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What Are ‘Dementia Villages’ And How Do They Work?

November 16, 2022 /

Dementia is not a specific disease, but rather a general term for the impaired ability to remember, think and make decisions that interfere with everyday activities. It is an umbrella term used to describe a range of symptoms associated with cognitive impairment, that covers diseases like Alzheimer’s, Vascular, Lewy Body and vascular frontotemporal – all of which mostly affects older adults.

For people aged between 62 and 69 – around every 2 in 100 people suffer from a type of dementia. That is over 6 million Americans, as well as 400,00 Canadians. People who have early to moderate dementia are often able to live in their own home being supported by friends, family or home care services. However, as cases of dementia worsens, one begins needing more care. Over time, the disease will affect one’s ability to carry out everyday activities, such as eating, bathing, dressing and toileting. When this happens, it is likely that people will no longer be safe living in their own homes, and will be moved into long-term care homes with around-the-clock care.

The problems come when the design and architecture of these homes don’t match with its intended purpose. Traditional nursing homes usually bear settings that are sterile and clinical. This means that the patients are living out their last years being forced as a person into a program of the institution, where they all eat at the same time, listen to music at the same time, sleep at the same time and so on. There is not enough attention focused on individual patients to explore what is their story, who they want to be and what they prefer to be spending their days on. 

“In any setting, the goal of good dementia care should be to preserve quality of life as dementia progresses.”

Vox

What are changes that need to be made for dementia care in nursing homes?

Vox: “How ‘Dementia Villages’ work”, 18.08.2022

Typical nursing homes can have dark tiles as flooring, and since people with dementia might perceive them as holes, floors should be visually consistent, without contrasting patterns. Brightly-colored doors and handrails will also help residents navigate around, and bright dishware has been shown to help people with Alzheimer’s eat more food. Acoustic ceiling tiles, soft furniture and carpeted floors can all help to absorb noises that cause disorientation. Glass-fronted cabinets give the residents a clean light of sight as to what is stored inside, and lighting fixtures that mimic natural light strengthens one’s circadian rhythms, which helps mitigate sundowning – where people with dementia become confused in the evening and night. 

These are all surface-level changes that offer a good starting point for better improving the care of dementia patients. But that is certainly too short of a length Eloy van Hal would go for, in order to better sustain the lives of these patients.

What are dementia villages?

Opera Beds: Inspiring Dutch village for those with dementia

Dementia villages, as people would call it, is an innovative care model for people living with advanced dementia. They are facilities disguised as perfectly normal neighbourhoods, where it’s got restaurants, barber shops, theatres, grocery stores and open green space. From the outside, they may look like any other neighbourhoods in the area, but in reality, it is a safe space for people with severe dementia, where everyone else in it, from waiters to barbers to grocery cashiers are all trained in dementia care.

The origins of dementia villages

LinkedIn: Eloy van Hal

The original dementia village, De Hogeweyk, was developed in the Netherlands where prior to its transformation, it was just a traditional nursing home. One of the De Hogeweyk’s founders, Eloy van Hal has managed several nursing homes and assisted living facilities and elderly homes over more than 20 years prior to building De Hogeweyk. He also coincidentally managed the former nursing home for several years, before its transformation into the neighbourhood De Hogeweyk. As one of the developers, Eloy was heavily involved in all stages of development from initial design, construction, planning, implementation and maintenance, as well as improving the concept. Eloy is hugely aware of the daily challenges dementia patients face as their memory extinguishes. 

How do they work?

An essential principle focused on by De Hogeweyk’s founders was normalcy – the vision of a normal life for people living with dementia. Despite the previously stated advice regarding surface-level changes to nursing homes, sometimes it is still better to create authenticity, rather than follow strict guidance based on institutions. All of those elements are still essential, but sometimes they are only the solutions to an institution. The design for De Hogeweyk took an extremely structural approach, as the team wanted their facility to look as much like the outside world as possible. 

Vox: “How ‘Dementia Villages’ work”, 18.08.2022

And this starts with lodging. Real households don’t contain dozens of people, while traditional nursing homes keep all residents under one roof. This creates a clash between the usual practice of nursing homes and the guiding principle of De Hogeweyk. 

What this facility did was split up residents into small groups of 6-7, each with their own houses- recreating the scale of a single family home. These houses and its units are then split up into different blocks to mimic the Dutch cities the residents are used to. Further additions include public spaces, gardens and squares, all of which are essential for building a community where people live. 

Each block was also given distinct landscapes and unique landmarks, ensuring the dementia patients could easily find their ways around. Furthermore, the theatre, barber shop, and grocery store were located in different buildings, encouraging a mixed use of the public spaces and intentional movement.

The variety of areas provides multiple scales of experience – from private bedrooms to public stress, which is then all given to residents as choices along with the autonomy to safely wander along that spectrum from very private to very public space. This helps further preserve quality of life.

Ultimately, De Hogeweyk’s design allows for a balance of safe design and controlled risks. Examples of this can be seen in walkways – which have high walls to guarantee no one falls over, handrails are in most every institution along with walkers granted to each resident, to further ensure their safety. 

What is the future for dementia villages?

2009, when De Hogeweyk was first established, is more than a decade ago, and since then, dozens of other dementia villages have opened across the globe. However, they have all been facing one major issue – cost. Without ample government funding, they can be prohibitively expensive and there is still a lack of sufficient evidence to say whether the dementia village model is better than traditional models of care. 

Our world is constantly changing for the better, and only with the future may we bring forth new ideas and ways of doing things. By creating an environment specifically designed for people with cognitive and physical impairments, dementia villages are a fascinating practice in universal design.

Bibliography

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