A Shift-Level Architecture for Person-Centred Dementia Care: The Care Delivery Framework and Engagement Index

The measurement of care quality in residential dementia settings operates almost entirely at governance cadence: quality-indicator dashboards aggregate quarterly, incident data captures failure rather than the presence of quality, and validated quality-of-life instruments are designed for research and audit rather than daily operational use. Between the organisational dashboard and the ward floor, there is no structured signal of whether person-centred care was actually delivered on a given shift. This paper presents a two-part architecture developed to close that gap. The Care Delivery Framework (CDF) organises each shift around four anchoring moments — opening, sequence, rounding, and handover — derived from extended observation of care delivery on a dementia ward. The Engagement Index (EI) is its measurement companion: a binary, observable-indicator system with three collection streams (ward-level supervisor observation, resident-level carer self-report, and a separate weekly family instrument), producing a per-shift Staff Practice Score, a weekly Family Relational Quality Score, and a weighted weekly composite. The architecture is positioned within Donabedian's process domain and Kitwood's account of person-centred care, and its family stream is designed as a deliberate response to the documented validity problems of proxy quality-of-life rating: families are asked only what they can directly observe, never to rate their relative's quality of life. The framework is unpiloted; it is presented here for methodological scrutiny, with a pilot protocol and known limitations stated. The paper's contribution is architectural: a shift-level process measurement system for person-centred dementia care, requiring no additional headcount, equipment or budget, with a structurally independent family observation stream.