Why 'dementia villages' might be the future of care for people with Alzheimer's

The future of Alzheimer's care might soon look less like a sterile hospital environment, and more like a cozy little neighbourhood.

The concept, known as a dementia village, is already being tested in Holland. There, patients with varying stages of dementia live in homes of five or six residents. There's a grocery store, gardens and community gathering spaces.

But behind the scenes, the village still operates as a nursing home, with trained practitioners there to take care of residents.

"We said, 'let's create something people will feel [is] comfortable, cozy, recognizable," Eloy van Hal told the Calgary Eyeopener. "We transformed the traditional nursing home into a traditional neighbourhood where people could continue their life. And we focused on what they still can do."

Van Hal was in Calgary Tuesday speaking to seniors' care workers about the dementia village, called Hogewey. He said the concept is all about "social inclusion," something that's often missing from traditional methods of care.

"The little neighbourhood is open to everybody but officially we are still a nursing home," he said. "I always say backstage we are a nursing home, a non-profit, state-funded nursing home. But on stage, what you see and what you experience when you walk through it and when you visit is a little neighbourhood." 

Ethical concerns

Here in Canada, there's a smaller re-creation of the Dutch dementia village in Penetanguishene, Ont. Few patients at either facility realize they're actually in a nursing home. It's a problem many care workers encounter when working with people who have dementia, said Dr. Lorraine Venturato, the University of Calgary's chair in Gerontology.

But Venturato said sometimes it's best that a person with dementia remains in their own reality, as opposed to being constantly drawn back into the "real world."

"Best practice for people with dementia these days is that we tend to go into their world," she said. "Rather then try to keep them in our reality, we tend to go to theirs now."

Previously, care providers would practice "reality orientation," Venturato continued.

"We wanted to keep pulling them into the here and now. If they thought it was 1950 and their mother was coming to pick them up from from school you would remind them that, 'no, it's 2000 and your mother's not coming, you're old, and you're in a nursing home.'"

'Lying and manipulating people'

Now, that practice is less frequent for those with moderate to late-stage dementia. That's why care facilities like Hogewey are held up as the "gold standard" of dementia care, said Venturato. 

"They've put such a lot of time and effort into thinking about the aspects of communal living that will help people with dementia to feel comfortable," she said.

According to Hogeway, the residents' awareness of where they are varies as each person is at a different stage in their dementia, and the fact that they are in a nursing home isn't deliberately kept from them. 

"One of the biggest challenges in dementia care is that thought that you're actually lying and manipulating people as well," said Venturato.

"But if they [the residents] think it's a village and it's lovely and they're happy, then that's much better than trying to convince someone everyday that they have dementia."

A growing problem

According to the Alzheimer Society of Canada, about 564,000 Canadians are currently living with dementia. That number is expected to rise 66 per cent to 937,000 by 2031.

The society reports that dementia costs $10.4 billion annually, including costs to the health-care system and out-of-pocket costs. 

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With files from the Calgary Eyeopener