Once upon a time, homes for older individuals were simple and warm places where residents could age gracefully. However, as time passed, these homes evolved into colder and more institutionalized spaces.
Among the various solutions that have emerged to return to a more caring home, dementia villages stand out as unique care communities. These villages offer a safe and nurturing environment for individuals living with dementia.
Last week, I had the privilege of experiencing firsthand the essence of these villages during my visit to The Village in Langley, British Columbia, Canada. Today, I'm excited to share with you this remarkable community and how it compares to other care communities.
How Care Homes Became Institutions
In the past, care homes for older adults were often more like a family that focused on creating a warm and comforting atmosphere, aiming to replicate the feeling of being in one's own home. Residents enjoyed a close-knit community environment where they could engage in daily activities and maintain a sense of autonomy.
So how did we transition to the more formalized institutions that often resemble hospitals? In the 20th century, the concept of care underwent significant changes:
Medicalization of Aging: As medical knowledge expanded, there was a growing recognition of specific health needs associated with aging. This led to the introduction of medical interventions within care homes.
Safety Concerns: To ensure the safety of residents, care homes started implementing stricter rules and regulations.
Efficiency and Scale: As care homes grew in size, there was a need for standardized routines and procedures to manage larger populations. This shift towards efficiency came at the expense of the personal touch.
Government Regulations: Increased government oversight and regulations aimed at ensuring the well-being of residents also influenced the transformation of care homes into more structured institutions.
In recent years, there has been a growing awareness of the need to strike a balance between ensuring the safety and well-being of residents while maintaining a homely and individualized environment
Innovative care models, like the dementia village, are examples of efforts to create environments that offer both safety and a sense of community.
Family Involvement
When it comes to dementia care, the presence of family and friends is incredibly important. It always saddens me to hear about family members or friends giving up on visiting someone living with dementia. Unfortunately, many people mistakenly think that if the person with dementia doesn't recognize them, their visits don't matter.
Even though someone with cognitive impairment might not remember your name or who you are, they still know that you hold a special place in their heart. That's why it's so crucial to keep in touch with someone living with dementia. They truly need your support. To understand why someone might forget you and how to deal with this challenging situation, check out our blog post The Day She Forgot Who I Am.
At The Village, the value of family and friends isn't just recognized; it's celebrated. Here, strong relationships are built through shared experiences. From enjoyable summer barbecues with family to festive holiday celebrations, these are the moments that create cherished memories for residents and their loved ones.
On the other hand, some care homes have rules that limit family visits during the first few important weeks after a resident moves in. Even though this approach is well-intentioned, it can accidentally make older individuals feel alone at a time when they need familiarity and comfort the most. At The Village, things are different. Families are warmly welcomed and encouraged to visit as often as they'd like. This open and inviting atmosphere makes adapting to the new environment easier.
During our visit to The Village, we witnessed something truly heartwarming. A group of around 10 friends and family members came together to visit. I'm not aware of any other places that not only permit but also encourage such gatherings. It was a touching sight to see.
Additionally, there's a resident at The Village who used to enjoy cycling. His biking buddies come to see him on their bicycles and even walk alongside him with their bikes. This thoughtful gesture helps him stay connected and feel like he's still part of their close-knit group.
Balancing Safety and Independence
In dementia care, maintaining an environment that ensures the well-being of individuals while preserving their sense of freedom and independence is of paramount importance.
Safety is a top concern for those with dementia. Cognitive impairments can lead to situations where an individual might unknowingly place themselves in danger, like leaving appliances on or taking a stroll and getting lost.
To address these risks, care facilities often put in place measures like secure entrances, surveillance, and structured routines. While these precautions are well-intentioned, they unintentionally create an environment that feels restrictive, compromising personal freedom.
Preserving autonomy is a key element in upholding dignity and enhancing the quality of life for individuals with dementia. The desire to feel in control of one's life and decisions holds immense emotional significance for all of us, regardless of cognitive impairment.
The visionary behind The Village, Elroy Jespersen, was inspired by innovative senior living approaches. He aimed to establish an environment where residents could maintain their full independence, experiencing a sense of liberation and control over their daily lives.
Jespersen highlights the concept of the "Dignity of Risk," emphasizing the delicate balance between ensuring a safe environment and allowing individuals to make their own choices.
While The Village operates within a closed community accessed only through a locked door, its residents enjoy unrestricted movement throughout both outdoor and indoor spaces.
The outdoor areas provide opportunities for fresh air and interaction with nature, featuring dedicated spots for gardening and farming. Residents even have the chance to engage with farm animals, such as goats and chickens, nurturing a connection with the natural world.
Incorporating modern technology is another strategy to ensure safety without impinging on independence. Smart home systems monitor residents, while wearable devices track their location and movement.
Family and friends do take residents out of The Village for walks in the area or drive to other locations.
The journey to strike the right balance between safety and autonomy in dementia care is an ongoing endeavor. The Village, however, has succeeded in creating an environment where both safety and autonomy flourish, enhancing the lives of those under their care.
Putting Residents First
During our engaging tour with Bonnie McDonald, The Village's warm-hearted Community Relations Manager, her genuine respect for the residents was immediately apparent. Beyond her enthusiasm for showing us the community, her unwavering commitment to the residents' well-being was very clear.
What struck me was her consistent practice of seeking residents' permission before entering their homes or rooms. While this might seem like a simple courtesy, it's a gesture that speaks volumes about the respect and dignity she upholds—a stark contrast to the experiences I've had in other care homes where such courtesy often falls by the wayside.
Bonnie's profound connection with the residents extended beyond knowing their names. She possessed an intimate understanding of their personal histories. Before their move to The Village, she takes the time to visit each potential resident in their homes, learning their interests and hobbies so she can later make sure attention is given to their preferred areas of interest.
A fascinating aspect of The Village's approach is that the next person on the waiting list doesn't automatically become the next resident. Bonnie shared an insight into this practice, highlighting how each "house" within the community possesses its own unique personality. Matching residents to a house that aligns with their temperament is a delicate process that ensures everyone finds their ideal home.
Regardless of the house they reside in, each individual has the freedom to determine their level of engagement. From selecting preferred activities to enjoying quiet contemplation at home, residents have the agency to shape their daily routines according to their desires.
The concept of structured timelines—such as fixed wake-up and breakfast times—is delightfully absent at The Village. Here, residents awaken and rise at their own pace, and not only choose their desired breakfast but may help make it themselves. Despite living within a communal setting, they retain full control over their lives, enjoying their independence.
The seamless blend of person-centered care and autonomy is genuinely heartwarming to witness. It's a testament to The Village's commitment to valuing the individuality, preferences, and dignity of each resident, fostering an environment where they thrive as unique individuals.
A Dementia-Friendly Community
When you enter The Village, you immediately sense a true community. What catches your eye is that everyone is dressed in their regular clothes—there are no clinical uniforms here. It's almost impossible to differentiate between residents, staff, and visitors, fostering a community environment rather than an institution.
The expanses of open spaces in The Village encourage free movement, although it could cause confusion when trying to locate one's house. However, the Village employs a clever color-coded system for its houses, simplifying the process of finding one's way back home.
Inside the rooms, residents are welcome to bring their own cherished furniture and personal belongings, with one exception—the wardrobe, which is thoughtfully provided. Initially, you might wonder about this choice, but a closer look reveals its purpose. The unique design of the wardrobe allows clothes to be hung at the front, ensuring they remain visible to the resident. This detail stems from an understanding that many individuals living with dementia struggle to recognize items once they're tucked away in closed closets or cabinets. To learn more about this sensory change, read If It’s Covered, It’s No Longer There within our blog post Understanding Dementia.
Within the village, a store awaits, offering residents the opportunity to engage in shopping. This goes beyond just food—residents can purchase items for baking and cooking, promoting a sense of independence and engagement.
Additionally, a charming café nestled within the community center and a welcoming hair salon cater to the residents' needs. These amenities not only offer convenience but also empower residents to carry out everyday tasks and errands independently.
The Village creates an atmosphere that prioritizes both comfort and agency, establishing a truly dementia-friendly haven that nurtures a sense of belonging.
Are There Drawbacks?
While dementia villages offer numerous benefits, it's essential to address their potential downsides as well. These are some of the drawbacks that might be associated with this type of community.
1. Financial Considerations:
A significant drawback of dementia villages is the cost associated with living in such specialized communities. The financial barrier often restricts access to only a few fortunate individuals. However, my personal experience during the visit to The Village surprised me, as the costs were notably lower than those of other care communities I'm familiar with.
The Village operates without an initial entrance fee, often referred to as a "buy-in." The monthly fee, covering accommodations and meals, is comparatively lower than what one might spend on 24/7 home care. For instance, the monthly rate for a studio is approximately $6,000 in US dollars ($8,200 CAD - Canadian dollars). This cost increases with additional care. The cost for assisted living is approximately USD $6800 ($9,200 CAD), assisted living plus is $7500 ($10,200 CAD), and complex care is close to $9000 ($12,200 CAD).
Luckily this village was not built for huge profits, but by those who felt the need to have a better care community for people living with dementia. In other countries, these villages have often been supported by the government which has kept costs comparatively low.
2. Segregation vs. Integration:
Critics of dementia villages raise an important point: by creating such isolated communities, are we inadvertently segregating those living with dementia instead of facilitating their integration into mainstream society? While I understand this perspective, I also believe that these communities serve as a valuable bridge until our cities and towns become more dementia-friendly, allowing individuals with cognitive decline to live independently within society. As of now, in my view, dementia villages represent one of the most viable options available.
3. Reinforcing Stigma:
Another argument against dementia villages revolves around the potential reinforcement of the stigma attached to dementia. Some worry that by establishing separate communities, we are perpetuating the idea that people with cognitive impairments should be kept apart from the rest of society.
While it's important to recognize the challenges and concerns surrounding dementiaa villages, it's equally important to emphasize their positive impact and potential.
Conclusion:
Dementia villages, like The Village in Langley, British Columbia, represent a creative response to the unique needs of individuals living with cognitive impairments. Their person-centered care, Inclusion of families, and innovative approaches demonstrate a true commitment to enhancing the lives of those living with dementia.
I would love to see in the future similar villages, where both older people with and without cognitive impairments live together. Such a model would not only prevent the segregation of people with dementia but also cultivate a sense of purpose by allowing others to extend help and support.
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