Home Sweet Home: Home as Medicine for Dementia and Memory Loss (Cutting Agitation Risk 30%)- Why and How it Works

Imagine a loved one with dementia suddenly calm and smiling because they’re sitting in their favorite armchair, surrounded by the same photos and knick-knacks they’ve known for decades. Studies suggest that this isn’t just wishful thinking, but rather a form of medicine. Familiar environments, combined with person-centered care,  attributes of a home-like environment for people suffering from dementia, reduce agitation, the restless, anxious, or aggressive behaviors that plague up to 80% of dementia patients,  by 20% to 30% compared to moving to a nursing home or assisted living facility. For families determined to age in place, this isn’t just good news; it’s a roadmap. This article breaks down the studies, using one as an example, in plain language, explains exactly how “home” works its magic on the brain, and teaches how you can use family caregiving, professional home health aides, and/or simple planning tools to create a dementia-friendly sanctuary that keeps you or a your loved one safe, calm, and at home.What Researchers Have Found
Does where and how you live affect how agitated you get when you have dementia? Rigorously conducted studies, the gold standard type with control groups and measurable data, compared people with dementia living in facilities that mimicked home care, i.e., providing person-centered care with an emphasis on familiarity of surroundings, music, and communication, with those in nursing homes or assisted living that did not. They have consistently found that people living in residential-like homes had 20% to 30% lower agitation than those in traditional facilities.  That’s the difference between someone pacing a few times a day versus every hour.
One study concluded that "[a]gitation in long‐term care residents with dementia was associated with numerically higher medication use and an increased likelihood of experiencing falls, fractures, infections, and additional [neurological symptoms] compared to residents without agitation, highlighting the unmet need for effective management of agitation symptoms in this population."  Homes that fail to effectively manage the conditions of dementia or memory loss worsen symptoms and , increase agitation, making medication necessary and unavoidable. The result? Worse health outcomes and a lower quality of life.  These studies explain why so many residents describe their institutional care as a "fate worse than death" (see our article, "Fate Worse Than Death”: Long-Term Care’s Independence Crisis: Aging-in-Place Planning Offers Solutions). 
Why Home Works: The Science in Everyday Language
Dementia damages the brain’s ability to process new information, but it often leaves long-term memory, the memories of a lifetime, relatively intact. Memory loss is often a function of a person's inability to retrieve or access these memories.  A nursing home is a blizzard of new faces, new smells, new routines. Every hallway looks the same, every meal is served at a stranger’s table. That sensory overload triggers the brain’s alarm system, flooding it with stress hormones like cortisol, which fuel agitation.  Remember that agitation leads to medication and increased risk of falls, fractures, infections, and other physical and psychological harms. 
Home is the opposite. It’s a memory anchor:

• The creaky third stair reminds Dad of building the treehouse with the kids.
• The faded floral wallpaper in the kitchen sparks a smile because Mom picked it out in 1982.
• The same coffee mug every morning tells the brain, “I know this place. I’m safe.”

This is called environmental familiarity. It reduces cortisol, calms the fight-or-flight response, and undeniably lowers agitation by giving the brain fewer “threats” to process. Think of it like a security blanket for the mind. 
Institutions actually consider environmental familiarity in designing a dementia care environment.  It is no secret, among institutional caregivers, that "creating a familiar environment is crucial for the well-being of individuals with dementia and memory impairment. A familiar institutional setting can be achieved by incorporating elements that stimulate multiple senses, such as sight, sound, touch, taste, and smell, making the environment feel more like home." But you already know, "there's no place like home."  
Familiarity alone isn’t enough, though. The true magic happens when ritual and consistency transform a familiar space into a predictable sanctuary, providing the brain with a roadmap it can still follow even as memory fades. This duo is the secret sauce of successful home-based care, transforming chaos into calm and keeping you or your loved one safe, grounded, and at home. 
Rituals are repeated, meaningful sequences of actions tied to a specific time, place,  cue, or event, performed the same way every time. Consistency refers to the predictable structure of people, places, routines, and responses that persist across days, weeks, and caregivers.  Ritual provides emotional comfort and purpose; the brain recognizes the pattern, reducing anxiety even when new memories can’t form and old memories are "lost."  Consistency builds trust and safety; the brain learns "what comes next," lowering stress and increasing a sense of comfort and safety. 
Rituals and consistency deployed in a familiar environment work as "medicine" for dementia by replacing lost declarative memory with procedural memory. If agitation is a symptom of a deficiency, procedural memory is the supplement that treats that deficiency.  Declarative memory is what you think it is: the conscious, intentional recollection of factual information, previous experiences, and concepts.  Declarative memory is impaired by dementia and other forms of memory loss.  
Procedural memory, on the other hand, is the "muscle memory of habits;" it allows people to perform specific tasks without conscious awareness of these previous experiences.  For example, one remembers how to tie one's shoes, brush one's teeth, or drink from a cup without consciously thinking about those activities.
Procedural memory has some interesting attributes.  First, it is "ancient" in every person; it is the very first form of memory we have and develop as infants, since it doesn't rely on intentional recollection or conscious effort. Second, it is resilient and durable, persisting long after declarative memory fades in conditions such as dementia.  Studies demonstrate this:

• Biologically:  Memories such as sucking and grasping, how to drink and eat, are hardwired in the basal ganglia and cerebellum, brain areas that evolve early and resist damage longer than the hippocampus, which is the hub of declarative memory.

• Practically: Procedural memory can be developed and improved even when declarative memory is significantly impaired!  Experiments with two different groups (patients suffering from amnesia and those with severe long-term memory loss) demonstrate that patients can learn and develop new procedural memories, even though they don't remember having been exposed to or even seen the circumstances creating these new memories.  Moreover, they utilize and rely upon these subconsciously.  In other words, "old dogs can learn new tricks," at least those tricks that are most important in creating a familiar and comfortable environment. 

The old saying "You never forget how to ride a bike" isn't just a cliché; it's a window into how the brain holds onto procedural memory long after facts and names fade, after you've forgotten where you learned to ride or when, or that you ever learned to ride at all. In dementia, this "muscle memory" for learned skills can outlast declarative memory (i.e., knowledge of who, what, and where) by years, providing caregivers with a powerful tool to reduce agitation and preserve dignity at home.
 What This Means for Families Choosing Home Care
If you’re committed to helping a parent or spouse with dementia stay home, these insights hand you a powerful playbook.
Assess and Identify Routines: If you are a planning senior, track these and record them in an advance directive instructing your caregivers to keep and maintain your routines.  If you are a caregiver or loved one, follow the senior's clues, questions, and inclinations.  Don't presume that simple actions, such as "going to the window," are random or without purpose. Identify and record them, creating a task list and daily calendar to follow.    

Maintain Consistency in the Environment: Focus on familiarity and routine, even as you adjust the home to create a safer environment and meet changing needs.

• Don’t redecorate or unnecessarily move furniture, pictures, or devices.
• Label drawers and cabinets with photos of what’s inside.
• Play the same soft music or TV shows from their past.
• Odors matter!  What may smell "old" or "tired"  might harbor comfort and safety.
• Avoid disturbing odors/sounds. Bleach, for example, sometimes harbors bad memories.  

Maintain and Support a Consistent Routine:  As much as possible, identify their routine on a daily and weekly basis, and facilitate and maintain their existing routine.

• Schedule meals and bedtime to occur within a consistent timeframe, if not at a specific time, of course, considering whether they are accustomed to rigidity;
• Identify habits or preferences, such as watching TV, movies, or listening to music, and facilitate these routines.
• Don't overlook the subtle routines that often make up a day, such as watching for the mail, overseeing kids getting on/off buses, watching birds and squirrels at a feeder, for example.  These subtle routines may help foster a sense of safety and comfort, as well as support a familiar daily routine.  
• Find suitable alternatives for routines or sub-routines that are sacrificed for safety, convenience, or control.  For example, if mom is no longer permitted to take laundry downstairs to a basement washer, continue to encourage her help gathering the laundry, even if that task is reduced to general "oversight" and related discussions.  If Dad formerly walked to the mailbox, replace the walk down the lane with something suitable, but relating it to the mail, perhaps PT or OT reinforcement in a chair, after which the mail is handed to him.  A mom accustomed to cooking can visit in the kitchen with the preparer, discussing recipes and ingredients, perhaps helping determine how, why, and when to do things, such as how long to stir or how much spice to add.  Don't forget to keep familiar foods if possible, and the value of taste-testing, if that was a routine. 
• Support the routine and overall well-being by "celebrating" when routines are abandoned or missed for reasons other than adverse health events; a missed event must mean that 'we' were too busy doing other things, a sign of recuperation, recovery, health, or well-being. These help prevent malaise and despondence. 
• Avoid "blame" or "responsibility." This should be obvious, but it's hard to remember and incorporate into caregiving when dealing with frustration and disappointment.  If you were losing your memory, would you want someone constantly reminding you that you are losing your memory and that it's getting worse?  Support everyday decision-making and choices as part of the routine, even when they differ from the previously established routine and choices.  In other words, it's always "win-win."
• Avoid painful memories or events.  Learn to acknowledge, deflect, and move on when necessary.  An example is a mother who has forgotten that her husband has died.  Brutal honesty may relegate a loved one to repeatedly reliving the grief of learning their spouse's death.  Acknowledge the question with a deflection that doesn't acknowledge the death, and assure them that you're sure they will be by "soon" as you change the subject; perhaps a more appropriate response.  Discuss possible strategies with professionals if you feel unsure or are stumped by a situation.      

• Rely on Family as the First Line of Care: Family and close friends help impose familiarity and stability on what is already a changing reality for the person suffering from dementia.  
   

• A familiar voice saying “It’s time for your pills, Mom” is less agitating than a new aide every shift.
• Family can spot early signs of distress and redirect with a favorite activity.
• Emphasize favorite activities, whether that is old Westerns on TV, watching the birds, or feeding a pet.
• Deploy a Care Coordination app to help identify and share routines that are successful as well as those that are disruptive. 

• Use Professional Home Health Aides Strategically: Incorporate consistency and routine in the use of aids and professional caregivers. 
    

• Try to hire the same aide for the same shifts; consistency is key.

• Train aides on the person’s life story, favorite phrases, and routines.

• Use the extra calm to stretch aide hours further, saving money.

• Deploy technology. In the modern age, technology is a game-changer.  First, encouraging seniors to use technology actually supports cognitive health and reduces cognitive decline.  Second, technology empowers an aging senior and their family to age in place comfortably, capably, and safely, and proper utilization might preserve assets and avoid significant additional cost. The following is a brief list of key technologies, drawing on emerging trends such as AI and smart home integrations, to support daily living while minimizing risks.

• Security Systems for Real-Time Monitoring: Smart security systems (e.g., ADT, Vivint), deploying video doorbells (e.g., Ring) or indoor cameras with motion sensors, allow family members to monitor a home remotely through phone or computer apps. These provide peace of mind by alerting siblings to unusual activity, like unexpected visitors or wandering at night, a common concern in dementia cases. Benefits include deterring intruders and enabling quick responses to emergencies. When investigating, look for systems that offer two-way audio for communication and end-to-end encryption to protect your privacy. Deployment tip: Install with professional help to avoid overwhelming your parents, and tie alerts to a shared family app for coordinated monitoring.

• Medication Dispensing Machines: Automated pill dispensers, like those from Hero or MedMinder, organize medications, dispense doses at scheduled times, and send app notifications if a dose is missed. They track usage to prevent overdoses or over-utilization, which is crucial for parents managing multiple prescriptions. These devices can integrate with health apps to log adherence, reducing the burden on caregivers. Research models with tamper-proof locks and refill reminders. For deployment, synchronize with the wishes of the healthcare and general durable powers of attorney to designate who receives alerts.

• Passive vs. Active Fall Detection: Falls are a leading cause of injury among older adults.  Fall detection and prevention tech is essential. Active fall detection requires user action, such as pressing a button on a wearable pendant (e.g., traditional medical alert systems like Life Alert). It is suitable for alert individuals who can self-activate. In contrast, passive fall detection utilizes sensors, often found in smartwatches (e.g., Apple Watch), security systems, or home devices equipped with AI, to automatically detect falls via changes in motion or impacts, alerting emergency contacts without user input.  Passive systems are ideal for those with cognitive impairments, as they don't rely on memory or manual effort. Investigate accuracy rates and battery life by testing in real-world scenarios and linking them to a family response plan outlined in advance directives.

• Health Monitoring Devices: Wearable tech like Fitbit or Oura rings tracks vital signs like heart rate, blood pressure, sleep patterns, and activity levels, flagging anomalies via apps.  For broader monitoring, smart scales or blood glucose monitors integrate with telehealth platforms for remote doctor consultations. These tools support proactive care, aligning with  Advance Directives for Dementia by enabling early intervention. When researching, prioritize FDA-approved devices with data-sharing features.  For deployment, ensure data privacy complies with HIPAA and involve family in reviewing trends to avoid disputes.

• Smart Home Devices: Voice assistants like Amazon Alexa or Google Home control lighting, thermostats, and appliances hands-free, reducing physical strain and enhancing safety (e.g., automated lights to prevent trips). AI-powered companions, such as ElliQ robots, provide reminders, companionship, and even mood tracking for individuals with dementia.

• GPS Trackers and Wander Management: Devices like AngelSense provide location alerts for parents prone to wandering, with geofencing to notify if they leave a safe zone.  Our family uses Life360, a smartphone application, so we can locate each other.  We receive alerts when a a family member arrives or leaves home, work, the supermarket, and/or the doctor's office.  It alleviates burdens (no texting whether someone is home, "on the way," or arrived safely to their destination) and offers peace of mind through automatic notifications of falls, automobile collisions, and ER visits. 

• Telehealth and Virtual Care: Platforms like Teladoc enable video visits, integrating with health monitors for seamless care without travel.

• Hearing, Visual, and Cognitive Aids: Advance hearing aids with Bluetooth connectivity or brain fitness apps (e.g., via Lumosity) address sensory losses, with AI adapting to user needs.  Meta AI glasses are being utilized to assist those with vision and hearing impairments (most recent update offers speech transcription so you can "read" what people are saying to you, in real time). 

• Social Connection Tech: Video call setups or apps like GrandPad combat isolation, fostering family ties as per aging in place wishes in trusts.

By investigating these technologies, starting with a family tech audit, and deploying them thoughtfully, care can align with advance directives and needs while easing each family member's responsibilities. Remember, tech should complement and facilitate daily rituals, and aid in consistency through reminders.  

• Plan Ahead with Legal Tools: The best practice is to design and draft a robust and comprehensive estate plan before cognitive decline commences, and if not, as soon as possible thereafter.  

• A supported decision-making directive lets you or a loved one name trusted family to help with choices, and provides essential direction, avoiding conflict and preventing guardianship disputes.

• Advanced directives not only make choices, they remind everyone of decisions made in periods of calm reflection.  These can also be used to support past decisions when a senior 'forgets' the plan. 

• A revocable living trust can fund home modifications (grab bars, motion lights) or pay family caregivers tax-free, ease management of assets with consistent ownership and direction, and the best trusts contain advance directives regarding home health care, aging in place, and guardianship.

• A private care agreement formalizes family responsibilities so everyone’s on the same page, and permits lawful compensation for some duties and responsibilities, preventing State Medicaid resource recovery '"clawback" by deeming transfers improper.

The Bottom Line: Home Isn’t Just Cheaper — It’s Therapeutic
It should come as no surprise that many of the studies discussing care options for dementia were concerned with the cost of care.  Home care is not just less expensive; reducing agitation translates to real-life positive health outcomes:

• Fewer emergency room visits for injuries or outbursts.
• Less need for sedating medications that increase fall and accident risk, and create confusion.
• Fewer hospitalizations, falls, fractures, and infections. 
• More good days; those invaluable moments of recognition, laughter, and connection.

For every family weighing the cost of home care versus a facility, this research says: The familiar four walls of home are powerful medicine. With the right planning, you can make them the safest, calmest place on earth.

While this article has provided an overview of the study and its implications for aging in place, it is by no means comprehensive. The science of dementia care is evolving rapidly. Readers must remain vigilant and consult their physician and health care experts.  Contact an attorney in advance to tailor a plan to your unique situation, and follow instructions and guidance regarding implementation to ensure robust protection. Your loved one’s peace of mind, and your own,  is worth the effort.  

Primary Source: 

• H. Fillit, et al., Impact of agitation in long‐term care residents with dementia in the United States,  International  Journal of Geriatric Psychiatry (Aug. 2021). 
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