Alzheimer’s Care: Building an Effective Organisational Structure Around the Person

By Mary Lourdes Bonnici

August Alzheimer’s Awareness Series 💜🧠

Throughout August, I am dedicating a special educational series to Alzheimer’s awareness, dementia care, organisational structure, leadership, communication and person-centred support.

Alzheimer’s disease does not affect only memory. Its effects can extend into communication, independence, relationships, decision-making and everyday life. Families and carers can also experience significant emotional, practical and social responsibilities.

For this reason, effective Alzheimer’s care cannot depend on one individual, one profession or one service. It requires a coordinated organisational structure that places the person living with dementia at its centre.

According to the World Health Organization (WHO, 2026), approximately 57 million people worldwide were living with dementia in 2021, with nearly 10 million new cases occurring each year. Alzheimer’s disease is the most common form of dementia and may account for approximately 60–70% of cases.

What Is Alzheimer’s Disease?

Alzheimer’s disease is a progressive brain disease and the most common cause of dementia. Dementia is an umbrella term describing conditions that affect cognitive functions such as memory, thinking and the ability to perform everyday activities.

It is important to distinguish dementia from normal ageing. Although dementia becomes more common with increasing age, it is not an inevitable consequence of ageing (WHO, 2026).

The experience of Alzheimer’s disease also differs between individuals. This is one reason why organisational systems should avoid treating every person according to an identical formula.

Effective support should recognise the person's:

• individual needs;

• abilities and strengths;

• preferences;

• personal history;

• relationships;

• cultural background;

• communication needs; and

• dignity and right to participate in decisions.

What Does “Organisational Structure” Mean in Alzheimer’s Care?

An organisational structure establishes who is responsible for what, how different roles interact, how information moves between services, and how decisions and care are coordinated.

Within dementia care, structure is particularly important because an individual may interact with multiple professionals and services over time.

NICE recommends that people living with dementia should have a single named health or social-care professional responsible for coordinating their care. Care planning should involve the individual, appropriate family members or carers, and relevant professionals (NICE, 2018).

Therefore, we can visualise effective Alzheimer’s support as a network rather than a simple hierarchy.

Diagram 1 – Person-Centred Alzheimer’s Care Structure

Ongoing Assessment • Communication • Review • Adaptation

The most important feature of this diagram is its starting point: the person.

The organisation exists around the individual—not the individual around the organisation.

1. The Person Living With Alzheimer’s

Person-centred care means recognising that a diagnosis does not remove someone's individuality.

People living with dementia should be encouraged and enabled to express their own views about their care. When necessary, communication can be adapted through approaches such as visual aids or simplified information (NICE, 2018).

This changes an important organisational question.

Instead of asking:

“What services do we provide?”

an effective organisation should also ask:

“What does this person need, value and want?”

That difference is fundamental.

2. The Care Coordinator

When several professionals and services are involved, fragmented communication can become a significant problem.

A named coordinator provides continuity.

NICE (2019) identifies coordinated care as an important quality standard for dementia services and recommends that a person living with dementia has a named practitioner responsible for coordinating their care.

The coordinator can help connect assessments, information, services, care plans and changing needs.

Visual Concept

Person → Coordinator → Right Service → Follow-up → Review

rather than:

Person → Service A → Service B → Service C → Confusion

Good coordination therefore reduces fragmentation and helps maintain continuity.

3. The Multidisciplinary Team

Alzheimer’s disease can create medical, psychological, functional and social needs. Consequently, effective support often requires expertise from different disciplines.

Depending on individual circumstances and the care system, this may include:

Doctors → Nurses → Psychologists → Occupational Therapists → Social Workers → Physiotherapists → Pharmacists → Dementia Specialists → Community Services

The objective is not simply to have many professionals involved.

The objective is to make them work together.

A multidisciplinary structure is strongest when responsibilities are clear, communication is effective and decisions remain centred on the individual.

4. Family Members and Carers

Families and informal carers are an essential part of the wider dementia-support system.

WHO highlights the substantial contribution of informal carers globally and the broader physical, psychological, social and economic effects of dementia (WHO, 2026).

However, supporting a person with Alzheimer’s can itself create considerable demands.

An effective organisational model therefore recognises two interconnected needs:

Person living with dementia

Care + dignity + independence + safety + participation

Family/carer

Information + education + emotional support + practical guidance + respite

Supporting carers is not separate from good dementia care. It contributes to the sustainability of the entire support system.

5. Leadership and Governance

Strong dementia services also require leadership.

Leadership establishes expectations for:

quality → dignity → safety → communication → accountability → learning → improvement

Leaders should encourage a culture in which the person living with dementia is respected as an individual rather than defined by a diagnosis.

Policies and procedures are important, but organisational culture determines how those policies are experienced in practice.

Compassion and structure therefore need to coexist.

Structure without compassion can become impersonal.

Compassion without coordination can become inconsistent.

Effective dementia care requires both.

6. Communication

Communication connects every part of the organisational structure.

Diagram 2 – Communication Cycle

Person Living With Dementia

↓

Family / Carer

↕

Care Coordinator

↕

Multidisciplinary Team

↕

Community and Support Services

↺ Information and Feedback Return to the Person

Communication should never become exclusively professional-to-professional.

Wherever possible and appropriate, the person living with dementia should remain involved.

7. Continuous Review

Alzheimer’s is progressive, which means needs can change.

A care structure that works today may require adaptation later.

Effective organisations therefore operate through a continuous cycle:

ASSESS → PLAN → COORDINATE → SUPPORT → MONITOR → REVIEW → ADAPT

This approach allows services to respond to changes in cognition, mobility, communication, behaviour, physical health, independence and family circumstances.

Care planning should therefore be viewed as a dynamic process, rather than a document created once and forgotten.

Why Organisational Structure Matters

A well-designed structure can help create:

clearer responsibilities

↓

better communication

↓

stronger coordination

↓

greater continuity

↓

more person-centred support

↓

better experiences for individuals and families

Organisational structure may sound like a management concept, but in dementia care its consequences are deeply human.

Behind every process is a person.

Behind every referral is a person.

Behind every care plan is a person.

And behind every diagnosis is an individual whose dignity and identity remain important.

Practical Example

Imagine an individual who has recently received an Alzheimer’s diagnosis.

A fragmented approach might require the person and family to contact different services independently, repeatedly explain their circumstances and attempt to understand who is responsible for each part of the care journey.

A coordinated model is different.

A named professional helps connect the individual with appropriate services. Information is provided clearly. The person's preferences are discussed. Family members or carers are appropriately involved. A care and support plan is developed and reviewed as circumstances change.

The difference is not necessarily the number of services available.

The difference is coordination.

Reflection Questions

1. Why should the person living with Alzheimer’s remain at the centre of the organisational structure?

My response:
I believe that a diagnosis should never become a person's identity. Every individual has a personal history, preferences, relationships, values and dignity. Services should therefore adapt around the individual wherever possible rather than expecting the individual to adapt entirely around organisational processes.

2. Why is communication important in Alzheimer’s care?

My response:
I believe communication creates continuity and understanding. When individuals, families, coordinators and professionals communicate effectively, information can be shared appropriately, responsibilities become clearer and changing needs can be recognised earlier.

3. What makes multidisciplinary working effective?

My response:
In my view, multidisciplinary working is not simply about bringing different professionals together. It requires clear responsibilities, mutual respect, appropriate information sharing, collaboration and a common purpose centred on the person.

4. Why should carers also receive support?

My response:
Carers may provide substantial emotional and practical support. Their own wellbeing matters, and providing information, education and appropriate assistance can help them continue their caring role while protecting their own quality of life.

5. What is the most important principle of an Alzheimer’s organisational structure?

My response:
For me, the most important principle is person-centred coordination. Systems, professionals and services should connect around the needs, dignity and voice of the person living with dementia.

Key Message

An effective Alzheimer’s organisational structure is not simply a hierarchy of professionals.

It is a connected network of people, knowledge, services, communication and compassion, organised around the person living with dementia.

When leadership is strong, responsibilities are clear, professionals collaborate, families are supported and the person's voice remains central, organisational structure becomes more than administration.

It becomes a framework for dignity.

💜 Awareness creates understanding. Understanding strengthens compassion. Compassion should guide the way we organise care.

Harvard-Style References

National Institute for Health and Care Excellence (NICE) (2018) Dementia: assessment, management and support for people living with dementia and their carers. NICE Guideline NG97. London: NICE.

National Institute for Health and Care Excellence (NICE) (2019) Dementia: Quality Standard QS184 – Quality Statement 4: Coordinating Care. London: NICE.

World Health Organization (WHO) (2026) Dementia. Geneva: World Health Organization.

World Health Organization (WHO) (2026) New WHO guidelines: up to 45% of dementia risk could be prevented or delayed. Geneva: World Health Organization.

Important links

World Health Organization – Dementia

NICE – Dementia Assessment, Management and Support

Alzheimer’s Disease International

© 2026 Mary Lourdes Bonnici, MBA. All Rights Reserved.

This article is the intellectual property of Mary Lourdes Bonnici, MBA. It is protected by copyright law. No part of this content may be reproduced, distributed, republished or transmitted in any form or by any means without prior written permission from the author.

This content is provided for educational and awareness purposes and should not be considered a substitute for professional medical advice, diagnosis or treatment.