says, “Increasingly, it’s part of the general conversation—there are books and movies about it. There was a time when no one wanted to talk about dementia. Now people want to have it diagnosed early. They actually come to the doctor to ask about their memory and request cognitive testing. This has been a very real and positive change.” He adds, “People are beginning to understand there are some ways to slow the course of dementia, and these often include lifestyle changes rather than medications.”
No Place Like Home
Instead of locking doors, there is a growing movement toward—and need for—helping people feel better about their surroundings and more at home where they are. Ms. Boudreau says, “We have gone from managing things like safety to prioritizing choice and preferences and considering the whole person. This is a dramatic change, but staff need time and training to be able to make this shift.”
She adds, “You can’t just unlock the door and say, ‘We have memory care.’ It’s more than enabling people to move around safely. It is about making settings and relationships a lot more natural.” This includes efforts such as on-site child day care programs, working gardens, and parks, creating environments that are “normal and natural. Ms. Boudreau stresses, “You need a culture of innovation that supports all this. If you have a risk-adverse team, they will be resistant.”
While there has been progress, concerns about safety often overshadow desires for autonomy and choice. Allen Power, MD, Schlegel chair on aging and innovation at the Schlegel-UW (University of Waterloo) Research Institute for Aging,2 says, “In reality, locked doors are a primary source of distress for people living with dementia.” He explains that a locked door is a sign of a system that hasn’t transformed enough to be flexible for individual care. “One size does not fit all. In fact, it’s the opposite of person-centered care,” Dr. Power says. In reality, he observes, “Exiting a door to go somewhere else is normal behavior; it’s something we all do on a daily basis.”
Well-planned design creates spaces where residents feel they are home. Darren Azdell, AIA, NCARB, LEED AP, principal architect at Pi Architects, says, “When designing for memory care, there is a focus on creating a more home-like, friendly environment. This makes the residents feel more at ease.” He adds, “A recent trend is using decals/wraps on unit doors that resemble the front doors of the homes they came from.” Another design element that increases feelings of home and comfort, he says, involves more seemingly natural access to exterior spaces, either visually or physically. Additionally, integration of circadian lighting that mimics a 24-hour day is becoming standard to support better sleep patterns and reduce agitation.
What’s in a Name?
Despite so many advances in dementia care and an understanding of Alzheimer’s disease and other cognitive changes, some stigmas still linger. When people hear the words “Alzheimer’s” or “dementia,” they often think the worst.
At first, some programs were called “dementia care” or “Alzheimer’s” units, but these came with a negative connotation. Memory care seemed less negative, and “the name just stuck,” says Dr. Sloane. Ms. Hunt comments, “We don't actually call anything on our campus memory care. When we use the term memory care, we're often calling out how somebody's deficits could be related to cognitive change in dementia, as opposed to coming from a strength-based lens of seeing how we can support someone as their brain is changing.” She further notes, “What we do on our campus for residential living would be defined as memory care by outsiders, but we take a brain-healthy approach to supporting people.”
The language of dementia care has changed in other ways. For instance, Dr. Sloane says, “We used to refer to ‘disruptive behaviors.’ But then we realized that what had been called ‘disruption’ was often the individual’s way of communicating. Then, they started calling them ‘behavioral symptoms of dementia.’ But that really wasn’t appropriate either, so now the official term is ‘behavioral expressions,’ which I love because that is what they are doing—expressing a feeling or a need.” He adds, “These expressions are only disruptive if you don’t understand that they’re trying to communicate.”
The Power of Strength-Based Approaches
One important trend is challenging communities, team members, and others to use strengths-based approaches. Ms. Hunt explains, “The strength-based approach involves seeing what people can do, empowering them to do for themselves as opposed to having others do things for them.” This is becoming more widespread, and more communities are adopting it.
Ms. Boudreau adds, “It’s important to have an awareness that this diagnosis doesn’t change someone as a person.” While a person might have limitations that grow as their dementia advances, there are still things they can and want to do. For instance, the woman who always loved to cook may not be able to make a full meal; but she can still help stir ingredients in a bowl or frost a cake. If they are treated with respect and empowered to be engaged, Ms. Boudreau suggests, they are more likely to believe in themselves.
Promising Models
There are some promising models for memory care, most of which prioritize inclusion, personalization, and engagement, as well as meeting residents where they are, focusing on their abilities instead of their deficits, and balancing measured risk with safety.
Ms. Boudreau says, “We are seeing models that create normalcy and connections, smaller household models, and integrated environments that allow people to move and engage freely.” She notes that while enabling measured risk is a viable and growing priority, “our whole system isn’t set up to support this.”
Ms. Hunt notes, “We have the first brain health and dementia prevention clinic in the United States in a partnership with Yale University. We are trying to create a destination where people who are early in their disease process can say, ‘This is how I want to live, and this is where I choose to be.’ Then they are able to age in place on the campus.”
Additionally, Livewell has created a Resilient Living Center for people with cognitive change and those concerned about their brain health. It hosts classes, clinics, and other activities and features a café, restaurant, art and performing arts spaces, and fitness studios. Ms. Hunt says, “People can come and experience a risk assessment with a nurse coach. They can learn about the modifiable risk factors and see those modalities in practice. Once people get diagnosed with neurocognitive dysfunction, they can get information on what to do next.”
Time for Integration
One challenge that remains is integrating people living with dementia with others. “There is still a stigma associated with dementia, and this impacts how others interact with and engage people living with cognitive impairment,” says Ms. Boudreau.
Part of the issue is that people without dementia don’t want to be reminded that this diagnosis could possibly be in their own future. As Dr. Power notes, “Sometimes the greatest stigma comes from other older people, and that comes from fear. As a result, they resist engaging with people they should be supporting.” He adds that it is more difficult to integrate residents where segregation already exists.
Dr. Sloane adds, “Segregating people reinforces stereotypes and negative attitudes about dementia.” However, he notes that attitudes are modifiable, and tools like the Dementia Attitude Scale, designed to measure attitudes toward people living with dementia, can help identify residents’—and others’—feelings about and behaviors toward those who have dementia or other cognitive issues, and that these attitudes can be changed with support and education.
What’s Next?
While memory care has evolved considerably, there are still goals to reach and challenges ahead. Ms. Hunt observes, “There is a difference between accepting and truly empowering people of all abilities. How are we treating brain health as an inclusive factor as opposed to using dementia as a segregator?”
“My hope is less about memory care and more about creating communities where people are living well with cognitive impairment—places where there is more integration, more freedom, more personalized environments, and greater engagements,” says Ms. Boudreau.
Joanne Kaldy is a freelance writer living in New Orleans, LA.
References
1. Shah K. Memory care: an analysis of the sector’s standing and dynamics. National Investment Center. July 20, 2026. https://www.nic.org/blog/memory-care-an-analysis-of-the-sectors-standing-and-dynamics/.
2. Schlegel-UW Research Institute for Aging. World Alzheimer’s Month. https://the-ria.ca/