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The face of rehabilitation is changing. For decades, rehabilitation professionals could often expect a relatively straightforward clinical picture: a patient with a specific orthopedic injury, acute illness, or post-surgical condition requiring restoration of function. Today, that model is becoming increasingly rare.

Instead, therapists are treating individuals with multiple chronic conditions, extensive medication regimens, cognitive impairment, behavioral symptoms, frailty, and complex social needs. At the center of this growing complexity is one reality healthcare can no longer afford to ignore - the rapid rise of dementia.

An estimated 7.2 million Americans age 65 and older are living with Alzheimer's disease in 2025, representing approximately 1 in 9 older adults.

The implications for rehabilitation are profound.

• 41.1% of nursing home residents have Alzheimer's disease or another dementia diagnosis.
• 44.1% of residential care (assisted living) residents have Alzheimer's disease or another dementia diagnosis.
• 35.2% of inpatient rehabilitation facility patients have Alzheimer's disease or another dementia diagnosis.
• 34.8% of home health patients have Alzheimer's disease or another dementia diagnosis.
• 40.4% of hospice patients have Alzheimer's disease or another dementia diagnosis.

Therapists working in senior living, SNFs, home health, and post-acute care are already treating patients with dementia every day, whether dementia is the primary diagnosis or not.

The Traditional Rehabilitation Model Is No Longer Enough

Historically, rehabilitation has focused heavily on restoring physical function. While strength, balance, mobility, and activities of daily living remain essential outcomes, therapists increasingly encounter patients whose greatest barriers to recovery are cognitive rather than physical. Therapists must understand how cognition, behavior, communication, environmental factors, and caregiver support influence outcomes.

A patient who cannot remember safety precautions, follow multi-step instructions, or understand the purpose of therapy requires a fundamentally different approach than a cognitively intact patient.

Dementia Is Not a Barrier to Rehabilitation - But Traditional Methods Often Are

One of the most persistent and damaging myths in healthcare is the belief that individuals living with dementia cannot improve through rehabilitation. It is a misconception I am deeply driven to challenge and disprove.

Throughout my career, I have witnessed firsthand the remarkable progress people living with dementia can achieve when therapy is adapted to meet their unique needs. Research and clinical experience continue to demonstrate that individuals with dementia can improve strength, mobility, balance, functional independence, quality of life, and engagement in meaningful activities.

The issue is not whether people with dementia can improve, rather the issue is whether we are willing to evolve our approaches to maximize their potential. Success requires moving beyond traditional rehabilitation models and embracing dementia-capable care strategies that support learning, engagement, participation, and function despite cognitive impairment.

Therapists must move beyond approaches that rely heavily on:

• Complex verbal instruction
• Recall-based learning
• Written home exercise programs
• Abstract reasoning
• Repetitive cueing that assumes memory retention

Instead, dementia-capable rehabilitation emphasizes:

• Procedural learning and habit formation
• Meaningful, purpose-driven activities
• Consistent routines
• Environmental modifications
• Visual and tactile cueing
• Caregiver integration
• Relationship-centered care

The therapist's role shifts from simply restoring function to enabling success despite cognitive impairment.

The New Competency - Dementia-Capable Care

As dementia prevalence grows, dementia-capable care is becoming a core clinical competency rather than a specialty skill. Therapists who develop and utilize these skills become significantly more effective in today's healthcare environment:

• Communication Strategies: Understanding how to adapt language, pacing, cueing, and interactions to reduce frustration and maximize engagement.
• Behavioral Understanding: Recognizing that many behaviors are forms of communication rather than symptoms to be controlled.
• Environmental Design: Identifying barriers and supports within the physical environment that influence function and safety.
• Caregiver Coaching: Teaching families and staff how to support function, participation, and quality of life beyond therapy sessions.
• Person-Centered Practice: Understanding life history, preferences, routines, and meaningful occupations to create interventions that resonate with the individual.

As healthcare providers, therapists are uniquely positioned to identify a broader clinical perspective. The future rehabilitation clinician is not simply a mobility expert or an activities of daily living expert. They are a systems thinker capable of navigating the intersection of cognition, chronic disease, medication management, functional performance, and quality of life.

By: Loren Jouppi OTD, OTR/L
Director of Clinical Solutions & Consulting