Hogeweyk in the Netherlands inspires paradigm shift based on inclusivity and community.
As the number of dementia cases increases, more “dementia villages” are opening across the globe. Modeled after the gold standard in memory care—Amsterdam-based Hogeweyk Dementia Village—these communities take a person-centered, integrated approach. Residents with severe cognitive impairment move about the village freely, interacting with fellow residents and staff.
Funded by the Dutch government, Hogeweyk currently serves 188 residents in 27 houses. Well-known as the gold standard in memory care, Hogeweyk was called by the authors of the 2020 World Alzheimer Report a “paradigm shifter.”
When the Hogeweyk first opened its doors in 2009, there were about 35 million people living with dementia around the world, according to Alzheimer’s Disease International, a nonprofit federation of Alzheimer and dementia associations. Today that number is more than 55 million, and the World Health Organization expects it to reach 78 million by 2030.
Apart from a Hogeweyk-inspired dementia-care day center in South Bend, Ind., there are currently no dementia villages in the United States. Serenbe, a wellness community outside Atlanta is working with the organization behind Hogeweyk to integrate their principles.
Another memory care community modeled on Hogeweyk is Avandell by United Methodist Communities in Holmdel, N.J. Still in the zoning process, firm based in New York, Avandell will comprise 15 homes in a farmhouse aesthetic, to reflect the rural surroundings. Designed by Perkins Eastman, the suburban-style community is set to include a town center with a grocery store, bistro and community center. Along with homes for 105 residents, there is a planned neurocognitive clinic and a senior resource hub, both of which will offer their services to the general public.
In the summer of 2017, a group of architects from Perkins Eastmans visited the Netherlands to learn about Hogeweyk. "We agreed as a practice that we needed to go see it for ourselves so we can talk to our clients and have an intelligent, informed opinion,” said Max Winters, Senior Associate at Perkins Eastman. “The most interesting thing about Hogeweyk Dementia Village is the philosophy that they espoused that, instead of starting with the regulations and the constraints from governments, health departments, etc., let’s start with what is normal and then work creatively within the constraints to achieve that.”
Myths of Memory Care
One of the biggest myths about memory care is that the primary job of the physical environment of a dementia community is to protect the residents from themselves and from other people. Obviously, safety and security are extremely important for this population because there can be some real challenges. The conversation is about experience and aesthetics whenever we have conversations about independent living but turns to safety and security immediately when it comes to memory care. More important are the relationships between the caregivers or the team members and the residents. The strength of those relationships is more effective than locking the door to the courtyard.
“The other side of that myth is that the primary role of the physical environment is to protect other people from the dementia residents by separating them. We're locking them away when some do much better cognitively in group settings where they can socialize with people who don't have dementia. We need to develop a more nuanced understanding of safety and security and how the built environment can achieve that while still connecting people together socially, regardless of cognitive ability,” says Winters.
Aging in Community
“People want to remain at home, they want to live in the community,” said Dr. Tarun Dua, who heads the Brain Health unit at the W.H.O.’s Department of Mental Health and Substance said in a recent New York Times article. “I think this is an important message. So even if we think in terms of dementia villages, how close they are to the community — that’s very important. They should be part of the community, rather than outside of it.”