Do dementia villages actually work? We just don’t know

Recently, dementia villages have gained popularity in Europe and Australia as an all-in-one solution to caring for and improving the lives of those with Alzheimer’s disease and dementia. The New York Times has reported that it looks like the “future of home care.”

Dementia villages are small-scale communities that offer shared housing, minor medical care, and psychosocial support in a neighborhood setting. Originating in Weesp, Netherlands, in 2009 in a village known as the Hogeweyk, the concept created a paradigm shift in dementia care, focusing on possibilities instead of disabilities. Now present in nine other countries, this care concept prioritizes autonomy and community engagement.

But while promising in theory, it’s not clear they actually work.

Residential care for those with Alzheimer’s disease and dementia in the United States has traditionally been housed in large-scale nursing homes or specialty care units that are clinical in nature. Staff in these settings hold a hands-on approach, scheduling routine programming and dining selections for their residents regularly.

This works for some patients. Research suggests many benefit from a smaller-scale approach and certain design factors, like outdoor space and home-like communal living. Having dedicated staff that can accommodate individual patient needs can lead to fewer hospitalizations, and reduced mental illnesses, such as anxiety and depression.

Dementia villages were developed based on these concepts. Residents are encouraged to move freely throughout the community and to continue the normal, daily activities they enjoyed prior to moving in. This can include gardening, shopping, going to the beauty salon, grabbing dinner at a restaurant, and much more.

Residents are supported by their designated household caretaker and the six to seven housemates that they were matched with by similar interests. A multi-disciplinary team of health care professionals, non-clinical workers, and volunteers scattered onsite offer support outside of the home. Although a gated community, dementia village amenities and outdoor walking paths are also open to the public.

But there isn’t any evidence yet proving that this care model is effective in providing better health and social outcomes than traditional memory care facilities. As far as I can tell, no research has yet been conducted to see whether dementia villages improve behavior, functional ability, cognition, and quality of life. More clarity on how dementia villages treat medical emergencies, chronic conditions, and end-of-life care would also be beneficial in evaluating these programs and determining whether they are viable options compared to other memory care concepts.

Furthermore, there are limitations. One concern with implementation is whether the dementia village model includes enough onsite clinical support for residents. For example, at the Hogeweyk, nurse practitioners only attend to basic medical needs in resident bedrooms and restrict any use of physical restraints (e.g., bedside rails, reclined chair) even for those at risk of regular falls. Most dementia villages have followed this example, though Village Landais Alzheimer in France and Village Langley in Canada have recently deviated from the norm by offering more aid. The former built an onsite infirmary and pharmacy, while the latter designated one-third of its housing for residents with advanced dementia in need of intensive care and supervision. The fact that the model can be adjusted is promising, but without incorporating more clinical support in future replications, this care concept is not a one size fits all in caring for varying levels of need.

Another concern with implementation is access and equity, especially as new evidence emerges on dementia care disparities in marginalized communities. Further questions remain on whether dementia villages are accessible to individuals living in rural areas, whether there are enough publicly funded spots available (if any) to include folks with a low socioeconomic background, and whether villages are racially and ethnically diverse and inclusive of LGBTQ+ elders.

But perhaps the biggest challenge to widespread dementia village implementation is, as you might expect, cost.

For countries with a private-paying market, like the U.S., few organizations have the funding and land to independently build neighborhoods that can accommodate the needs of a dementia village. Up until late 2022, the U.S. only had a couple of day programs — one in Indiana and one in southern California — that were inspired by the concept, and none contain housing.

Now zoning for the first residential dementia village in the U.S. has been approved in New Jersey, but it is estimated it will cost $12,000 per month for most residents (U.S. average monthly cost for memory care facilities is $7,500). While 10% of these spots are reserved for Medicaid recipients, it is unclear how much care will be covered. Even for those in countries that offer generous government subsidies, families still struggle to cover their portion (averaging up to 3,500 euros per month).

None of this is to say that dementia villages are an idea that should be, well, retired.

Residents and families appear to like the comforting and humanized care that dementia villages offer. Compared with traditional residential care, this structure offers family members more ways to connect with their loved one: going on outdoor walks, grabbing coffee, going to the movies, etc.

But too often, proponents ignore these serious problems. We need more research into whether dementia villages are a sustainable and effective form of care that should be uncritically heralded as an easy choice over traditional care. In fact, it may be best for researchers to study existing facilities and their patient outcomes before building more of them. This will be crucial in determining whether this model is as good as it seems.

Kristina Carvalho, MSW, is a policy analyst at the Boston University School of Public Health.