Dementia Village Pioneers a New Approach to Care 

I am really excited about this concept and would love to work there!!

“We want to help people enjoy life and feel that they are welcome here on this earth,” says Yvonne Van Amerongen.

Van Amerongen is a cofounder of Hogewey, a Dutch village created exclusively for people with dementia. Intended to honor residents’ values and culture, the village features 23 typically Dutch houses designed to feel natural to residents, whether they’re comfortable in settings that are urban, aristocratic, working class, religious, or something else.

The businesses in Hogewey’s town square are staffed by workers who are specially trained to understand and communicate with people who have dementia. Residents have the freedom to stroll through the square, choose activities that nurture their backgrounds and interests, and help prepare foods they like to eat. With its 2:1 caregiver-to-resident ratio, the Hogewey neighborhood is said to help residents eat better, require fewer medications, and feel more joy than residents who live in traditional nursing homes.

Welcome to ‘Dementia Village’

An innovative community in Amsterdam offers ailing seniors more freedom and a taste of the past. Is it a model for the future?

In the Dutch municipality of Weesp, not far from Amsterdam, sits the village of Hogewey. At first glance, it looks like any other village, with shops, restaurants and a movie theater. Apartments surround a courtyard complete with rippling ponds, trickling fountains, vibrant seasonal flowers and benches perfect for enjoying a sunny afternoon.

This village, however, is quite unusual. Hogewey, sometimes referred to as “Dementiaville,” is an ongoing, 20-year-old experiment in cutting-edge dementia care. Home to 152 men and women living with severe dementia, the community has 23 residential units, each shared by 6 to 8 residents. Around-the-clock care is provided by 240 full- and part-time “villagers” who are actually trained geriatric nurses and caregivers dressed in street clothes. The staff takes care of everything from cooking meals and planning activities to assisting with bathing, personal care and medications. Even the individuals staffing the various village “businesses” are trained in dementia care. (MORE: Take the Virtual Dementia Tour)

Eloy van Hal, a facility manager for Vivium Care Group, the parent company of several senior care facilities, including Hogewey, says its founders’ vision was of a more humane, engaging dementia care community. “They wanted to make it a place where you want to be,” he says. Residents can experience life as they once had, making their own choices, performing everyday tasks and socializing with people who share similar interests.

Hogewey was originally a single, enclosed building, but its operators became convinced that smaller, separate, more open buildings would serve patients better. Yvonne van Amerongen, one of the founders, adds: “It was 1992 and Hogewey was being run as an ordinary care home: wards, common rooms where 20 people sat watching TV, doing nothing, waiting for medication, for meals. It wasn’t living. It was a kind of dying.”

Despite opposition from some critics who thought the creation of an illusory village was immoral, Hogewey’s founders went ahead with their plans. Now residents are not required to follow a set daily schedule. They can choose their routines for breakfast, coffee, lunch and dinner, although each house plans its meals, shops and cooks together. There are also 30 social “clubs,” catering to interests in classical music, baking, walking and others, and providing residents the opportunity to do some of the things they did before they became ill.

The Co-existence of Freedom and Security

To ensure patient safety, Hogewey is a secure, closed community, but within its confines residents are free to roam and explore as much as they wish. If they get lost or confused, there is always a “villager” nearby to provide assistance. (MORE: Not Your Father’s Nursing Home: A Visit to the Urban Green House)

Regular reminiscence therapy is one of the keys to the Hogewey approach. The staff strives to place residents in realistically constructed environments that allow them to relive their memories in a calm, peaceful and safe atmosphere. Caregivers work to bring back fond memories of earlier life through food, music, home decorations and other stimulation. (Styles from the 1950s through the ’80s are predominant.) Residents “eat dinner at a table with normal plates and enjoy the smells of food cooking in the kitchens of their homes,” van Hal says. “When they step out in the rain, they are outside, as cold is a part of normal life.” The residents still get the care they need, he says, but by having the staff adjust to their daily rhythms, Hogewey has found a way to provide “something special in a normal way.”

The approach, Hogewey management believes, limits the types of behavioral issues often found in traditional dementia units. With relatively less agitation and aggression, there is also reduced need for psychotropic drugs. Hogewey’s team feels it provides residents a sense of purpose – something often absent in a traditional nursing home environment.

Not everyone adapts well to life at Hogewey, though. “About once a year there’s not a good match,” van Hal says, usually the result of psychiatric problems or the fact that “not everyone is good in small-scale living.”

A ‘Normal’ Life Can Be Costly

Some critics continue to oppose the idea of creating a “fantasy” world. But proponents tout the village as the most compassionate possible form of dementia care. The homelike setting, they say, allows residents to live as normal a life as possible, eating dinner family style, visiting with friends, stopping by the barbershop or going for a walk whenever they wish. (MORE: How Can We Keep Seniors in Their Homes as Long as Possible?)

As you might imagine, money is one of the greatest barriers to making self-contained villages like Hogewey the standard for dementia care. The cost to build the community was slightly more than $25 million, $22 million of which was provided by the Dutch government. Residents pay approximately $7,000 monthly and there is a waiting list for admission. Still, officials from nations across the globe have studied Hogewey and are examining how to replicate at least some elements of its vision; a larger version of the village is slated to open in Switzerland in 2017.

While Hogewey does all it can to create a sense of normalcy, its caregivers have no illusions about the reality they face. “The people who live here are deeply demented. They need 24-hour care. Everyone who lives here eventually dies here,” van Amerongen says. “At the end, it’s every bit as tough as you can imagine.”

Dementia Village ‘De Hogeweyk’ in Weesp

Inside the complex, there is a park with a pond, a long boulevard, several squares with cafés and restaurants, as well as a theatre square. There is enough space to allow for the pronounced urge to move typical for the illness, and there are plenty of areas for communication and social exchange. Although people suffering from Alzheimer’s disease are often still very fit physically, they have problems with memory and mental capacity. They feel disoriented and can’t manage without help. Here they can move about freely on the grounds without having to worry about not finding their way back home again. A total of 23 apartments are provided on a gross floor space of 12,000 m2. The row houses with clinker brick facing are no more than two storeys high and contain one double room and seven single rooms each. 152 senior citizens live in ‘De Hogeweyk’ at the moment.

External neighbours can get a glimpse of the living situation of the elderly from the higher housing blocks adjacent to the complex. Photograph: Madeleine Sars, Eindhoven