According to the World Health Organization, over 55 million people across the globe have dementia, and each year, the number grows by nearly 10 million. Naturally, the ongoing onset of this deadly condition prompts solutions—but the world is unsure how to proceed. Even with America alone investing over 3.7 billion dollars in Alzheimer’s research in 2023, a cure has yet to be found. In its place, dementia patients have been ushered into nursing homes, which are, despite the sincere intentions surrounding them, objectively sterile and—in some ways—dehumanizing. 

Dementia

But first: what is dementia? Dementia is an umbrella term for a group of conditions characterized by the impairment of at least two crucial functions, such as memory loss and judgment. The most common type of dementia, and the most infamous, is Alzheimer’s disease. Beginning in the hippocampus, a part of the brain associated with memory, neurons in the brain are destroyed. This damaging activity then expands to other areas, affecting the frontal lobe (responsible for personality and decision-making) and, eventually, the brainstem, which is responsible for bodily functions like breathing, thus rendering Alzheimer’s disease—and others similar to it—a fatal condition. Some symptoms of Alzheimer’s disease include, but are not limited to, the following: memory loss, difficulty completing tasks, poor judgment, and changes in mood, personality, or behavior.

Hogeweyk’s Origins

With the spike in dementia in recent decades, research and healthcare have advanced considerably, with dementia care homes along with them. However, like most nursing homes, the interior of these homes can feel sterile with their blank, white walls and non-stimulating environment. In the late twentieth century, the Hogeweyk—a dementia nursing home in the Netherlands—began to make incremental changes in their own care home, motivated to build an environment that optimized and prioritized the lives of dementia patients. It began in small steps: smaller wards, colorful decorations, and second-hand furniture. They took their first leap of faith in 2005 when they tore down parts of its building to begin the construction process. In 2008, Hogeweyk reopened, offering its innovative services to its community. 

In place of its original facility lay a simulated neighborhood, complete with homes, parks, stores, theaters, cafes, and more. Like a standard nursing home, the residents at Hogeweyk are cared for and supervised by trained staff. Yet in contrast to a standard nursing home, Hogeweyk effectively breaks the stigma of dementia to the world and provides its residents with a sense of autonomy and purpose, striving to allow them to live their lives as normally and meaningfully as possible. But how could this arrangement possibly work? The residents at Hogeweyk are in advanced stages of dementia. They are not capable of navigating a village and controlling financial decisions. Where are the staff in this predicament? Are they furthering the simulation through acting, and if they are, is this care home ethical? 

The Layout

Before diving into the specifics of the lifestyle at Hogeweyk, it may make more sense to first explore the layout of Hogeweyk. Hogeweyk houses 188 residents, with 27 houses and 6 to 7 per house. Each house has a living room, kitchen, private bedrooms, bathrooms, a storage and laundry room, and a private outdoor space. The trained staff at Hogeweyk consists of nurses, doctors, psychologists, physiotherapists, and social coaches. Staff personally watch over each household, while others participate in other facilities and blend into the community’s daily life, far outnumbering the number of residents. As a result, residents receive professional care and support day and night. The village itself has streets, courtyards, and alleyways, and facilities include a restaurant, a cafe, a supermarket, a theater, an office, various club rooms, a physiotherapist, and a hair and beauty salon. To encourage hobbies and provide valuable social opportunities, a community billboard announces weekly group activities, like music clubs, gardening, and sewing. 

Lifestyle and its Logistics

Still, the layout of Hogeweyk doesn’t answer concerns regarding its functionality. For example, the supermarket: how do residents make purchases? Do they use real money or an equivalent to Monopoly money? Is money even something that would benefit residents to handle? In truth, when residents come to the supermarket, money is not present at all. The products lack price tags, and money is not paid at checkout. It is accounted for that Hogeweyk’s residents may not be able to make financial decisions, so money is a complexity that has been removed entirely. 

Aside from money, a more ethical concern can be speculated, arising from Hogeweyk’s similarities to a fictitious simulation. Despite this vital misunderstanding, there is technically nothing fake about Hogeweyk. The social community is not simulated, and the residents there can build genuine connections and relationships with each other. To avoid dehumanizing Hogeweyek’s residents, the staff themselves are additionally trained to avoid thinking of themselves as authority figures. Each facility fulfills its advertised function, and the staff at Hogeweyk are not actors; they use their professional skills, whether it be as a nurse or a hairdresser, to serve and support the residents, just as they’d do in any other village and community. Although the logistics of Hogeweyk are complex, each is devised in an effort to prioritize the happiness of its residents, and Hogeweyk’s inherent brightness and liveliness indicate that the thought put into this special nursing home has not gone to waste. 

Cost

However, even if the efforts of the staff and founders didn’t go to waste, how about the money spent on Hogeweyk? Higher quality means higher costs, and if the costs are unreasonable, it will be difficult to establish this kind of nursing home in other locations. However, the founders of Hogeweyk took great care to ensure that its costs were not impractical. For example, instead of investing in a physical therapy room, they designed each building to be farther away from each other to encourage exercise. Or, instead of having a private bathroom in every suite, each household has only two bathrooms, as many family homes do. By making compromises such as these, Hogeweyk had the same budget as any other standard nursing home in the Netherlands, an impressive feat considering its vast scope of care. 

Ultimately, Hogeweyk is a unique and revolutionary approach to dementia. Instead of focusing on just the physical care of each patient, Hogeweyk has made a point to also focus on their patients’ social, emotional, and mental well-being. Through their hard work, residents can find meaning despite their disease and have a sense of autonomy over their lives. As dementia becomes more and more common in the world, it may be time to seek not only the cure for it, but to globally implement the kindest way of caring for it.