How “dementia villages” work

Summary

The Hogeweyk in the Netherlands is a 'dementia village' designed to provide a normal life experience for residents with severe dementia. Unlike traditional nursing homes, it features small group living, personal belongings, and public spaces like a theater and grocery store to foster a sense of community. The village's design prioritizes autonomy, safe movement, and a reduction in antipsychotic medication use, highlighting the importance of universal design for both dementia patients and the general population.

Takeaways

• 🏘️ The Hogeweyk is a 'dementia village' designed to provide a normal life experience for people with severe dementia.
• 🌐 It resembles a typical Dutch neighborhood with amenities like a restaurant, barber shop, and grocery store, but with a focus on dementia care.
• 🧠 Dementia is a brain disease that affects memory, causing individuals to forget recent events and rely more on memories from their past.
• 🏠 In traditional nursing homes, residents often live in a sterile, clinical environment that lacks personalization and autonomy.
• 🔑 The Hogeweyk emphasizes 'normalcy' by creating a living environment that closely resembles the outside world, with private rooms and personal belongings.
• 👥 Residents are grouped into small units of 6 or 7 to mimic the scale of a single family home, fostering a sense of community and belonging.
• 🏡 Each neighborhood within The Hogeweyk has distinct landscapes and landmarks, helping residents navigate and feel at home.
• 🚶‍♂️ The design allows for a balance of safety and controlled risk, providing residents with the freedom to move between private and public spaces.
• 🌞 Features like bright dishware, acoustic ceilings, and natural light fixtures are implemented to improve residents' well-being and orientation.
• 💊 Since adopting the village model, The Hogeweyk has reported a significant decrease in the use of antipsychotic medication among residents.
• 🌟 Dementia villages are an example of universal design, creating environments that work well for both people with and without dementia, and can inform broader design practices.

Q & A

What is The Hogeweyk and how does it differ from a typical neighborhood?

The Hogeweyk is a 'dementia village' in the Netherlands designed for people with severe dementia. Unlike a typical neighborhood, everyone in it, including grocery store cashiers, barbers, and waiters, are trained in dementia care, providing a specialized environment that still resembles a normal neighborhood with amenities like a restaurant, barber shop, and theater.

Why is the concept of a 'dementia village' significant in the context of aging populations worldwide?

The 'dementia village' concept is significant as the proportion of older people in the population is rising globally, leading to an increase in the number of people with dementia. Such environments are designed to help these individuals feel safe and free, even as they lose the ability to recognize the world around them, addressing the growing need for specialized care.

How does The Hogeweyk's approach to dementia care differ from traditional nursing homes?

Traditional nursing homes often provide care in a sterile and clinical setting with a one-size-fits-all approach to daily activities. In contrast, The Hogeweyk focuses on preserving the quality of life by offering a more personalized and autonomous living experience, with small group living, private rooms, and a variety of public spaces that encourage social interaction and movement.

What are some of the design elements in traditional nursing homes that can be improved to better cater to people with dementia?

Design improvements in traditional nursing homes include visually consistent flooring without contrasting patterns, brightly colored doors and handrails for better navigation, bright dishware to encourage eating, acoustic ceiling tiles and carpeted floors for noise reduction, glass-fronted cabinets for clear sightlines, and lighting fixtures that mimic natural light to strengthen circadian rhythms.

How does The Hogeweyk's structural design contribute to the well-being of its residents?

The Hogeweyk's structural design contributes to well-being by creating an environment that closely resembles the outside world. It includes small group living arrangements, private rooms with personal belongings, distinct neighborhoods with unique landmarks, and separate buildings for public services like theaters and grocery stores, all of which encourage intentional movement and a sense of community.

What is the guiding principle behind The Hogeweyk's design for people with dementia?

The guiding principle behind The Hogeweyk's design is 'normalcy'. It aims to provide a vision of a normal life for people living with dementia, allowing them to maintain a sense of autonomy and a connection to familiar surroundings and activities.

How does The Hogeweyk ensure a balance between safety and autonomy for its residents?

The Hogeweyk ensures a balance by providing a design that allows for controlled risk. For example, walkways do not have overly high walls to prevent falls, and instead of handrails everywhere, walkers can be used to provide mobility support, allowing residents to move safely while maintaining a sense of independence.

What evidence supports the effectiveness of The Hogeweyk's approach compared to traditional care models?

Since transitioning from a traditional model, The Hogeweyk has reported a decrease in residents on antipsychotic medication from 50 percent in 1993 to just 8-10 percent today. Additionally, studies have found that features of dementia villages, such as small-scale living, increased daylight, and outdoor gardens, can reduce psychiatric symptoms, behavioral issues, and agitation, while improving spatial orientation and quality of life.

What challenges does the dementia village model face in terms of widespread adoption?

The dementia village model faces challenges such as high costs, which can be prohibitive without ample government funding. Furthermore, there is a need for more evidence to conclusively determine whether this model is superior to traditional care models.

How does The Hogeweyk's approach to dementia care reflect the principles of universal design?

The Hogeweyk's approach reflects universal design by creating an environment that works for as many people as possible, regardless of their ability. It emphasizes the importance of designing spaces that are inclusive and accommodating to everyone, including those with cognitive and physical impairments.

What message does The Hogeweyk convey about the humanity and aspirations of people with dementia?

The Hogeweyk conveys the message that people with dementia are human beings with aspirations and desires, not just patients to be cared for. It emphasizes the importance of providing them with freedom, choice, and the opportunity to engage in meaningful activities throughout the day.

Outlines

00:00

🏘️ Dementia Village: A New Approach to Care

The Hogeweyk in the Netherlands is a unique neighborhood designed to cater to the needs of individuals with severe dementia. Unlike traditional nursing homes, this 'dementia village' offers a range of everyday amenities such as a restaurant, barber shop, and theater, staffed by dementia care professionals. The concept aims to provide a sense of normalcy and freedom for residents while they navigate memory loss. The Hogeweyk's founders, including Eloy van Hal, emphasize the importance of preserving the quality of life for dementia patients, even as they require full-time care. Traditional nursing homes are often criticized for their clinical and uniform environments, which can be disorienting and dehumanizing. In contrast, The Hogeweyk focuses on creating a space that resembles the outside world, with private living quarters, distinct neighborhoods, and public spaces that encourage social interaction and autonomy.

05:01

🌟 The Hogeweyk's Design Philosophy and Global Impact

The Hogeweyk's design philosophy prioritizes safety and controlled risk, avoiding overly restrictive measures like high walls or unnecessary handrails. Instead, it provides walkers for residents to move freely and purposefully within the village. Since its opening in 2009, the model has inspired the creation of similar dementia villages worldwide. However, the high cost and lack of extensive evidence comparing it to traditional care models have raised questions about its efficacy. Despite this, The Hogeweyk reports a significant reduction in residents on antipsychotic medication, and studies support the benefits of features like small-scale living, increased daylight, and outdoor gardens for improving the well-being of dementia patients. The Hogeweyk's approach is a testament to universal design, creating environments that are inclusive and beneficial for all, regardless of cognitive or physical abilities. It challenges the perception of dementia patients as passive recipients of care, emphasizing their humanity and desire for freedom and activity in their daily lives.

Keywords

💡Dementia Village

A 'Dementia Village' refers to a specialized community designed for individuals with severe dementia, where every aspect of the environment is tailored to support their needs. The concept is exemplified by The Hogeweyk, a neighborhood in the Netherlands that features a restaurant, barber shop, theater, and grocery store, all staffed by dementia care professionals. This approach aims to provide a sense of normalcy and autonomy for residents, allowing them to engage in daily activities in a safe and controlled environment.

💡Severe Dementia

Severe dementia is an advanced stage of cognitive decline where individuals experience significant memory loss and difficulty in recognizing their surroundings. In the context of the video, The Hogeweyk is specifically designed to cater to the needs of people with severe dementia, ensuring their safety and quality of life through specialized care and environmental design.

💡Cognitive Impairments

Cognitive impairments refer to a decline in cognitive abilities such as memory, attention, and language skills. The video highlights how dementia villages like The Hogeweyk are designed to accommodate residents with cognitive impairments, creating an environment that supports their daily functioning and social interaction despite their condition.

💡Universal Design

Universal design is the concept of creating products, environments, and systems that are usable by all people, to the greatest extent possible, without the need for adaptation or specialized design. The video discusses how dementia villages, by focusing on inclusive design, can serve as a model for universal design, benefiting not only those with dementia but also the broader population.

💡Quality of Life

Quality of life in the context of the video refers to the well-being and satisfaction experienced by residents of dementia villages. The design and operation of these villages aim to preserve and enhance the quality of life for individuals with dementia by providing a familiar, safe, and stimulating environment that supports their physical, social, and emotional needs.

💡Memory Loss

Memory loss is a key symptom of dementia, where individuals struggle to recall recent events or maintain new information. The video script uses the metaphor of a photo album to illustrate how individuals with dementia might forget their 'last pictures,' or recent memories, more easily than older ones. Dementia villages are designed to help residents navigate this challenge by providing familiar and consistent environments.

💡Autonomy

Autonomy in the context of dementia care refers to the ability of residents to make choices and have control over their daily lives. The video emphasizes the importance of autonomy in preserving the quality of life for individuals with dementia, with dementia villages like The Hogeweyk providing a range of spaces and activities that allow residents to exercise choice and independence within a safe environment.

💡Antipsychotic Medication

Antipsychotic medication is a type of drug used to treat certain mental health conditions, including symptoms of dementia such as agitation and aggression. The video mentions that The Hogeweyk has seen a significant reduction in the number of residents on antipsychotic medication since transitioning to a village model, suggesting that the environment and care approach may contribute to reduced reliance on such medications.

💡Environmental Design

Environmental design in the context of the video pertains to the deliberate planning and arrangement of spaces to support the needs of individuals with dementia. This includes features like visually consistent flooring, brightly colored navigational aids, and natural lighting to enhance wayfinding and reduce disorientation. The Hogeweyk's design is a structural approach to environmental design, aiming to mimic the outside world and provide a sense of normalcy.

💡Normalcy

Normalcy in the video refers to the goal of creating an environment that feels familiar and routine for individuals with dementia. The Hogeweyk's guiding principle is to provide a 'normal life' for its residents, despite their cognitive impairments. This is achieved through the design of the village, which includes separate living units, public spaces, and various amenities that resemble a typical neighborhood, allowing residents to engage in daily activities that they would in a non-clinical setting.

💡Controlled Risk

Controlled risk in the context of dementia villages like The Hogeweyk refers to the balance between providing a safe environment and allowing residents to experience a degree of risk that is typical of daily life. The video discusses how certain design elements, such as the absence of high walls along walkways, are intended to promote independence while still ensuring safety. This approach encourages residents to navigate their environment with support, rather than being overly restricted.

Highlights

The Hogeweyk is a 'dementia village' in the Netherlands designed to provide a normal living environment for people with severe dementia.

The neighborhood includes a restaurant, barber shop, theater, grocery store, and green spaces, all part of a facility for dementia care.

Residents live in a setting that mimics a typical Dutch neighborhood, with all staff trained in dementia care.

The rise in the elderly population is expected to increase the number of people with dementia, necessitating innovative care environments.

Dementia villages aim to preserve residents' quality of life by creating safe and free-feeling environments despite memory loss.

Traditional nursing homes can be sterile and lack personalized care, unlike dementia villages that focus on individual life stories.

Good dementia care should maintain quality of life, even as residents' abilities change.

Dementia villages use design elements like consistent flooring, bright colors, and noise-absorbing materials to enhance residents' well-being.

The Hogeweyk's guiding principle is 'normalcy', aiming to provide a normal life for those with dementia.

Residents at The Hogeweyk live in small groups of 6 or 7, emulating the scale of a single-family home.

Each neighborhood in The Hogeweyk has distinct landscapes and landmarks to help residents navigate and build a sense of community.

Dementia villages encourage autonomy by allowing residents to safely move between private and public spaces.

The Hogeweyk's design balances safe design with controlled risk, promoting independence without over-reliance on institutional features.

Since The Hogeweyk's opening, the use of antipsychotic medication among residents has significantly decreased.

Studies support the benefits of dementia villages, showing reduced psychiatric symptoms and improved spatial orientation.

Dementia villages are an example of universal design, creating environments that work for people regardless of their abilities.

The Hogeweyk's approach reminds us that people with dementia are individuals with aspirations and a desire for freedom and autonomy.

Transcripts

At first glance, The Hogeweyk looks a lot like any other neighborhood in the Netherlands.

It’s got a restaurant, barber shop, theater, grocery store, and open green space.

You can see people walking around, getting groceries, having coffee.

The difference is that this neighborhood is a facility for people with severe dementia.

And everyone else in it

from grocery store cashiers to barbers to waiters

are trained in dementia care.

This model of care has been dubbed a "dementia village".

As people continue to live longer around the world,

the proportion of older people in the population will continue to rise

and that means a steep increase in the number of people with dementia.

Caring for that population will require designing environments

that help people feel safe and free

even as they lose the ability to recognize the world around them.

And the architects behind dementia villages

think they might just have figured out the formula to do it.

This is The Hogeweyk.

Social life is happening there so you can see it now.

That's Eloy van Hal, one of The Hogeweyk's founders.

Dementia, it's — of course — a brain disease.

If you look at your life as a photo album

you forget the last pictures.

The last pictures, they fall out of the album and so you remember the past better

when you were younger.

And that's a daily challenge for the individuals: how to live with memory loss.

In early stages, people with dementia can live at home, looked after by family, friends

or home care

but they eventually need full-time care.

Often, that care comes from traditional nursing homes.

But those settings can be sterile and clinical.

You all dine together in a big dining area.

You all have to listen to the same music at the same time.

Where you're forced as a person into a program of the institution.

There's not that much attention to who are you really

what is my life's story, who am I, what do I prefer

to do during the whole day.

In any setting, the goal of good dementia care

should be to preserve quality of life as dementia progresses.

In traditional settings, like nursing homes

surface-level changes are a good place to start.

Since people with dementia might perceive dark tiles as holes

floors should be visually consistent, without contrasting patterns.

Brightly colored doors and handrails help residents navigate around

and bright dishware has been shown to help people with Alzheimer’s eat more food.

Acoustic ceiling tiles, carpeted floors, and soft furniture

can absorb noises that trigger disorientation.

Glass-fronted cabinets help residents have a clear line of sight

to what’s stored inside.

And lighting fixtures that mimic natural light

strengthen residents’ circadian rhythms, which helps mitigate sundowning

where people with dementia become confused in the evening and night.

Some of the advice about lighting, clear lines, surface patterns, and so

are based on institutions.

Instead of normalizing the environments, all those elements are essential.

But sometimes they are the solution for an institution.

But The Hogeweyk’s design solution is different.

Instead of changing surface-level design to preserve quality of life for people with dementia

they took a structural approach

and designed their facility to look as much like the outside world as possible.

Our guiding principle here is normalcy.

It’s the vision of a normal life for people living with dementia.

That starts with lodging.

Traditional nursing homes keep all their residents under one roof.

But real households don’t typically consist of dozens of people.

So, The Hogeweyk split its residents up into small groups of 6 or 7

recreating the scale of a single family home.

Inside, each resident has a private room furnished with personal belongings.

The units are split up into different neighborhoods to mimic Dutch cities residents are used to.

The public space, the gardens, the streets, the squares.

They are equally important if you want to build a community where people live.

Each neighborhood’s public space was given distinct landscapes and unique landmarks

so people could easily find their way around.

And destinations like the theater, barber shop, and grocery store

were put in separate buildings

encouraging intentional movement and intermingling in that public space.

These different areas provide multiple scales of experience

and residents are given the autonomy to safely wander along that spectrum

from very private to very public space.

That autonomy helps further preserve quality of life.

People stay in their own bedroom.

Many people socialize in the living room.

But you can also decide to leave the house

because the front door is open and to walk to your own private outdoor space

your terrace or balcony or your own garden

or you walk further into the neighborhood where you can mingle.

So, it's about choice, choice, choice:

where you want to be during the whole day and with whom.

Crucially, The Hogeweyk’s design allows for

a balance of safe design and controlled risk.

Walkways, for example, don't have super high walls

to guarantee no one falls over.

You see handrails everywhere in institutions.

The question is, do you need a handrail everywhere?

Or do you want to provide a walker, where you can walk with two hands on the walker,

and make it accessible for the walker?

Since The Hogeweyk opened in 2009

dozens of other dementia villages have opened across the globe.

But without ample government funding, they can be prohibitively expensive.

And there isn’t enough evidence yet to say whether the dementia village model is better

than traditional models of care.

The Hogeweyk claims that since they transitioned from a traditional model to the village

the number of residents on antipsychotic medication decreased from 50 percent in 1993

to just 8-10 percent today.

And there have been studies backing up different features that dementia villages use.

One review of the evidence found that uncrowded, small-scale living

resulted in fewer psychiatric symptoms and behavioral issues among residents with dementia.

And that increased daylight lighting reduced their behavioral issues

and improved spatial orientation.

Another review found that outdoor gardens can reduce agitation

and improve quality of life for people with dementia.

But by creating an environment specifically for people with cognitive and physical impairments

dementia villages are a fascinating practice in universal design:

design that works for as many people as possible, regardless of their ability.

And they can teach us something about where the outside world falls short.

If you design well for normal people without dementia

you design also well for people with dementia.

We forgot that people with dementia are human beings

with a lot of aspirations.

We forgot that people with dementia are not patients

where you can put them in a chair and wait until they die.

They are people who want to do certain things during the day.

And they know and they're happy to have this freedom.