Bringing home the evidence on dementia villages

By Carli Wallington

Lately, you may have heard about dementia villages in the news. Dementia villages are long-term care homes that resemble villages and are designed for people with advanced dementia.

Dementia is a condition that affects the brain and makes everyday tasks – both mental and physical – more difficult as time goes on. The most common type of dementia is Alzheimer disease. Other types include Lewy body, vascular frontotemporal, and dementia associated with other conditions like Parkinson disease.


More than 400,000 Canadians live with dementia — most are over the age of 65. People with early to moderate dementia can often live in their home when supported by family, friends, or home care services. But people living with advanced dementia need more care. Over time, dementia affects the ability to carry out everyday activities, like eating, bathing, dressing, and toileting. People with dementia who can no longer live safely in their own homes are often moved to long-term care homes with around-the-clock care. As Canada’s population ages, the number of people living with dementia will increase. As a result, there will be a greater need for effective care models to support these individuals during the early, moderate, and advanced stages of dementia.

The dementia village – also known as the Hogeweyk Care Concept – is an innovative care model for people with advanced dementia. The first dementia village, De Hogeweyk, was developed in the Netherlands. Before its transformation, De Hogeweyk was a traditional nursing home. The redesigned De Hogeweyk is equipped with townhouse units that are shared by small groups of residents with similar lifestyles and interests. Further, all the services of a small village are available to residents, like a village supermarket, restaurant, pub, and theatre. These design elements allow residents to live life and receive care in a more home-like setting. Person-centred care at De Hogeweyk is centre stage. This type of care focuses on meeting the needs of the individual, while honouring their values, choices, and preferences. Assisted when necessary by staff, volunteers, or family, residents participate in everyday activities that are meaningful to them, like shopping at the village supermarket, preparing meals, enjoying the garden, or attending a concert.

For many, dementia villages based on the Hogeweyk Care Concept are a new and exciting way to care for people with advanced dementia. But we must ask ourselves — what does the evidence say? To answer this question, CADTH reviewed the emerging evidence on dementia villages. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures. Below are some key findings from CADTH’s review.

First, CADTH sought to answer the question: Do dementia villages improve residents’ quality of life? How individuals and researchers define “improved quality of life” can differ, but some examples for someone living with advanced dementia might include being more physically active, using less medication, or experiencing less agitation or anxiety. Currently, there’s not enough evidence to confidently say whether dementia villages improve quality of life for residents. However, dementia research has found that certain design factors may improve quality of life – such as, the design of small-scale, home-like group living environments, as well as access to outdoor space and gardens. These factors are key elements that have been incorporated into the dementia village concept.

Second, knowing whether a program produces good results for the money spent is important for those making decisions on whether to incorporate dementia villages into the current health care system. Unfortunately, not enough information on the cost-effectiveness of dementia villages was found to draw any conclusions. In-depth cost evaluations are certainly needed. What is known is that financial aspects, such as one-time costs (like the building of a facility) and on-going operational costs (like the possible need for more staff), would need to be considered.

Importantly, if dementia villages were to be made widely available in Canada, we must consider how easy or hard it is for individuals to access or use these villages. High monthly costs for residents in private facilities, limited availability for publicly funded spots, and limited accessibility for those living in rural or remote communities could make it hard for many Canadians to access dementia villages.

Overall, many see dementia villages as an attractive alternative to traditional long-term care homes – a place where people with severe dementia can live their lives with dignity and respect. Several dementia facilities modeled after the Hogeweyk Care Concept are planned for or under construction in Canada. As these facilities are established, it is important that good-quality evidence is collected on the benefits and costs of this type of care.

CADTH’s Health Technology Expert Review Panel (a committee that offers direction on CADTH projects) also created a position statement from this bulletin. Both this and the bulletin are freely available at cadth.ca. Visit our website to learn more about CADTH, follow us on Twitter @CADTH_ACMTS, or speak to a CADTH Liaison Officer in your region.

Carli Wallington is a Knowledge Mobilization Officer at CADTH.

 

 

 

 

 

1 COMMENT

  1. The concept of villages or small communities for those with dementia would be a bonus to the people affected by dementia and to the family members in that it is a “familiar” environment – something that a person can function in comfortably.
    In order to recreate a home-like environment, it would make sense to change the model of care from a medical to a social care model which is more in line with family and “home”. Of course adjunct Client-driven care services would be needed preferably by health care teams driven by a geriatric philosophy which is lacking in health care today where that are far more seniors than in the previous generation, but they too could have been better cared for by maintaining or rehabilitating to their ability level and concentrating on what is actually important to seniors and in this care to those with dementia.
    Reading “Towards a Community-based Dementia care strategy: How do we get there from here?” Morton-Change, Frnace Strategies for Dementia Care; and “A Qualitative study of how people living with dementia achieve and maintain independence at home: stakeholder perspectives”Rapaport, Penny,
    BMC, makes for interesting reading and food-for-thought on what people who have dementia want, and that ought to be the prespective when creating a home-like environment that offers freedom of choice, risks, autonomy and independence as able.
    The cost of care would drop if the care model changed. The options for housing alternatives would change. The how-to-provide care based on the social care model with adjunct Client-driven menu of care, based on, and adapted to needs, would reduce costs as well. Quality of life, quality of care and satisfaction of clients and family would improve. Medications prescribed likely would decrease and there would likely be less of a need to add any medications.
    This is not an untried care model as there are 8 Million informal caregivers in Canada providing care with few resources available, dependent on where one lives, particularly with those living at home now. And a large number of those who are being cared for have some form of dementia.

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