The Polarity of Therapy and Caregivers for People Living With Dementia—and How They Can Support Each Other Despite Their Differences

By a Therapist by Day and a Caregiver by Night

By day, I am a therapist—trained to assess, document, treat, measure outcomes, and discharge. I speak the language of goals, functional gains, evidence-based practice, and reimbursement. By night, I am a caregiver to a family member with dementia—managing medications, redirecting behaviors, navigating emotional loss, and living in the reality that progress is often nonlinear or nonexistent.

Living in both worlds has shown me a polarity that few truly see unless they stand in both spaces: the structured, time-limited world of physical, occupational, and speech therapy services versus the continuous, emotionally demanding, often invisible world of caregiving. These two systems are frequently positioned as separate, sometimes even in quiet opposition—but for individuals with dementia, they must work together if care is to be truly person-centered.

Two Systems, Two Philosophies

Rehabilitation services are built on restoration and maintenance. Physical therapy focuses on mobility, balance, strength, and fall prevention. Occupational therapy emphasizes activities of daily living, environmental adaptation, and safety. Speech-language pathology addresses communication, cognition, and swallowing. Each discipline operates within defined episodes of care, documentation requirements, and payer-driven expectations.

Caregiving, on the other hand, has no episode end date. There is no discharge plan. Caregivers are not reimbursed, rarely trained, and often emotionally tethered to outcomes that therapy cannot promise. The caregiver’s “treatment plan” is survival—keeping a loved one safe, dignified, and as comfortable as possible through a progressive disease.

The polarity lies here: therapy is goal-driven and time-bound; caregiving is relationship-driven and indefinite.

The Tension No One Talks About

As therapists, we are taught to identify potential, maximize function, and measure change. As caregivers, we quickly learn that dementia does not follow neat trajectories. A patient may perform beautifully in a therapy session and be unable—or unwilling—to replicate those skills at home. Therapists may recommend strategies that are clinically sound but emotionally unrealistic for families already stretched thin.

Caregivers may feel frustrated when therapy ends, perceiving discharge as abandonment. Therapists may feel helpless when caregivers are overwhelmed or unable to carry over recommendations. Both sides can feel unheard, undervalued, or misunderstood.

Yet neither side is wrong.

Where Support Can—and Must—Happen

The bridge between therapy services and caregiving begins with humility and mutual respect.

Therapists must recognize that caregivers are the true long-term care providers. They are the ones implementing strategies at 2 a.m., managing behaviors without backup, and absorbing the emotional toll of cognitive decline. Education must be practical, flexible, and realistic—not idealized.

Caregivers, in turn, benefit from understanding that therapy is not a cure but a support. Therapy can offer tools, perspectives, and problem-solving approaches that ease caregiving burden, even when functional improvement is limited. Maintenance, safety, and quality of life are valid—and often the most important—outcomes.

Reframing Success in Dementia Care

For individuals with dementia, success is not always improved scores or independence. Sometimes success is fewer falls, reduced frustration, safer swallowing, or one meaningful moment of connection. Therapy services can help caregivers reframe expectations, adapt environments, and preserve dignity. Caregivers provide the continuity and emotional context that therapy alone cannot.

When therapists invite caregivers into the care process as partners—not just recipients of instructions—outcomes improve for everyone. When caregivers feel validated rather than judged, they are more likely to engage, ask questions, and sustain strategies over time.

A Shared Mission

Despite their differences, therapy services and caregiving share a common mission: to support the person behind the diagnosis. Dementia care is not about choosing one model over the other—it is about integration.

As someone who lives on both sides of this divide, I believe the future of dementia care depends on collaboration, not polarity. Therapists must see caregivers as experts in lived experience. Caregivers must be empowered to see therapy as a resource, not a failure when decline continues.

When we stop working in silos and start listening across roles, we move closer to care that is compassionate, realistic, and human. And for people living with dementia—and those who love them—that collaboration makes all the difference.