Dementia Villages

At first glance, Hogewey, a small community situated about 20 km outside of Amsterdam looks like any other Dutch town. Residents go about their lives normally, picking up groceries, going to the movies and catching up with friends. But unknown to them, they are leading an orchestrated life, a false reality. There are surveillance cameras everywhere, and residents are watched every hour of the day. From the shopkeeper to the gardener, from the hair stylist to the dentist, every one is part of the deceit.

Hogewey is a nursing home disguised to look like a village. It was designed to house people suffering from severe dementia. Unlike typical nursing homes, where patients live in drab buildings, with long hallways and polished floors, and nothing but the television for company, Hogewey attempts to create a livable society for these helpless people. Inhabitants live in shared houses, they have a theater, grocery stores, a post office, gardens and clubs. Every shopkeeper, every waiter, and every housekeeper is a Hogewey employee playing their part, in Truman Show-style. Hogewey has around 150 residents, and 250 caretakers.

Hogewey’s supermarket. Photo: Hans Erkelens/Flickr

The Hogewey concept was founded by Yvonne van Amerongen while she was working as a staff member at a traditional Dutch nursing home. Having seen how nursing homes functioned, van Amerongen became committed to making these places more livable and less sufferable. Van Amerongen realized that the important thing at this stage in life, more than having access to the best treatment, is to have the freedom to do things one liked to do. She envisioned a setup where patients can live an ordinary, normal life, in a supportive, home-like environment, engaging in activities that are meaningful to them.

Opened in 2009, the Hogewey facilities consist of nearly thirty two-story brick houses and other town amenities sprawled over a four-acre campus. Each house is occupied by six or seven residents with shared interests and backgrounds, attended to by one or two caretakers. The houses are uniquely styled to reflect each group’s lifestyle, such as having different types of music playing, varied interior design, different food and even different methods of table setting.

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Residents choose their own daily schedules for meals and activities. Some residents may choose to dine at the village café or restaurant. Others may choose to be served in the house. Every month, residents are doled out fake money to use at the village supermarket or at the restaurants. Sometimes residents pick what they need from the supermarket and simply walk out the door. No (fake) money exchange takes place.

The goal of all these arrangements is to preserving one’s sense of autonomy, which is very important in dementia care. Even the smallest detail can mean a lot for some.

“If we know that you have sugar in your coffee, we will still ask you every day, 'Do you want sugar in your coffee?' so you can make that choice every day," said facility manager Eloy van Hal. “That you can still decide what you put in your coffee is important.”

The psychological benefit of leading a happy and contented life on physical health is immense. The residents at Hogewey take fewer medications, eat better, live longer, and appear more joyful than those in standard elderly-care facilities.

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Hogewey’s success has inspired many other “dementia villages” across the world. There is one at Penetanguishene, in Ontario, Canada, and another one near Canterbury, in Kent, England.

The novel initiative, however, faces one criticism. Some question whether it is ethical to deliberately deceive vulnerable people by creating a fake, manufactured utopia. But proponents of dementia villages argues that there is no harm in “benevolent manipulation.” Researchers observed that even though residents live in an illusion of normality and independence, they appear to be calm and balanced, and that’s all that matters in the end.

A 2013 paper by a group of German researchers noted:

We believe that, despite ongoing ethical discussions, the most important point is to meet people’s needs. And if one way to do this would be to create the effective impression of being (a little bit more) independent, self-responsible, and in control of things and situations, then this might be the way to go.

“There is nothing fake about (Hogewey),” agrees Megan Strickfaden, a design anthropologist at the University of Alberta. “It is a space for people to live in, like any other space. It doesn’t trick people in any way. They have access to groceries, activities, public and private spaces like they would in any city or town.”

Schulz cautioned that while exploring dementia-care options, families shouldn’t get caught up much with the model of care espoused by a provider. At the end of the day, “If the person can feel safe, comfortable, loved, cared for, content, peaceful and at ease, you are so far ahead because most behaviours we see come from anxiety, uncertainty, confusion and not feeling cared for as a person.”