Long-term care facilities in the Netherlands try to implement new design approaches to enrich their environments and to cope with the changes and innovations in the Dutch healthcare sector. An enriched environment supports both quality of life of people with frail health and the well-being of the healthcare professionals who take care of them. Despite the increased attention devoted to built environments in relation to health, a gap in knowledge remains how to implement new design approaches. The aim of this study is to present a structural approach for a decision-making process to help to create enriched small-scale care facilities for older people with a frail health condition. A case study was conducted to understand how the structural approach contributes to implementing design features of an enriched environment. The structural approach identifies the key factors (such as shared language, collective understanding and involvement of stakeholders) that should be considered when developing such facilities and describes the critical steps for decision-makers for such environment. This case study provides a rich source of information from actual experiences for a better understanding of steering mechanisms for decision-making by the management of small-scale care facilities.