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.
De Hogeweyk, a residential community in Weesp, Netherlands, is the world’s first dementia village—a place where people with advanced dementia live in an environment that looks and functions like a normal town, complete with a supermarket, restaurant, theater, and town square. Rather than confining residents to a traditional nursing home with locked doors and institutional routines, Hogeweyk normalizes daily life for people with severe memory loss by creating familiar, walkable spaces where they can move freely.
This approach fundamentally changes how caregiving happens: instead of residents adapting to a facility, the facility adapts to how residents want to live. This article explores how Hogeweyk works, what research shows about its effectiveness, and how this Dutch model is now being replicated across the world—including the first dementia village coming to the United States in Wisconsin. We’ll examine both the promising results, like the dramatic reduction in psychiatric medications, and the honest limitations of the model that developers and families should understand before hoping for similar solutions in their own communities.
Table of Contents
- How De Hogeweyk Reimagined Dementia Care in the Netherlands
- The Physical Design That Changes Everything
- Life in the Village—Community Over Confinement
- The Medication Reduction That Surprised Researchers
- The Limitations and Honest Challenges
- The Global Expansion and America’s First Dementia Village
- What Comes Next—The Future of Dementia Care Design
- Conclusion
How De Hogeweyk Reimagined Dementia Care in the Netherlands
De Hogeweyk opened in December 2009 as an experimental answer to a painful reality: traditional memory care units confine people with dementia to locked wards where the environment constantly reminds them of their loss of freedom. The village was designed and built at a cost of €19.3 million, funded primarily by the Dutch government (€17.8 million) with €1.5 million from local organizations. The initial vision was ambitious—create a space where residents could maintain dignity, autonomy, and connection to normal life, even as their cognitive abilities decline.
The village started with 23 houses designed to accommodate 152 residents, supported by 250 staff members. In 2018, recognizing the demand and success of the model, Hogeweyk expanded by adding 4 additional houses, bringing the total to 27 houses serving approximately 188 residents today. The monthly cost per resident is approximately €5,000—comparable to traditional nursing homes in the region, which is significant because Hogeweyk achieves a fundamentally different quality of life at similar expense, not at premium pricing. This cost parity matters for policy conversations: dementia villages aren’t expensive because they pamper residents; they’re expensive because they require more staff and infrastructure, but the cost is manageable within existing eldercare budgets.
The Physical Design That Changes Everything
Walking through Hogeweyk, you don’t see institutional hallways or medication carts. Instead, you encounter a village layout with winding streets, a tree-lined town square, a working supermarket with real products, a café, a restaurant, a hair salon, a theater, and residential gardens. Each house accommodates 6 to 7 residents and is designed around a lifestyle theme—some reflect working-class Dutch life, others upper-class traditions, and still others reflect rural or urban settings. The idea is that residents with severe dementia often cling to long-term memories more reliably than recent ones; if you live in a house reflecting the era and lifestyle you remember, the environment reinforces rather than contradicts your sense of reality. However, the physical design alone doesn’t explain Hogeweyk’s impact.
The staffing model matters equally—and this is where many imitations struggle. Hogeweyk staff members wear normal clothing, not clinical uniforms. They work in community roles: some operate the café, some work the supermarket, some tend the gardens. This blurs the line between caregivers and community members. A resident who wants to go shopping doesn’t experience it as a “therapeutic activity”—they experience it as a normal trip to a real shop, assisted by someone who happens to be staff. For people with dementia whose minds are trapped in earlier decades or unable to process abstract concepts, this normalization is more therapeutic than any protocol could be.
Life in the Village—Community Over Confinement
One of the most striking features of Hogeweyk is that residents are not locked in. They can walk freely throughout the village grounds. Security measures exist (the perimeter is monitored, for instance), but the open circulation removes the psychological weight of being locked away. For family members accustomed to memory care units where their loved ones are confined to locked units, this openness is disorienting at first—how can this be safe? But Hogeweyk’s answer is pragmatic: residents are monitored by community members (staff working in visible roles), and the village environment is specifically designed to be disorienting in a supportive way—confusing enough that residents don’t try to leave, but comfortable enough that they don’t feel trapped. Daily life in the village centers on ordinary activities. Residents eat meals in the restaurant or café.
They shop in the supermarket (with staff assistance if needed). They attend performances in the theater. They visit the hair salon. They spend time in the gardens. The rhythm of the village creates structure without feeling imposed. This matters because residents with advanced dementia often resist care when it feels like control, but they participate willingly in normal activities. A woman who refuses to bathe when a nurse approaches her with a washcloth might happily bathe after a staff member mentions she has a date to attend the theater—the activity becomes the reason, not the medical procedure.
The Medication Reduction That Surprised Researchers
One of the most measurable outcomes from Hogeweyk is the dramatic reduction in antipsychotic medications. Before moving to the village model, approximately 50% of residents with advanced dementia received antipsychotic drugs—typically prescribed to manage behavioral symptoms like aggression, wandering, or agitation. At Hogeweyk, by 2019, that figure had dropped to approximately 12% of residents. This shift is significant because antipsychotics in elderly dementia patients carry serious risks: increased risk of stroke, cardiovascular events, sedation that accelerates cognitive decline, and loss of the person’s personality as the medication dulls emotional responses.
The medication reduction likely reflects both the environment and the care model. When residents live in a village that makes cognitive sense to them, when staff interact as community members rather than controllers, and when daily life follows familiar rhythms, behavioral symptoms often diminish naturally. There’s less reason to act out if you’re not constantly confused and frightened. However, this outcome comes with an important caveat: the research demonstrates medication reduction, but comprehensive clinical studies validating whether the village model produces better overall health outcomes—in terms of cognition, functional ability, or behavior—compared to well-staffed traditional memory care remain limited. Hogeweyk has been observed, but not yet rigorously tested against high-quality alternatives.
The Limitations and Honest Challenges
Despite its international reputation, Hogeweyk is not a cure or a universal solution. The village is designed for people with end-stage to advanced dementia—those who are no longer aware they have dementia, who live in earlier memories, and who respond to environmental cues more than cognitive rehabilitation. It’s not appropriate for early-stage dementia patients, who benefit from cognitive therapy, reality orientation, and engagement with their present circumstances. It’s also not appropriate for people with dementia who have severe medical needs (requiring hospital-level care) or psychiatric conditions that predate dementia.
The model also requires significant staff presence—250 staff for 188 residents—and Dutch labor market conditions that favor generous staffing. The Dutch healthcare system’s funding model, cultural values around eldercare, and willingness to invest in specialized infrastructure created conditions that allowed Hogeweyk to exist. Replicating this in countries with different labor costs, healthcare funding, or cultural attitudes toward institutional aging is genuinely difficult. A home-like environment requires more staff, not fewer, because people are moving freely and require subtle supervision rather than structured control.
The Global Expansion and America’s First Dementia Village
Hogeweyk’s success inspired similar projects worldwide. Dementia villages have been developed or are in development in multiple European countries, Australia, China, and Canada. But America has lagged behind, partly due to the cost and partly due to skepticism about a model that seems idealistic rather than evidence-based. That’s changing.
Agrace, a nonprofit hospice and elder care provider, is building the Ellen & Peter Johnson Dementia Village in Madison, Wisconsin—the first Hogeweyk-inspired dementia village in the United States. The facility represents a $40 million investment, with a capacity for 65 residents and expected opening in 2027. Groundbreaking is scheduled for spring 2026. This project signals that the model has moved from experimental Dutch initiative to mainstream American eldercare development, and it offers a test case for whether the philosophy and design principles translate to a different healthcare context.
What Comes Next—The Future of Dementia Care Design
As dementia prevalence rises globally—driven by aging populations and increasing diagnosis rates—the question is whether dementia villages will become standard or remain boutique services for the wealthy or fortunate few. The Ellen & Peter Johnson Village in Wisconsin will provide crucial data on the American context: costs, staffing challenges, sustainability, and actual outcomes compared to traditional memory care in the U.S. system.
The deeper insight from Hogeweyk, regardless of whether the village model scales globally, is that dementia care design matters profoundly. People with advanced dementia respond to environment, to dignity, to normalcy, and to meaningful activity. They respond poorly to confusion, control, and isolation. Whether that recovery of wellbeing happens in a designed village or in a reimagined traditional facility, the principle holds: the way we house and support people with dementia either reinforces their loss of self or creates conditions where their remaining sense of self can breathe.
Conclusion
De Hogeweyk demonstrated that dementia doesn’t have to mean confinement, medication, and the loss of personhood. By creating an environment where residents with severe memory loss could live in ways that made sense to them—walking freely, participating in normal activities, interacting with staff as community members—the village achieved measurable improvements, including a reduction in antipsychotic medications from 50% to 12% of residents.
The model has inspired global interest and will soon be tested in the American healthcare system through the upcoming Ellen & Peter Johnson Dementia Village in Wisconsin. However, families and communities should approach dementia villages with clear eyes: the evidence for improved health outcomes remains limited, the model requires substantial staffing and infrastructure investment, and it’s most appropriate for people with end-stage dementia. The true legacy of Hogeweyk may not be that every dementia patient should live in a village, but that every dementia care setting should ask itself: Are we designing this for the person with dementia, or are we designing it for administrative convenience? That question, applied thoughtfully, can transform care—even without building an entirely new village.
You Might Also Like
- How Service Dogs Are Being Trained Specifically for Dementia Patients and What They Cost
- Why Former Athletes Are Getting Dementia at Younger Ages and the Research Behind CTE
- Why Athletes Get Dementia More Often
For more, see National Institute on Aging.
