Even for the most challenging groups, there are programmes in which staff can be trained or outside directors engaged. Many day-care centres but few nursing homes use the Sonas programme. Devised by an Irish nun, Sister Mary Threadgold, it helps to break through the fog of dementia.
Colm O'Connor, administrator of the Senior Helpline and Third Age centre in Summerhill, Co Meath, is passionate about the need for community involvement in nursing homes.
"The community at large is ignoring the existence of nursing homes, so what's happening is that people are taken out of their community, become invisible and disappear. There needs to be a link between the matron and outside organisations, so that you have a situation like in Drogheda, where some computers were donated to a home and schoolchildren came in to teach the residents how to use them. Or like our links here in Summerhill with St Joseph's in Trim, where there's a choral group going involving the residents and this community. People in those places should be a part of the community."
Dr Suzanne Cahill, director of the dementia-services centre at St James's Hospital in Dublin and lecturer in social gerontology at Trinity College, Dublin, agrees. She stresses that "the new culture of care" is not about non-stop occupational therapy anyway. It's about something more natural, homely and domestic.
"It's not about 'this is Monday morning and everyone must play bingo,' " says Dr Cahill. "What we would be challenging is the 'routine-isation', where there is no distinction drawn, for example, between the routine of a night owl or an early riser, one who likes a drink in the evening or one who prefers early bed.
"We are beginning to witness some positive changes in the culture of care in Ireland, as borne out by the kind of multiple consultations we in the dementia services have had throughout the year with health boards and architects keen to embrace best practice in design.
"In Scandinavia, they would be promoting non-therapeutic activities - it might be as simple as allowing people to do their own bit of washing and having a line in the garden to peg the stuff out on, or setting the table or dusting. Most people with dementia are women, because it's an age-related condition, and women have been used to domestic activity all their lives, so why are they suddenly barred from doing anything?
"The best kind of therapy is the kind that allows people to keep control of their lives, where they have choice and dignity and inclusion."
So in Scandinavia, apart from the central kitchen, they also have small, domestic-style, high-tech kitchens and trained staff geared to allow residents to potter around and even make a cup of tea without the sky falling in - and, yes, they are just as health-and-safety-conscious as the Irish.
In Scandinavia, they believe the physical environment is crucial, so they take seriously the "small, homely and domestic" brief, with a notable absence, for example, of long, featureless corridors. Nursing homes are built in units of eight to 10 residents, each with private bedrooms and en-suite facilities. The toilet is visible from the person's bed - an important cue for someone prone to confusion. Cues and signs are regarded as vital tools in enhancing memory and reorientating people.
In many places, when a family wishes to place a relative in a home they are shown an empty room and told that furnishing and decorating it is their responsibility. The bedroom will be personal, therefore, full of familiar possessions.
The common area will include a "quiet room" - an alternative to restraint or drugs for someone who becomes distressed - with soft music and gentle colours and in sight of the garden. There will be small nooks and conversation places indoors and out, and a discreetly fenced-off garden with a careful selection of fragrant plants and shrubs, outdoor furniture and barbecues in the summer.
There will be no heart-stopping alarm bells if a resident tries to slip away. Sensors and passive alarms alert staff silently and without fuss. These are all considered important elements in maintaining quality of life for people who have had to put themselves into the care of others but whose rights must continue to be respected.
In the Republic, by contrast, we are still struggling to recognise an older person's right to stimulation of the most basic kind. "We are very good at the physical care," says Drury, "and often you will hear people saying about a particular nursing home, 'Well, they look after them so well there.' But I say, 'It doesn't matter how she's powdered and painted - what happens to her during the day?' Very often, an activities programme seems to depend on staff complement rather than being seen as an absolute given."
An absolute given? Not likely. In a study for the National Council on Ageing and Older People, in which nursing homes were asked for details of "quality initiatives", only just more than half had any. Of those that did, top of the "quality initiatives" was "therapies" - including physiotherapy - and next was "individual assessment", as if these were optional luxuries and not the basics of any professional care plan.
But this may be a flattering picture, given that only a third of the 580 long-term care facilities in the State responded to the questionnaire in the first place.
