Cognitive Ramps – Seeing Dementia as a Disability, Not Just a Disease:
When someone uses a wheelchair, we don’t expect them to “overcome” stairs. We build a ramp.
Yet when someone lives with dementia, too often the burden is placed on the person to compensate for memory loss, confusion, or language difficulties.
What if we treated dementia the same way we treat other disabilities — by building cognitive ramps that provide access, dignity, and independence?
Shifting the Lens: Disease vs. Disability
The way we frame dementia shapes the way we respond to it.
Disease lens: We focus on symptoms, decline, and “managing behaviors.” The expectation is that the disease will worsen, and our role is damage control.
Disability lens: We focus on barriers and access. The expectation is that with the right supports, a person can still engage, contribute, and succeed.
This shift changes the question from “What’s wrong with the person?” to “What’s missing in their environment?”
What Do Cognitive Ramps Look Like?
Just as physical ramps open up access to buildings, cognitive ramps open up access to daily life. They don’t change the person — they change the environment around them.
- Environmental Cues
- Clear signage with both words and pictures.
- Memory boxes or personal markers outside doors.
- Contrasting colors to highlight toilets, plates, or pathways.
♦♦These are ramps for wayfinding and recognition.
- Communication Supports
- Short, concrete phrases.
- Gestures or visual prompts alongside words.
- Consistent tone and body language.
♦♦These are ramps for comprehension and expression.
- Meaningful Roles
- Folding laundry, watering plants, greeting visitors.
- Structured opportunities to contribute to community life.
♦♦These are ramps for purpose and identity.
- Predictable Routines
- Visual schedules or posted daily activities.
- Consistent rhythms that reduce anxiety and promote security.
♦♦These are ramps for confidence and stability.
Why This Matters in LTC
Seeing dementia through a disability lens does more than help residents — it also transforms staff and families.
For Residents: Independence lasts longer, dignity is preserved, and daily life feels purposeful.
For Staff: Stress decreases when the environment, not the resident, is seen as the barrier. Staff become facilitators instead of “behavior managers.”
For Families: Families can shift from grief to pride as they see their loved one thriving with the right supports.
Practical Questions for Leaders
For LTC managers and directors, the fall season is a natural checkpoint. Ask yourself:
- Where are the “stairs” in our environment that make life harder for residents?
- What simple ramps — visual, sensory, or structural — could we build to open up participation?
- How might our culture change if we stopped asking people with dementia to adjust, and instead adjusted the environment around them?
Dementia doesn’t erase personhood — but environments can. By reframing dementia as a disability and committing to build cognitive ramps, we move from managing decline to enabling living. Just as a physical ramp opens doors for someone with mobility challenges, a cognitive ramp opens dignity, choice, and purpose for someone living with memory loss.
