One Size Doesn't Fit All - Why People Living with Dementia Need Choices

For many people living in the early stages of dementia, everyday freedoms shrink quickly. Going for a walk, doing familiar hobbies, or moving safely around the community can suddenly feel risky or daunting. Families step in to protect, routines narrow, and people who were once active and independent can feel their world becoming very small.

Inside though, the desire for purpose, contribution, and dignity remain strong.

In Aotearoa New Zealand, people with mild cognitive impairment or early dementia are usually offered just one funded support option: the traditional adult day activity programme. These services provide vital respite for carers and offer social connection, activities, exercise, and lunch. In some cases, they include community visits. These programmes work well for many.

However, no single model can meet the diverse needs of everyone living with dementia, yet it's currently the only publicly supported option.

Why Choice Matters

Research and lived experience tell us that people with dementia need three things to maintain wellbeing:

• Autonomy - the ability to make choices and shape the day

• Reciprocity - opportunities to give and contribute, not just receive care

• Dignity and identity - space to express who they are

People living with dementia often experience boredom and frustration. Motivation disappears and people may experience emotional distress, anxiety or depression. There may also be a loss of confidence and control. Some of these may be brought about by changes in the brain, but we know that the environment around the person plays a significant role too. For instance, these feelings may arise when choice is limited and individual needs aren't met.

Simply put: a one-size-fits-all system undervalues the person and limits their potential.

Other options

That's where Home4All comes in. At Home4All we offer something different than the traditional adult day activity programme, a more "tailored-to-you" style service. Our visitors get choice in their day, and freedom to do the things they did prior to their diagnosis.

While this level of activity and freedom may not suit everyone, that's kind of the point. One size doesn't fit all, and Home4All provides another option.

Sources

Research consistently shows that people living with dementia need three things to maintain wellbeing:

• Autonomy - being able to make choices and shape their day (Wolfe et al., 2021; Stumpf et al., 2025).

• Reciprocity - opportunities to contribute and participate, grounded in relational personhood and dignity frameworks (SerbserKoal et al., 2024; Denier & Gastmans, 2022).

• Dignity and identity - being recognised as a whole person with capabilities and rights, a core ethical requirement in dementia care (Denier & Gastmans, 2022; Lev et al., 2025).