Reviewed by the Help Dementia Editorial Team — our editors review every article for accuracy against guidance from the National Institute on Aging, the Alzheimer’s Association, and peer-reviewed sources.
Dementia village sits at the center of this dementia and brain health question.
America is beginning to adopt the dementia village model, a revolutionary approach to memory care inspired by successful Dutch communities. Currently, two major dementia villages are actively under construction in Wisconsin—the Agrace Ellen & Peter Johnson Dementia Village in Fitchburg and Livasu Village in Sheboygan County—while a third project, Avandell in New Jersey, faces regulatory delays. These communities represent a fundamental shift away from traditional nursing homes and assisted living facilities toward intentionally designed environments where residents with dementia can maintain independence, dignity, and purposeful daily routines within a safe, contained setting. The Agrace project in Wisconsin is the most advanced, with a groundbreaking scheduled for spring 2026 and an opening expected in September 2027.
This $40 million facility will house 65 full-time residents across eight household units, modeled directly after Hogeweyk, the pioneering Dutch dementia village that opened in 2009 and now serves 188 residents. Unlike traditional memory care units with locked doors and clinical corridors, these villages feature realistic streetscapes with shops, restaurants, movie theaters, and parks—all designed to feel like authentic neighborhoods while maintaining security and medical oversight. The dementia village concept addresses a critical gap in American memory care. Most existing options force residents into binary choices: independent living (which becomes unsafe as cognition declines) or institutional care (which strips away autonomy and meaning). Dementia villages occupy the middle ground, providing the structure and supervision that advanced dementia requires while preserving the psychological benefits of normalcy, choice, and community engagement.
Table of Contents
- What Are Dementia Villages and How Do They Differ From Traditional Care?
- The Agrace Ellen & Peter Johnson Dementia Village: Fitchburg’s Landmark Project
- Livasu Village and Early-Stage Development in Sheboygan County
- Avandell in New Jersey and the Regulatory Challenges Facing the Model
- The Cost Question and Affordability Concerns
- The Design Philosophy and Environmental Factors
- The Future of Dementia Villages in America
- Conclusion
What Are Dementia Villages and How Do They Differ From Traditional Care?
Dementia villages are purpose-built residential communities designed specifically for people with moderate to advanced dementia who can no longer safely live independently but don’t require intensive medical intervention. Unlike locked memory care units, villages are intentionally designed to feel like small towns or neighborhoods, with genuine storefronts, sidewalks, and public spaces where residents move about freely. The key difference lies in the environment: while a nursing home resident with dementia faces beige institutional walls and restricted movement, a dementia village resident can take a walk to the village café, browse the grocery store, or sit in a park—all while trained staff members are embedded throughout the community, positioned to assist without being visibly intrusive. Hogeweyk in Winsnum, the Netherlands, pioneered this model and remains the gold standard. Opened in 2009, it demonstrates that residents with advanced dementia thrive when given autonomy within a safe perimeter. Staff members at Hogeweyk don’t wear uniforms and blend into the community.
Residents maintain daily routines that resemble normal life: some work in the garden, others help prepare meals, many socialize in common areas. The result has been measurable improvements in resident mood, reduced behavioral issues, and fewer psychiatric medications needed—metrics that traditional care facilities struggle to match. The American dementia village movement began with the recognition that U.S. care standards, while medically competent, often fail the psychological and social needs of people with dementia. The standard nursing home approach prioritizes efficiency and risk mitigation, which can inadvertently infantilize residents and increase depression and agitation. Early research suggests that the psychological benefits of autonomy and normalized living may actually reduce certain behavioral complications, though long-term American data is still being gathered.
The Agrace Ellen & Peter Johnson Dementia Village: Fitchburg’s Landmark Project
The Agrace project in Fitchburg, Wisconsin, is the closest to reality and offers the clearest picture of what American dementia villages will look like. Developed by Agrace, a nonprofit hospice and palliative care organization, the village will sit on six acres and include a Main Street layout with a restaurant, spa, grocery store, movie theater, shops, and multiple parks and gardens. The core residential component consists of eight household units, each designed to house eight residents in a home-like setting, creating a more intimate scale than institutional care. The $40 million price tag reflects the specialized architecture and staffing requirements. Ellen and Peter Johnson, Madison philanthropists, provided a $7 million donation to support the project, helping to demonstrate that wealthy benefactors increasingly see dementia village development as a legacy investment.
The facility will serve 65 full-time residents, plus an additional 40 to 50 day club members who commute to participate in activities and socialization. The groundbreaking is expected in spring 2026, with opening scheduled for September 2027. However, the Agrace project also reveals a critical limitation of the dementia village model: cost and accessibility. At $40 million for 65 residents, the per-bed construction cost is substantially higher than conventional memory care facilities. This raises a vital question: who will be able to afford the resulting care? Unless the model receives insurance reimbursement adjustments or substantial public funding, dementia villages risk becoming exclusive communities available only to affluent families. The Agrace model will need to demonstrate that outcomes justify the cost before other developers commit to similar projects.
Livasu Village and Early-Stage Development in Sheboygan County
Livasu Village, located in the Town of Wilson within Sheboygan County, Wisconsin, represents the second major American dementia village project. At 79 acres with plans for 124 homes, Livasu is designed at a significantly larger scale than Agrace and will ultimately house more residents. However, unlike Agrace, which has detailed architectural plans, committed funding, and a construction timeline, Livasu remains in early-stage development. The project has been identified and publicly announced but has not yet reached the groundbreaking phase. The larger footprint of Livasu (79 acres versus Agrace’s six acres) suggests a different design philosophy—one that may aim for greater spatial separation between households or more extensive recreational facilities.
More homes (124 versus Agrace’s 65) could potentially achieve better per-unit economics, making the model more scalable and affordable. However, a larger campus also introduces challenges that Hogeweyk’s smaller model avoided: increased distances between residents and staff, greater complexity in maintaining a cohesive community feel, and potentially higher operational costs. The extended timeline for Livasu underscores that while the dementia village concept is gaining momentum, implementation remains in early stages. Developers must navigate zoning regulations, obtain health department approvals, secure financing, and recruit specialized staff—processes that routinely extend timelines and inflate costs. Livasu’s progress will be closely watched by other potential developers, as its success or difficulties will influence whether the model expands beyond Wisconsin.
Avandell in New Jersey and the Regulatory Challenges Facing the Model
Avandell, a dementia village project proposed for Holmdel, New Jersey, represents the third significant American initiative—though it currently exemplifies the obstacles the model faces. Developed by United Methodist Communities, Avandell is planned for an 18-acre site but has encountered zoning issues and regulatory delays from the New Jersey Department of Health. As of early 2026, the project has not yet broken ground, and no clear timeline for construction commencement has been announced. The Avandell delays reveal a fundamental challenge for American dementia village development: regulatory frameworks were built around traditional care models and don’t easily accommodate the novel approach of “purposefully constrained freedom.” Zoning boards may question whether a facility with 120+ residents qualifies as residential, institutional, or something else entirely. Health departments must reconcile standard care regulations with an operational model that differs significantly from nursing homes.
These regulatory hurdles are real barriers that will slow U.S. adoption of the model, especially in states with more restrictive long-term care licensing frameworks. Despite delays, Avandell’s existence matters. It demonstrates that the dementia village model has captured the attention of major nonprofit care operators, not just small experimental initiatives. United Methodist Communities’ commitment suggests growing industry recognition that traditional memory care is inadequate and that investment in alternative models is justified. However, the regulatory friction Avandell faces is a warning: rapid national expansion of dementia villages will require policy changes and regulatory flexibility that may not materialize quickly.
The Cost Question and Affordability Concerns
One of the most significant tensions in the American dementia village movement is financial sustainability. Hogeweyk in the Netherlands operates within a universal healthcare system where specialized care is funded through social insurance. The American context is fundamentally different: care is financed through private pay, Medicare, Medicaid, and long-term care insurance, none of which currently reimburse at rates reflecting the full cost of dementia village operations. Initial estimates suggest that Agrace’s per-resident construction cost will exceed $600,000 (total $40 million divided by 65 residents), and annual operational costs will likely be $100,000 to $150,000 per resident—substantially higher than typical assisted living or even some high-end memory care facilities. Without insurance reimbursement adjustments, these costs place dementia villages beyond reach for middle-income families and dependent on wealthy residents or philanthropic support.
This economic reality threatens to create a two-tier system: dementia villages for the affluent, and traditional institutional care for everyone else—potentially exacerbating inequality in end-of-life care. Some developers hope that improved outcomes and reduced crisis hospitalizations will eventually justify premium pricing to insurance companies and government programs. If dementia village residents experience fewer emergency room visits, reduced medication needs, and better quality-of-life metrics, payers might eventually reimburse at higher rates. However, this remains speculative. Until American dementia villages produce multi-year outcome data, the cost barrier will remain the single greatest obstacle to widespread adoption.
The Design Philosophy and Environmental Factors
Dementia villages are built on a specific environmental psychology: people with dementia function better when their surroundings are familiar, normalized, and non-threatening. This translates into architectural choices that distinguish dementia villages from medical facilities. Instead of nurse call buttons and fluorescent lighting, residents see storefronts, gardens, and natural light.
Instead of medication carts and clinical staff, residents encounter trained caregivers in civilian clothes integrated into the community rhythm. The Agrace village’s Main Street design includes a restaurant, movie theater, and shops—spaces that allow residents to engage in meaningful activities and social interaction even as their memory declines. Research on environmental design in dementia care suggests that such spaces reduce wandering, decrease aggressive behavior, and increase engagement compared to institutional settings. However, creating and maintaining these spaces requires staff training, community management, and continuous adjustment—operational complexities that traditional facilities don’t face and that can drive costs upward.
The Future of Dementia Villages in America
The emergence of multiple dementia village projects across Wisconsin, New Jersey, and (by extension) the broader U.S. signals a significant shift in how the care industry is thinking about memory care. The model is no longer purely aspirational or experimental—it’s moving into actual construction and operation.
Over the next five years, the success or failure of Agrace, Livasu, and Avandell will likely determine whether dementia villages become a meaningful alternative to traditional care or remain a niche option for the wealthy. Success will require three elements: (1) demonstration of superior outcomes in resident quality of life, behavioral health, and family satisfaction; (2) regulatory evolution to accommodate the model within existing care licensing frameworks; and (3) financial innovation, likely including insurance reimbursement adjustments, public funding mechanisms, or philanthropic support at scale. The Hogeweyk model has proven that dementia villages can work and can improve lives. The American question is whether the model can work within American healthcare economics and regulatory environments—and whether the country will commit the resources to bring it to scale.
Conclusion
The dementia village concept represents a genuine alternative to the institutional care model that has dominated American memory care for decades. With projects actively under construction in Wisconsin and regulatory processes underway in New Jersey, the U.S. is beginning to implement a model that emerged from the Netherlands and has demonstrated measurable success in creating more humane, psychologically supportive environments for people with advanced dementia. The Agrace Ellen & Peter Johnson Dementia Village will be the first test case, opening in September 2027 with a design directly inspired by Hogeweyk’s proven approach.
However, realizing the full potential of the dementia village model will require addressing significant barriers. Cost remains the primary obstacle—dementia villages are substantially more expensive than traditional care, and without insurance and policy reforms, they will remain accessible only to affluent families. Families interested in dementia villages should begin conversations with care advisors and local developers now, as these communities will likely have extended waiting lists. At the same time, advocates and policymakers should recognize that a care model which improves resident quality of life and family satisfaction may justify the investment, particularly if it reduces crisis healthcare utilization and improves outcomes that traditional care cannot match.
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For more, see NIH MedlinePlus — cognitive testing.
