Connected care: aligning the system to support people

Imagine waking up in a room that feels vaguely familiar yet impossibly strange. The walls are the right colour, but the pictures look wrong; the corridor outside echoes in ways your childhood home never did. A friendly-looking woman steps in carrying towels. You sense she wants to help you wash, but you can’t quite place her face or find the words to say you’re frightened. Your heart races; you lash out, you shout. You’re not trying to hurt anyone. You can’t make sense of what’s happening around you.

This could be happening in a residential care facility, or it could be happening in your own home with a support worker you’ve never met before covering a shift. The setting changes, but the human experience remains the same.

The friendly looking woman is Jenny. In residential care, she’s on her sixth double shift this fortnight. In home-based support, she’s rushing between clients because two colleagues couldn’t cover their visits. Whether she’s managing a medicine round in a facility or trying to provide personal care in an unfamiliar home, she knows rushing makes things worse. She remembers the incident report she needs to complete, the family member who’s concerned, the care plan that needs updating. She also remembers yesterday, when this same person swung out and caught her cheekbone. It still throbs. Jenny takes a breath and smiles anyway, but a small part of her body braces for impact.

Both people in this scene carry stress that did not start with them. It seeps from funding formulas that reward task completion over relationship-building, from service models that fragment care across multiple providers, from quality-assurance tools that measure compliance but not connection, and from homes never designed for changing needs or support systems stretched too thin.

Beyond single-fix solutions

When distress happens, we often zoom in on a single fix: write another care-plan strategy, schedule refresher training, maybe prescribe a new medicine. ABC charts are good practice for recording and planning new strategies, but these simple tools don’t hit the mark alone we need to take a broader perspective. These approaches, while well-intentioned, fail to acknowledge the intricate network of upstream factors that create the conditions for distress in the first place.

To transform dementia care, we must abandon the fiction that complex problems have simple solutions. The most meaningful innovation isn’t a new technology; it’s seeing the problem differently.

The systems factors

• Language and documentation

The stories we tell about dementia mate wareware in our documentation, our handover reports, our conversations with whānau become self-fulfilling prophecies. When incident reports describe a resident as “aggressive” or “non-compliant,” they construct a narrative that positions the person as a problem to be managed rather than a human being experiencing distress. Record that a resident was “angry” and you prime staff to expect danger; note that they were “upset” and you invite empathy.

This language choice ripples through the entire care system, shaping expectations, influencing interventions, and ultimately determining outcomes. When we consistently frame cognitive decline as a series of losses rather than acknowledging remaining strengths and capacities, we create environments that amplify decline rather than supporting resilience.

• Culture and risk

Culture is influenced by many things: the language we choose, the stories we repeat, and the attitudes we hold toward risk and human rights. When incident notes cast the resident as a danger and cue staff to tighten control, those language cues ripple outward, shaping how teams balance risk and how freely they honour choice. Embracing “dignity of risk” means supporting positive risk-taking that upholds human rights rather than defaulting to restrictive practices. Research completed at Auckland University shows that care culture is directly linked to reduction in antipsychotics.

Central to culture of care is safeguarding ensuring people feel safe to speak up about concerns, including potential elder abuse. When staff know their voice will be heard rather than silenced, the entire care environment becomes safer for everyone, and distress is reduced for both those receiving and providing care.

• Environmental design

A dementia-capable environment is not just tasteful colours and uncluttered hallways. In residential settings, good sight-lines reduce disorientation, familiar objects reaffirm identity and reduce fear, which reduces the likelihood that Jenny will need to dodge a swinging arm. In home-based support, it’s about understanding how the person’s own environment can be modified to support their changing needs—removing trip hazards, improving lighting, creating clear pathways, and maintaining familiar routines within their own space. Clear way-finding frees people to move independently, whether in a purpose-built facility or their own home, preserving dignity and reducing the need for restrictive supervision. Quiet spaces for de-escalation matter whether it’s a sensory nook in a care facility or a peaceful corner of someone’s own living room. Design that allows easy access to gardens, or technology that enables independence at home, directly reduces distress, frustration, and dependency.

• Staff wellbeing and emotional contagion

Staff wellbeing is not just about employee satisfaction it directly impacts resident experience through emotional contagion. People with dementia often pick up on emotions more acutely than we might expect, as their emotional responses can be heightened even when cognitive abilities decline. When staff are not feeling supported, are tired, or are carrying stress, residents sense this emotional state and respond accordingly. Jenny’s exhaustion and apprehension about being hurt doesn’t just affect her it creates an atmosphere that the resident feels and may react to with increased distress.

• Decision-making frameworks

How deeply supported-decision-making frameworks are embedded in daily routines matters profoundly. This might mean involving someone in choosing their clothing, timing of breakfast, or when to shower seemingly small choices that preserve autonomy and reduce distress While substitute decision making sometimes plays a role these decisions need to be made considering what the person would want if they were able to make the decision themselves. When residents participate in choices about their routines, even in small ways, they feel control, and distress declines.

Interested in learning more?

Join us at our upcoming Summit to explore these systems approaches in depth with fellow leaders and practitioners.

We’ll explores other system factors in part two of this blog.