INNOVATIONS IN DEMENTIA CARE

I read a news story about a little village in Holland called Hogeway. At first glance Hogeway seems like any normal small community. It has houses, a grocery store, a restaurant, a theatre, a barber shop, as so forth. People happily stroll throughout the shops, squares and courtyards or the local park. Hogeway is a clean, orderly community with 152 residents.


They all have one thing in common: Severe dementia.

You see, Hogeway is actually a nursing home but its residents don’t know that. All Hogeway’s “normality” is not real ― it is contrived ― but again the residents are unaware of that. They are happy in their fantasy world. The goal is to make living as normal and familiar as possible within the scope of each resident’s disease. It’s an interesting concept in health care.

Residents live in one of 23 houses with about six others, according

to lifestyle. Each house has one or more health care workers to oversee and assist with life.  Residents are free walk where they wish in the town because they can’t get lost. Special two-seater bikes allow residents and workers, or a family member, to ride throughout the village.  They live protected lives and they are happy.

A Hogeway employee, Yvonne van Amerongen, was quoted as saying, “We protect our residents from the unsafe world. They do not understand the world outside this because the outside world doesn’t understand them.” Hogeway is partially funded through taxes and residents contribute according to their income.

The Hogeway approach and philosophy to dementia care is so successful that it has generated interest in other countries including Canada. A Hogeway style village is located in Penetanguishene, Ontario. Families and residents are very happy with the facility.  

Julian Hughes

But as with any good idea there will always be naysayers and the Hogeway approach to dementia care is no exception.  English bioethicist and deputy chair of the London based Nuffield Council on Bioethics, Julian Hughes, is troubled about being deliberately artificial.  In 2009, the Council issued a report that stated the Hogeway approach “serves to undermine the remaining grip the person with dementia may have on the everyday world.”

O please!

I disagree with the position of the illustrious bioethicist and his Council. Hogeway is for people with severe dementia. If they are happy living in a pretend world, let them. Is the Hogeway philosophy and approach to care condescending or patronizing? I don’t care. We are talking about irreversible progressive dementia. The patient’s happiness, safety and quality of life are the important issues. Let them live in a fantasy!  Is Hughes against it because he didn’t think of it? Someone please give bioethicists something constructive to do with their time.

Goodness! We should welcome innovative ideas in nursing home care. The Hogeway philosophy is a breath of fresh air and a far cry to how so many of people with severe dementia are institutionalized in sterile nursing homes. These settings may be safe but they are unfamiliar to the patient. (I know of cases where dementia patients were essentially warehoused until they died.)

As the population ages, society will face increases amounts dementia. We need to welcome creative or novel approaches to their care that gives them increased quality of life.

According the Alzheimer’s society of Canada, one in twenty people over the age of 65 has dementia. The numbers steadily increase to one in four Canadians over the age of 85 have Alzheimer’s disease. I suspect the the numbers are similar in the U.S.


We need innovative ways to care for this population. I think the Hogeway approach is worth considering. It’s not for everyone but it

allows some people with severe dementia to live in healthy, happy, safe and stimulating environments that resemble normal community life. And that taps into the Common Good about which I have previously written and spoken about across Canada and the United States. 

The common good involves EVERYONE and that includes the physically, developing disabled, the aged, and those yet to be born. Communities that exclude anyone are not really communities at all because the common good is not being served. The dignity of people with severe dementia involves protection from the harshness and cruelties of the world. Not only does it involve protection but it also involves creating environments for people to thrive as individuals and groups. Reaching fulfillment means different things at different times, stages and states in people’s lives.  

Fulfilment for a person suffering from severe dementia may simply mean being happy and as free as possible from anxiety.  If we can put in place environments to help achieve that goal, let’s do it. If reality is beyond reach or too fearful, let them live in a fantasy. 


When even memories fade, all that matters is to be loved.

MDP