Dementia care is becoming increasingly important in Japan as the elderly population grows. Care homes are designed so that caregivers can easily observe and subsequently respond to the needs of people with dementia. However, the layout of care homes can become overly restrictive for residents, for example, by not providing intermediate spaces where people can spontaneously interact and initiate conversations. We present a case study that explores the implementation of video monitoring in two purpose-built care homes in which we were asked to help overcome the blind spots presented by the layout. We collected data both before and after the implementation of the video monitoring in order to understand its effect. The balance between people’s sense of security and the concerns about loss of privacy through video monitoring is well established. However, we found that video monitoring had a beneficial effect on both the caregivers and the residents if implemented sensitively. Furthermore, the implementation of video monitoring could support the design of more beneficial care home layouts. In conclusion, we propose that the sensitive implementation of video monitoring be considered alongside design of the physical layout of care homes.