Village-inspired facilities that mimic every day life are proving very successful for patients with dementia.
Rather than the usual clinical, sometimes isolated support environments allocated to seniors or people with dementia, this new concept sees a gated community with individual houses, green space and amenities.
The village is designed as a community to be domestic and feel familiar to patients.
Patients can shop, get their hair done or see a movie – safely.
As our ageing population brings increasing challenges to the global healthcare system, this model could serve as example for a range of senior support facilities particularly those suffering the effects of dementia.
According to the World Health Organisation, two billion people will be aged 60 and older by 2050, an increase from 605 million today. Meanwhile, 25 to 30 per cent of people aged 85 or older have some degree of cognitive decline.
Dementia alone is a global crisis and is also recognised as one of the national health priorities in Australia.
Alzheimer's Australia reports that worldwide that today there are more than 44 million people with dementia and a further 135 million predicted to be diagnosed by 2050.
Locally, the Australian Institute of Health and Welfare notes that 322,000 Australians were estimated to have dementia in 2013.
“Based on projections of population ageing and growth, the number of people with dementia will reach almost 400,000 by 2020, and around 900,000 by 2050,” the organisation’s website states. “Over 50 per cent of permanent residents in Australian Government-funded aged care facilities had a diagnosis of dementia."
With such alarming stats, it makes sense to explore a range of design strategies to house and support patients with dementia.
One of the most talked about facilities is De Hogeweyk, regularly called Dementia Village, in De Hogeweyk in Amsterdam. It was fittingly designed by Dementia Village Architects with directors Frank van Dillen and Michael Bol.
Opened in 2009, the refreshing approach resembles a typical community, offering patients with dementia their own personalised “home” and opportunities to shop at a local supermarket or relax in the “village square.”
Residents are also encouraged to socialise and walk about within the secure facility.
De Hogeweyk has 23 houses for 152 seniors with dementia. Each house has six to eight people and at least one permanent staff member.
Houses are differentiated by lifestyle such as urban, artisan, Indonesian, homey, Goois (upper class), cultural and Christian. Daily activities are organised for residents to also reflect a typical lifestyle.
“The fact that a resident cannot function 'normally' in certain areas, being handicapped by dementia, does not mean that they no longer have a valid opinion on their day to day life and surroundings,” the facility's website states.
Carers are disguised as shop assistants, gardeners and so on, and help residents manage their homes, cook or purchase supplies.
The village also includes a restaurant, bar and theatre, all of which are open to neighbouring communities as well. De Hogeweyk has streets, squares, gardens and a park where residents can walk about without feeling confined to a room.
Safety is a key priority for patients with dementia, and the village offers a secure environment. According to Alzheimer's Australia, “people with dementia may become disoriented and get lost in unfamiliar, or even in previously familiar surroundings.”
The organisation believes the best living environment for a person with dementia is one which helps them to be as happy and independent as possible.
"We protect our residents from the unsafe world. They do not understand the world outside this because the outside world doesn't understand them," Yvonne van Amerongen, an employee at De Hogeweyk who also helped develop the concept, told CBS News.
“No big anonymous buildings, but instead manageable and pleasant residential areas,” the architects said of the village. “Where it is comfortable for everyone to live. Where residents feel safe at home. Where they enjoy living out their final days, connected with family, caregivers and healthcare providers. Where they can enjoy the precious life they were used to and still want to lead.”
The team is also working to create the Mahal Cielo Village as an Alzheimer facility in San Luis in California.
Switzerland has a similar support centre in the works, which is planned to be opened in 2017 according to the Daily Mail. Dubbed Dementiaville, the £17 million village is modelled on De Hogeweyk and is being designed along the lines of the 1950s-style houses of a neighbouring village near Bern in Switzerland.
Last year, modelled on De Hogeweyk, Georgian Bay Retirement home in Penetanguishene, Ontario opened a memory care facility designed to recreate the look and feel of the 1950s and 1960s.
Rooms are themed with a vintage kitchen with a garage with a 1947 Dodge helping to transport patients to a time they may recall. CBS News also reported that all the doors in the themed rooms of the facilities look like bookshelves, so residents won't recognize them and stray.
The same article also addresses the ethical decision of purposely deceiving patients.
“It's worrisome when a village or aspects of it are deliberately deceitful,” said Julian Hughes, the deputy chair of the Nuffield Council on Bioethics in London, England who was part of a working group for Nuffield's 2009 report on ethical issues in dementia, including truth-telling. “Patients who realise something is amiss could become upset and slightly paranoid,” he added.
van Amerongen says that kind of criticism comes from people who don’t understand how De Hogeweyk operates.
“The people who work at Hogewey aren't merely actors trying to create the illusion of a normal neighbourhood,” she told CBS.
She also revealed that not all staff were nurses, with real cooks and waiters who did not necessarily have health care credentials but were trained to deal with dementia patients.
"There's no trick here," she said.
This customised community concept for housing patients with dementia is supported by various studies. A 2014 report titled A systematic review--physical activity in dementia: the influence of the nursing home environment found that 90 per cent of patients with dementia who are residing in the nursing home environment remain physically passive for most of the day.
The study lauded the influence of a more active environment.
“Positive results on the residents' levels of physical activity were found for music, a homelike environment and functional modifications," the abstract reads. "Predominantly positive results were also found for the small-scale group living concepts.”
So the message is clear: a sense of home and independence is valued by people experiencing dementia.
This design could indeed support the ageing population and give an array of nursing homes and healthcare facilities a new lease on life.