Walk into most aged care homes across Australia and you’ll find something familiar—perhaps a group of residents gathered for bingo, music performance, or an afternoon tea in front of a favourite DVD. These social activities are often the heart of daily life in aged care, especially for those living with moderate to advanced dementia.

And while these moments of joy and connection are meaningful, here’s the problem: they’ve become the main offering, rather than one part of a broader approach to supporting health, independence, and dignity.

We’re keeping people occupied, but not always helping them stay mobile, engaged, or as independent as they could be. And it’s not because we don’t care—it’s because the system is stuck in an outdated model that over-relies on social engagement and under-delivers on rehabilitation.

We Need More Than Social Activities

Let’s be clear: social activities are important. They help reduce loneliness, boost mood, and create a sense of community. But they’re not a substitute for physical or cognitive therapy—and the research makes that very clear.

In fact, when structured physical and cognitive therapies are introduced—even in later stages of dementia—they lead to:

• Improved mobility and balance
• Slower functional decline
• Better quality of life
• More meaningful participation in everyday life

In a major study comparing exercise plus social activity verses social activity alone, the authors found that it was the combined approach that yielded the greatest improvements in the individual participants daily function (Roschel et al., 2015). That’s a powerful finding—and one that should make us all stop and ask: why isn’t this the standard in aged care homes currently? And whilst I can hear you saying, we have exercise groups for our dementia residents. I would challenge you to evaluate, how many of these actually involve exercise that meet evidence-based recommendations for intensity, frequency and type required to make a real impact on daily function or falls risk.

But Can Rehabilitation Really Work in Later-Stage Dementia?

There’s a common myth that once someone has moderate to severe dementia, rehab “won’t do much.” But that’s simply not true.

Here’s what the evidence tells us:

• People with dementia benefit from exercise programs that are tailored to their abilities. These programs can improve strength, walking ability, and even mood.
• Even those with more advanced dementia have shown gains in mobility and endurance when given simple, familiar movement routines like walking or functional stretching (Tappen et al., 2000).
• Cognitive rehabilitation, which focuses on helping people maintain function in daily life, has shown that people can set and achieve personal goals—even in moderate stages of dementia.
• Programs like Cognitive Stimulation Therapy (CST)—which involve structured group sessions—have been shown to improve thinking skills and reduce symptoms of depression.

So why aren’t more aged care facilities running these kinds of programs regularly?

What Could a Rehab-Focused Program Actually Look Like?

The good news? We don’t need to reinvent the wheel—we just need to rethink the balance. Here’s how a more rehabilitation-focused approach could look in practice, right inside a residential aged care home:

Functional Exercise, Not Just Walking Rounds

Twice or three times a week, small-group exercise sessions using simple, functional movements—like standing up from a chair, balance practice, or step-ups. These can be led by a physio or trained care staff, with modifications for different ability levels.

In-Room Exercise Routines

For residents who prefer or need to stay in their rooms, short daily routines could include leg lifts, reaching tasks, or supported standing. These small movements at the right intensity and duration can help maintain joint flexibility and strength—key for preventing falls and discomfort.

Outdoor Activity with Purpose

Use resources like the ENJOY Seniors Exercise Park (already being trialled in Australia) or set up small outdoor walking tracks with resting points and social cues. Residents can walk and interact at their own pace while still benefiting from gentle cardiovascular activity.

Functional Mobility Circuits

Think of it like a mini obstacle course—set up stations in a common area with tasks that mimic real-life movements:

• Lifting and placing weighted objects
• Throwing & catching weighted balls
• Practising sit-to-stand movements against resistance
• Wall-supported push ups
• Sweeping with a weighted broom
  This creates variety, purpose, and structure—turning “exercise” into something familiar and meaningful.

Cognitive Engagement with a Purpose

Offer cognitive rehabilitation sessions where residents work toward personalised goals—like remembering routines, using assistive tools, or communicating more effectively.

Run group-based cognitive stimulation therapy sessions where residents participate in structured discussions, games, and activities designed to boost thinking skills and social interaction.

And for those who enjoy technology, even simple tablet-based games or movement games (exergaming) can combine fun with real therapeutic value.

So, What’s Holding Us Back?

Honestly? It’s not that we don’t care. It’s that:

• Aged care staff are under pressure and often under-resourced
• Rehab is wrongly seen as “too advanced” or “not worth it” for those with dementia
• Funding models still prioritise basic care and comfort over active therapy
• Social activities are easier to run and more familiar than therapy programs

But comfort without capability isn’t enough.

If we want to support people living with dementia to live well—not just be cared for—we have to shift our mindset and our model.

What Needs to Change in Australia’s Aged Care Homes

Here’s what a rehab-first culture would involve:

1. Include rehabilitation in every care plan. Not just when someone has a fall—but proactively, every week.
2. Train all staff in movement-based and cognitive engagement techniques. You don’t need to be a physiotherapist to support a resident to do sit-to-stands safely.
3. Make therapy visible. Let families and residents know that part of their care includes maintaining function—not just comfort.
4. Use funding to drive outcomes, not just activities. Fund what works: therapy that maintains independence, reduces care needs, and preserves dignity.
5. Keep social activities—but give them a therapeutic edge. Add movement to music sessions, include memory prompts in art, or do gardening with purpose.

We Can, and Should Do More

Dementia doesn’t mean giving up on rehabilitation. In fact, it means leaning into it more than ever.

When we help someone with dementia stand a little taller, move a little more easily, or remember how to do something on their own, we’re not just adding days to their life—we’re adding life to their days.

We need to move beyond bingo.

We need aged care homes where rehabilitation is as routine as morning tea.

Because people living with dementia deserve more than passive care. They deserve to keep doing, not just keep existing.