De Hogeweyk, often referred to as the “Dementia Village,” is an internationally recognized best-practice model in the field of dementia care. Situated in Weesp, Netherlands, and operated by the Vivium Care Group, this pioneering care environment integrates architectural design, social inclusion, and person-centered health services to enhance the quality of life for individuals with advanced dementia. This represents a paradigm shift in dementia care: away from custodial models and toward human-centered, participatory, and sustainable environments. Its integration of architecture, health, and community design provides a compelling blueprint for future aging-in-place strategies.
Introduction: Rethinking Dementia Care
Dementia is one of the fastest-growing public health challenges worldwide, with the number of people affected expected to triple by 2050. Conventional institutional care models often prioritize clinical control over quality of life, resulting in environments that may exacerbate confusion, anxiety, and isolation among residents.
De Hogeweyk challenges this paradigm by offering a small-scale, lifestyle-oriented residential model that supports autonomy, social engagement, and dignity in aging. The initiative aligns with contemporary frameworks in public health and gerontology that call for integrated, community-based, and rights-driven responses to cognitive decline.
Historical Background and Vision
The vision for De Hogeweyk originated in the early 1990s, when practitioners at the Hogewey nursing home recognized that traditional approaches to dementia care failed to meet the emotional and psychosocial needs of residents. In response, the team developed a concept grounded in salutogenesis—a health promotion theory introduced by Aaron Antonovsky that emphasizes coherence, meaning, and social connectivity. After more than a decade of research and development, De Hogeweyk opened in 2009, funded through a combination of public health insurance and governmental capital investment totaling approximately €19.3 million.
Architectural and Spatial Design:
– Layout and Infrastructure
Occupying approximately 1.3 hectares, De Hogeweyk is designed as a gated, pedestrian-oriented village. It features 27 residential houses grouped around shared public spaces such as streets, courtyards, gardens, a supermarket, café, theatre, and hair salon. These amenities support the continuation of everyday life patterns while providing a secure and controlled environment.
– Lifestyle-Based Housing
Each house accommodates 6–7 residents and is themed according to familiar cultural and lifestyle backgrounds, such as “Urban,” “Homely,” “Cultural,” or “Indonesian.” The interiors reflect the décor, music, language, and customs aligned with residents’ life histories, which enhances orientation, reduces behavioral disturbances, and supports identity continuity.
Operational Model:
– Person-Centered, Non-Clinical Care
Staff at De Hogeweyk fulfill dual roles: while medically trained, they operate as neighbors, shopkeepers, or household members rather than in formal uniforms. This approach facilitates natural social interaction and reduces the institutional feel of care delivery.
The model minimizes pharmacological intervention, emphasizing relational care, physical activity, sensory stimulation, and participation in daily routines (e.g., cooking, cleaning, gardening). Studies have found that such environments can reduce the use of antipsychotics and improve behavioral symptoms among individuals with dementia.
– Autonomy and Safety Integration
Freedom of movement is preserved within the secured village perimeter. Residents are able to move independently across public areas, fostering autonomy and self-efficacy, while a discreet surveillance system ensures safety. This balance between liberty and protection is central to the model’s ethical framework.
Social and Health Outcomes:
– Enhanced Quality of Life
Quantitative and qualitative evaluations suggest that De Hogeweyk residents experience significantly improved well-being compared to those in traditional care facilities. Benefits include:
- Lower levels of anxiety, depression, and aggression
- Increased social interaction and participation in group activities
- Higher levels of physical activity and functional independence
– Family and Community Engagement
The inclusive design facilitates active participation of family members and volunteers. Relatives can dine, celebrate, or simply accompany residents within an environment that mirrors a real-life setting, enhancing family bonds and reducing caregiver stress.
– Staff Satisfaction and Retention
Due to the human-centered ethos and team-based structure, De Hogeweyk reports higher staff satisfaction and lower turnover compared to conventional facilities—an important indicator of organizational sustainability in healthcare.
Financial Model and Economic Feasibility:
– Capital Investment and Funding
The initial investment for De Hogeweyk amounted to approximately €19.3 million. Of this, €17.8 million was publicly funded through Dutch social health insurance and aging infrastructure grants. The village’s long-term viability is anchored in the Dutch long-term care system, which is among the most comprehensive in Europe.
– Operating Costs and Cost Efficiency
- Monthly costs per resident range between €5,000 and €8,000, broadly comparable to high-quality institutional care.
- The cost-benefit analysis indicates reductions in medication use, fewer hospitalizations, and improved health outcomes, which can lower indirect and system-wide costs.
- Public-private synergies—including café and theater revenues, volunteer services, and academic partnerships—further enhance operational efficiency.
– Value for Society
From an economic standpoint, the broader social return on investment (SROI) is notable. By improving residents’ autonomy and reducing caregiver burden, De Hogeweyk contributes to public health goals and reduces long-term systemic pressure on acute care facilities.
Transferability and Policy Relevance:
– Replication Potential
While the Dutch policy context is uniquely supportive, De Hogeweyk has inspired replication efforts worldwide, including:
- Village Landais Alzheimer (France)
- Gundsølille Landsby (Denmark)
- Pilot projects in Canada, Germany, Switzerland, and Australia
Success in other contexts depends on adapting the model to local cultural, regulatory, and financial conditions.
– Challenges:
- High start-up costs can be a barrier in systems with limited public health investment.
- Some critics argue the approach involves elements of “benevolent deception“—curating an idealized reality for residents, which raises ethical concerns around informed consent and autonomy.
- The staffing model requires intensive training and a high staff-to-resident ratio, making scaling complex.
Nonetheless, these concerns are outweighed by measurable benefits in dignity, safety, and psychosocial health—particularly when grounded in ethical planning and transparent design.
Lessons for Sustainable Social Innovation:
De Hogeweyk offers a replicable framework for inclusive and health-promoting design. Key transferable elements include:
- Spatial configurations that support behavioral orientation and social engagement
- Lifestyle-based environments as tools for emotional grounding and cultural continuity
- Blended roles for care staff that humanize the caregiving experience
- Integrated operations with local businesses and volunteer networks
- Data-driven governance informed by interdisciplinary research partnerships
At Planet 3 PM, we aim to bring best-practice concepts like De Hogeweyk into action. We support public and private stakeholders across Europe in developing socially sustainable, financially viable, and community-integrated care models. Let’s co-create dementia-supportive communities that combine care, autonomy, and dignity.
👉 Contact us today at 📧 projects@planet3pm.si to explore our services and partnership opportunities.