Dementia care has traditionally been provided by specialist clinics and centre-based services. These services sometimes do not fully address the seniors’ needs for emotional wellbeing, personal care, emergency support, home safety and caregiver support. To respond to this challenge, Hua Mei Dementia Care System, a home-based care management service was designed by a Singapore-based NGO, Tsao Foundation, to provide person-centred support for persons with dementia (PwD). The HMDCS team comprises a physician, a social care manager, a nurse clinician, an assistant social worker and two therapy assistants. Methods and Results: In the first two years of implementation, HMDCS enrolled a total of 84 clients. 75% of the clients were of FAST (Functional Assessment STaging of Alzheimer disease) Stage 4 and 5 upon enrolment. Majority of them were of acute need for care based on InterRAI MAPLe 5 Score. Out of a total of 84 patients, a preliminary evaluation was conducted on 30 patients who had participated in HMDCS for a minimum of three months and were assessed at least twice. 90% of these 30 patients showed an average improvement of 60.8% in challenging behaviours as measured by RMBPC (Revised Memory and Behavioural Problem Checklist). Meanwhile, 60.7% of 28 PwD had an average improvement of 38% in caregiver stress as measured by ZBI (Zarit Burden Interview). Conclusion: Insight gained from HMDCS suggests that dementia care requires an appropriately trained- interdisciplinary team that addresses PwD’s, as well as their caregivers’, biopsychosocial needs in a coordinated approach.