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This study reports on the cultural adaptation of the Environmental Assessment Tool-Higher Care (EAT-HC) in Germany, Japan, and Singapore. The purpose is to compare the content validity assessment, focusing on common and unique challenges encountered by each nation. In Germany, the security through environmental safety features and segregation of residents is highly debatable. Japan's challenge is for gerontologists to work closely with facility directors and architects to balance the cultural aspects of design. In Singapore, there is a gap in dementia design literacy for healthcare practitioners and designers. Identifying culturally sensitive aspects benefits further adaptation of the EAT-HC worldwide.