Dementia Villages: Terrific or Trickery?

A diagnosis of dementia can be both scary and heartbreaking to a family. Scary because dementia is irreversible and will worsen with time, and heartbreaking because, once diagnosed, there is little left patients can do within society but live out their days in a nursing home. At least, this was true before the emergence of Hogewey and the living facilities they set up. The Holland-based senior society is set up so that dementia patients can roam freely through secure streets, parks, and storefronts and live under the guise of normalcy.

Unbeknownst to them, the “villagers” with whom they share their days are actually caregivers in regular clothing. They are always nearby to assist with the activities of the patients without disturbing the image they have of their fully functioning society. Proponents of this new type of living facility are quick to point out the happiness and health benefits which older people experience, while opponents say the communities are tricking the elderly into thinking they are home instead of in senior care.

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Benefits of a Dementia Village

Hogewey designed its community to reflect the way patients lived when they were younger, because this is what they will likely remember. There are different types of housing, from the upper echelons of society, to working class homes, to homes with cultural and ethnic roots which mimic the homes in which they once lived. There is a grocery store, a theatre, and a restaurant, all manned by trained personnel who are ready to help patients at any time. They can roam safely to the park in the development and shop for their own groceries, and still they have caregivers which provide their meals, their baths, and their medications while seamlessly integrating into the patient’s lives.

Doctors have already seen improvements in patient health. Because they are allowed more freedom and a sense of a normal life, behavioral problems and anxiety occur in fewer patients. Lowering these issues, which are common in dementia patients in standard nursing facilities, means they don’t need medication to subdue or sedate them. In an article published by Neurology Today in 2012, Jannette Spiering, the founding director of Hogewey, stated quite bluntly, “Medication is lower, because people don’t feel trapped.”

Importantly, the standard of living provided at Hogewey is just as affordable as most other healthcare in Holland. The price at the time of the article was about $200 US dollars per day which was comparable to other facilities. The cost may even lower as Spiering said that the cost of medication is dropping. About 50% of patients were on antipsychotics when Hogewey’s housing model began compared to the 20% reported in the article written 20 years later. They attribute this to the fact that patients get a sense of freedom they would not have in another type of facility which leads to happier, healthier lives overall.

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Problems with the Model

Some have debated the ethical consequences of this type of living. Is it wrong to essentially build a lie around dementia patients to make them feel better? This setup is basically The Truman Show but instead of being watched on television, seniors are being watched by caretakers as they live their “normal” lives every second of their day. However, Steven DeKosky, dean of the University of Virginia School of Medicine, cited that those with dementia do not perceive reality in the same way others do, so a patient-centered reality should not be considered a problem as long as they are comfortable. Spiering also noted that the focus should be on the health and mental wellbeing of the patients. Truly, at the core of their facility is a deep love and respect for the patients and their wishes.

Future of Dementia Villages

Similar facilities in Germany and Switzerland modeled themselves after Hogewey, and there is a good market in the United States to follow suit as Alzheimer’s and other diseases of the mind continue to affect elderly Americans every day. The question society has to ask is whether or not telling the full truth is more important than the health and wellbeing of older people. For most, the answer is simple. Instead of sticking people in a hospital bed, let them build their own home instead in places like Hogewey; good senior care is that which gives autonomy and happiness to all who need it.