Governed AI-Agent Coordination for Dementia Care: Architecture, Safety Contracts, and Evidence-Derived Workflow Verification

Individuals with Alzheimer's disease (AD) and Alzheimer's disease-related dementia (ADRD) experience memory and thinking changes that impact their ability to use digital daily management tools. For example, adding an event to a digital calendar requires multiple steps that may act as barriers to independent use for individuals with AD/ADRD. This paper presents AI-Care, a conversational agentic artificial intelligence (AI) layer built on top of a remote caregiving platform co-designed with people with AD/ADRD. AI-Care is designed to reduce the cognitive load on individuals with AD/ADRD when managing everyday tasks such as setting calendar reminders and organizing to-do lists through natural-language interaction with a voice-first chatbot. The system uses a LangGraph-based stateful orchestration approach in which each request passes through sanitization, intent classification, context loading, safety checks, deterministic slot collection, tool execution, and response composition. Safety-critical responses, particularly around medications and allergies, are grounded in caregiver-verified records rather than free-form model generation. The system does not make autonomous medical or treatment decisions. Incomplete or ambiguous requests are handled through controlled multi-turn clarification rather than silent failure or guessing. The system supports both typed and spoken input, with voice output through ElevenLabs text-to-speech. Longer responses are chunked before synthesis to avoid rushed playback. A preliminary pilot with four individuals with mild-to-moderate AD/ADRD showed that users found the system trustworthy, competent, and likable, and were able to complete the evaluated coordination tasks through conversation. We describe the design goals, system architecture, safety controls, and findings from this formative evaluation.

Agentic AI systems plan, use tools, maintain state, and act across multi-step workflows with external effects, meaning trustworthy deployment can no longer be judged by task completion alone. The current literature remains fragmented across benchmark-centered evaluation, standards-based governance, orchestration architectures, and runtime assurance mechanisms. This paper contributes a bounded evidence synthesis across a manually coded corpus of twenty-four recent sources. The core finding is a governance-to-action closure gap: evaluation tells us whether outcomes were good, governance defines what should be allowed, but neither identifies where obligations bind to concrete actions or how compliance can later be proven. To close that gap, the paper introduces three linked artifacts: (1) a four-layer framework spanning evaluation, governance, orchestration, and assurance; (2) an ODTA runtime-placement test based on observability, decidability, timeliness, and attestability; and (3) a minimum action-evidence bundle for state-changing actions. Across sources, evaluation papers identify safety, robustness, and trajectory-level measurement as open gaps; governance frameworks define obligations but omit execution-time control logic; orchestration research positions the control plane as the locus of policy mediation, identity, and telemetry; runtime-governance work shows path-dependent behavior cannot be governed through prompts or static permissions alone; and action-safety studies show text alignment does not reliably transfer to tool actions. A worked enterprise procurement-agent scenario illustrates how these artifacts consolidate existing evidence without introducing new experimental data.

Autonomous agentic AI systems driven by Large Language Models (LLMs) introduce a new class of security, privacy, and compliance challenges: an agent that can invoke tools, manipulate data, install software, and coordinate with peer agents across organizational boundaries must be constrained not just by authentication and access control, but by the full structure of enterprise governance. This includes specifying what agents are permitted and prohibited from doing, what they areobliged to do after certain actions (e.g., notify the CISO), under what conditions a standing obligation may be waived, and which rules take precedence when policies conflict. This governance problem exceeds what current policy engines provide. Systems such as XACML, Rego, and Cedar address only the permit/prohibit subset of this governance structure. They do not provide obligation lifecycle management, meta-policy conflict resolution, dispensations that waive obligations in specific circumstances, and ontological reasoning over domain class hierarchies commonly found in applications such as healthcare, cybersecurity, or data privacy. We propose AgenticRei, which realizes key governance requirements such as obligations, dispensations, policy conflict resolutions, and reasoning over policies, as well as the basic permit/prohibit constraints. We use a deontic policy language built on the Rei framework, expressed as OWL (Web Ontology Language) and evaluated at runtime by a high-performance logic engine entirely outside the LLM. The same pipeline governs both tool invocations by the agent and agent-to-agent messages. We show through examples that deontic policies capture governance constraints around security and privacy that mostly cannot be expressed in current production engines. Our approach composes naturally with industry-standard frameworks like A2AS.