What is the best dementia village in the world? An exploration of innovative care models

The world's first dementia village, De Hogeweyk in the Netherlands, opened in 2009, revolutionizing the approach to memory care by normalizing the living environment. This model has inspired many others worldwide, but the question remains: what is the best dementia village in the world? This exploration dives into the most renowned examples.

Quick Summary

There is no single 'best' dementia village, as the ideal environment depends on individual needs. However, the Dutch village of Hogeweyk is the most famous and influential model, setting the global standard for person-centered dementia care. Other notable examples exist in Australia, Norway, and Italy.

Key Points

• Hogeweyk as the Benchmark: De Hogeweyk in the Netherlands is the world's most famous and influential dementia village, pioneering the concept of normalcy in care since 2009.

• Personalization Over Institutions: Dementia villages move away from traditional, hospital-like settings by creating home-like environments tailored to residents' previous lifestyles.

• Global Innovations: The Hogeweyk model has inspired variations worldwide, including NewDirection Care in Australia (inclusive microtown) and Carpe Diem in Norway (community integration).

• Safety with Freedom: While secure, these villages are designed to feel open and free, with subtle security measures that protect residents from wandering while encouraging movement and autonomy.

• Benefits of Person-Centered Care: Residents in these villages often experience reduced stress and may require less medication due to a more stimulating and familiar environment.

• No Single 'Best' Fit: The ideal care solution depends on an individual's specific needs, preferences, and the available financial resources. Assessing multiple options is crucial.

The Pioneering Paradigm: Hogeweyk in the Netherlands

In the Amsterdam suburb of Weesp, De Hogeweyk stands as the original and most celebrated dementia village. The community houses over 150 residents with severe dementia in a simulated village environment, complete with streets, gardens, shops, and cafes. This approach is founded on the principle of "normalcy," providing a familiar, non-institutional setting that reduces anxiety and improves quality of life.

The Design and Philosophy of Normalcy

Hogeweyk's design carefully re-creates the familiar rhythms of everyday life. Residents live in small, shared houses with trained caregivers who wear normal clothes and act like neighbors, not medical staff. The village is securely enclosed, but the subtle security measures create a sense of freedom, not confinement. Houses are decorated according to specific "lifestyles" (e.g., urban, traditional Dutch, cultured), helping residents connect with familiar pasts.

Life Inside Hogeweyk

• Autonomy and Activities: Residents are encouraged to participate in daily activities like cooking, shopping at the in-village supermarket (where no real money is exchanged), or visiting the theatre or restaurant.
• Health and Well-being: Studies suggest that residents at Hogeweyk show improved functioning and require less medication than those in traditional nursing homes. The emphasis is on active, meaningful engagement rather than passive care.
• Criticisms and Ethical Considerations: Some critics have raised ethical concerns, likening the village to a "Truman Show" scenario where residents live in a staged reality. However, proponents argue that this is a compassionate approach to maintain dignity for those who can no longer navigate the complexities of the real world.

Leading the Way: A Look at Other Innovative Villages

Since Hogeweyk's inception, similar concepts have emerged worldwide, each with unique features.

NewDirection Care, Australia

Known as a "microtown," NewDirection Care in Bellmere, Australia, integrates residents with dementia alongside seniors without cognitive impairments. This fully inclusive community offers a high degree of normalization and social interaction, focusing on community integration rather than segregation. Amenities include a corner store, cinema, and cafes, mimicking a typical suburban environment.

Carpe Diem Dementia Village, Norway

Carpe Diem, located near Oslo, takes the concept of community integration a step further by inviting local community members to visit and participate in village activities. This intentional mixing aims to reduce the stigma associated with dementia and foster greater social connection for residents. The environment is designed to be a civic space with varied residential buildings, a town square, and landscaped paths.

Villaggio Emanuele, Italy

This dementia village in Rome, built with a strong focus on replicating a historical Italian town, has successfully emulated the Hogeweyk model. It provides a safe, stimulating environment where residents can benefit from the person-centered approach, including specialized programs to help preserve cognitive abilities.

Comparison: Dementia Villages vs. Traditional Memory Care

Choosing the right care setting is a deeply personal decision. The table below outlines key differences between innovative dementia villages and more traditional memory care facilities.

Feature	Dementia Villages (e.g., Hogeweyk)	Traditional Memory Care
Environment	Designed to resemble a familiar village or microtown with multiple amenities.	Institutional setting, often with long hallways and standardized rooms.
Autonomy	Maximized resident freedom within a safe, enclosed, and monitored environment.	Controlled environment with restricted movement to prevent wandering.
Activities	Resident-driven, reflecting real-life routines and interests (shopping, cafe visits).	Structured, group-based activities often following a fixed schedule.
Staff Roles	Staff wear casual clothes and blend into the environment, acting as neighbors or assistants.	Staff typically wear uniforms or scrubs, making their medical role explicit.
Socialization	Encourages natural interaction among residents and with visiting community members.	Limited opportunities for spontaneous social interaction.
Cost	Generally high, though funding models vary by country.	More varied, with options across different price points, but often still expensive.

How to Choose the Right Facility for Your Loved One

When considering your options, it's crucial to look beyond a facility's reputation and focus on what truly meets your loved one's needs. The National Institute on Aging offers helpful guidance for navigating this process.

• Assess Needs and Preferences: Consider your loved one's specific stage of dementia, behaviors, medical needs, and personal preferences. Would they thrive in a bustling village or prefer a quieter setting?
• Visit and Observe: Take tours of several facilities, both announced and unannounced. Observe staff-to-resident interactions, cleanliness, and the atmosphere. Do residents appear engaged and content?
• Check Credentials and Training: Inquire about staff training in dementia care, such as Certified Dementia Practitioners, and staff-to-resident ratios.
• Review Financials: Understand the cost structure, what's included, and what payment options are available, such as long-term care insurance or government programs.
• Trust Your Gut: Pay attention to your emotional response. Does the environment feel warm, comfortable, and respectful?

Conclusion: A Shift Toward Compassionate Care

Ultimately, the concept of the "best" dementia village is subjective, but the influential model of Hogeweyk and its global successors have fundamentally shifted the conversation around dementia care. By focusing on person-centered care, dignity, and a sense of normalcy, these innovative communities offer a powerful alternative to institutional living. Their success reminds us that with thoughtful design and compassionate support, it's possible to create environments where people with dementia can continue to live fulfilling, meaningful lives.

For more detailed guidance on choosing a long-term care facility, visit the National Institute on Aging.

Frequently Asked Questions

Where is the original dementia village located?

The original dementia village, De Hogeweyk, is located in the suburb of Weesp, near Amsterdam in the Netherlands.

How do dementia villages compare in cost to traditional memory care?

Dementia villages often have high construction and operational costs, which can result in higher resident fees. However, some are government-subsidized, like Hogeweyk, making them comparable to traditional nursing home costs in that region.

Are there any dementia villages in the United States?

Yes, while fewer than in Europe, some dementia villages and day centers inspired by the model exist or are in development in the United States, such as Avandell in Holmdel, N.J., and the Glenner Town Square in San Diego.

What is the primary goal of the dementia village concept?

The primary goal is to deinstitutionalize, transform, and normalize care for people with advanced dementia by creating a safe, stimulating, and familiar environment that maximizes resident autonomy and dignity.

Do dementia villages help reduce medication use?

Some facilities following the dementia village model, including Hogeweyk, have reported reduced use of antipsychotic and other medications compared to traditional care settings, attributing this to the therapeutic and normalized environment.

What are some alternatives to dementia villages?

Alternatives include specialized memory care units within assisted living facilities, residential care homes, the Green House model (small-scale homes), and in-home care services supported by technology and family caregivers.

How do caregivers interact with residents in a dementia village?

Caregivers are trained to blend into the village environment, wearing casual clothes and adopting natural, supportive roles rather than appearing as clinical staff. This approach helps reduce anxiety and fosters a more comfortable, normalized atmosphere.