Aged care occupational therapy · Dementia
Dementia Care at Home
As an occupational therapist, I often see families trying to manage situations that used to be simple but are becoming increasingly difficult. Showering may turn into an argument. Getting dressed may take much longer. A walking aid that was previously used safely may suddenly become confusing.
With dementia, the answer is not always to keep asking the person to do something the same way.
Occupational therapy looks at what the person can do right now, what is making the activity difficult, and what can be changed around them. We may adapt the environment, simplify the task or change the way a carer gives instructions.
We cannot reverse the neurological changes caused by dementia, but we can often change the world around the person to make everyday activities easier to understand, safer and more manageable. That is the main idea we will explore in this article.
Cas Health Occupational Therapy
8-minute read
Let’s talk about dementia care, because while there is plenty of information about the condition itself, families can still be left wondering how to manage everyday life. If you’re caring for someone living with dementia, you may already know the daily pressure, the emotional strain and the uncertainty when something that worked yesterday becomes difficult today.
We’re going to look at some practical ways to make those daily situations more manageable. Through aged care occupational therapy, we can explore changes to the home, the activities a person does and the way support is provided.
Here’s our roadmap:
We’ll start with the challenges carers face, explain what occupational therapy involves, look at the Allen Cognitive Disabilities Model and its assessments, then explore how those findings translate into support at home.
1. The carer’s challenge: adjusting when things change
One of the hardest parts of caring for someone with dementia is that something that worked yesterday may not work today.
When a familiar routine suddenly becomes difficult, carers can easily start questioning themselves. Did I explain it badly? Did I step in too quickly? Should I have done something differently?
But adapting the approach is not a failure.
Dementia can affect how a person understands instructions, solves problems, remembers steps and responds to their surroundings. Their abilities may also vary from day to day. Holding tightly to the same routine can sometimes create more frustration for both the person and the carer.
Instead, we can start asking different questions.
Could the activity happen at another time? Could there be fewer distractions? Would demonstrating the task work better than explaining it? Could we break the activity into smaller steps?
Learning when to change the approach is an important part of supporting someone living with dementia.
2. What occupational therapy actually does
Occupational therapy is centred around the things people need and want to do in everyday life. For someone living with dementia, that might include getting dressed, showering, preparing food, moving safely around the home or continuing activities they enjoy.
An OT does not only look at the person’s diagnosis. We look at the relationship between:
the person, the activity, the environment and the support being provided.
For example, someone may still be physically capable of showering themselves but become stuck because they cannot remember what comes next.
Rather than immediately doing the whole task for them, we might explore whether one instruction at a time, a visual demonstration or a simpler bathroom setup helps them continue participating.
The goal is not necessarily to make the person perform an activity exactly as they once did. The goal is to find a way of doing it that matches their current abilities while preserving as much participation as possible. This reflects the problem-solving approach described throughout the transcript.
3. Understanding abilities through the Allen model
To know what needs to change, we first need to understand the person’s current functional abilities.
One framework some occupational therapists use is the Allen Cognitive Disabilities Model, developed by occupational therapist Claudia Allen. It helps clinicians understand functional cognition: how thinking abilities affect what someone can actually do during everyday activities.
Consider getting dressed.
A person needs to recognise their clothes, understand what they are for, follow a sequence, notice mistakes and work out what to do when something unexpected happens.
Someone may still have the physical strength to dress themselves while struggling with one or more of these cognitive steps.
Understanding where the difficulty occurs helps the OT decide whether to change the task, the environment or the amount and type of support being provided.
4. Why assessments may include unfamiliar activities
Some cognitive assessments used by occupational therapists can look unusual at first.
For example, the Allen Cognitive Level Screen uses leather-lacing tasks. A family member may understandably wonder what stitching leather has to do with showering, dressing or living safely at home.
The reason is that familiar activities can sometimes hide cognitive difficulties.
A person may complete a routine they have performed thousands of times because the activity is deeply familiar. Watching only that routine may therefore not show how they respond when they need to learn something new, remember instructions or solve an unfamiliar problem.
An unfamiliar activity gives the therapist another perspective.
An OT may combine this with more recognisable activities such as organising medications, handling money, preparing toast or completing other everyday tasks. These activities allow the therapist to observe things such as attention, sequencing, problem-solving and safety during performance.
The assessment score itself is not the end goal. What matters is understanding what that information means for everyday life.
5. Turning the findings into practical changes
Once we understand more about the person’s abilities, we can work with them and their carers to adjust everyday activities.
The aim is to find a level of involvement that feels manageable and meaningful. A task that is too demanding may cause frustration, while one that offers little interest may not hold the person’s attention. Their enjoyment and willingness to participate matter.
Here are a few examples of what that problem-solving can look like. These are starting points to discuss with an OT; the right approach depends on the person.
Practical adjustments to explore together
| Everyday difficulty | What an OT might explore |
|---|---|
| Following the steps of showering | Practise one instruction at a time, demonstrate an action and allow time for a response. |
| Finding familiar items | Keep everyday items in a consistent, visible place and reduce unnecessary clutter. |
| Moving around the home | Review lighting, clear routes and how equipment is used in the spaces the person actually moves through. |
Changes should be introduced thoughtfully, with attention to the familiar cues the person already uses. A complete rearrangement of a room may create new difficulties.
Equipment also needs to suit the person’s abilities. If a walking aid or shower chair is becoming difficult to use, the OT can review how it is being used and work with other clinicians where appropriate. A cognitive score alone should not determine whether equipment is suitable
What does the research say?
Research also suggests that occupational therapy provided in the home can support both people living with dementia and their family carers.
A 2019 review of 15 trials found that home-based OT may help improve everyday activities and quality of life and reduce some behavioural and psychological symptoms of dementia. Family carers also reported benefits including less distress related to behaviours, fewer hours spent providing assistance and improved quality of life.
6. Getting started and reviewing support
Occupational therapy for dementia should not be viewed as a single assessment followed by recommendations that remain unchanged forever.
Dementia is progressive.
A strategy that works well today may need to be adjusted later.
An OT might assess the person, work with the family on practical strategies and environmental changes, and then finish therapy when those goals have been addressed. That does not mean occupational therapy can never be used again.
A fall, hospital admission or noticeable change in everyday function may be a reason to review the person’s abilities and reconsider their environment, equipment or support strategies.
For carers, one of the simplest places to start is with one activity that has become difficult.
Instead of asking:
“Why can’t they do this anymore?”
try asking:
“What part of this activity has become difficult, and what could we change around them?”
It might be the environment.It might be the number of steps. It might be the equipment being used.
Or it might simply be the way the instruction is being given. That shift in thinking is really the central message of occupational therapy in dementia care.
A sudden change needs medical attention.
New confusion or a rapid change in alertness may indicate delirium or another acute illness. Seek urgent medical assessment rather than waiting for an OT review. If you suspect delirium, call 000 or go to an emergency department.
What is one change to the environment, the task or the way you offer support that you could explore with an OT? Start there, and give yourself room to learn as needs change.
Occupational therapy support in Melbourne
Cas Health provides mobile aged care occupational therapy in Melbourne, including home assessments, equipment recommendations, home modification advice and training for everyday tasks.
Explore support with Cas HealthSources & further reading
- American Occupational Therapy Association — Occupational therapy’s historical roots in meaningful work
- Occupational Therapy Australia and Dementia Australia — Occupational Therapy and Dementia: Joint Position Statement (March 2026)
- Allen Cognitive Group — History of the Cognitive Disabilities Model
- Allen Cognitive Group — Allen Cognitive Level Screen, Version 5
- Dementia Australia — Creating a dementia-friendly home
- Bennett et al. (2019) — Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis. BMJ Open, 9, e026308
- Wenborn et al. (2021) — Community Occupational Therapy for people with dementia and family carers: the VALID randomised controlled trial. PLOS Medicine, 18, e1003433
- Australian Government — Support at Home service list (24 September 2026)
- Australian Government — Services under Support at Home
- Healthdirect Australia — Delirium
