As we become more deeply concerned with the care of people with Alzheimer's disease and related disorders, it becomes increasingly clear that design is not just an incidental concern, but is integral to a well balanced program for this population. It is gratifying that over the last few years attention has begun to focus on the basic issues of quality of care. We have only begun to examine the potential of the physical surroundings in preventing and dealing with the loss of function-vision, hearing, mobility, social behavior and mental competence. It is, at the same time, equally disheartening that many involved in institutional care still seek only to meet minimum code requirements without responding to care, care management and the residence itself. The facilities themselves look dismal and depressing and perhaps more importantly, do not function much better. The average facility may have a ”decorated“ lobby, but design that is both functional and attractive is the exception. Often buildings are renovated or ”designed“ without architectural or professional design input. These ”design efforts“ are characterized by the inclusion of super graphics, the cosmetic approach of bright colors and the inclusion of grab bars and handrails. It is my view that incorporating environmental design into the quality of care and care management programs can greatly enhance these programs to the benefit of both the cognitively impaired and the staff.