The objective of this instrumental case study was to explore interrelationships among routine activity situations on 2 Alzheimer's special care units (SCUs) and 2 resident quality-of-life (QoL) indicators: daily time use and emotional well-being. Fourteen residents participated. We collected data across four 12-hr days using computer-assisted direct observations and computed associations of activity situations with QoL indicators and mean durations of QoL indicators in activity situations and daily by facility. We compared mean durations of QoL indicators across facilities and analyzed time-use profiles of 2 residents. We found that participants’ capacities for activity engagement and emotional vitality were infrequently expressed at both SCUs. Diminished QoL was attributable to participants’ dementia-related impairments coupled with insufficient attention to their occupational needs, initiatives, and capacities. Findings call for occupational therapists’ involvement as educators, mentors, and consultants to enhance the effectiveness of routine activity situations in promoting QoL through everyday occupations.