Canadians living with dementia “want to maintain their independence; they want to live at home and engage with their community,” says Pauline Tardif, former CEO of the Alzheimer Society of Canada. With that in mind, Canada’s first publicly funded dementia village is set to open next summer.
The number of older adults in Canada is expected to increase by 68 per cent over the next 20 years; one in four seniors aged 85 and older is diagnosed with dementia. Thus, novel ways of caring for dementia patients are urgently needed. Dementia, most commonly caused by Alzheimer’s disease, can impair one’s ability to remember facts, communicate ideas and carry out activities in their daily life. Patients living with dementia not only require considerable care and attention, but also exhibit behavioural changes like aggression that are distressing to others around them.
However, as dementia progresses and patients can no longer rely on themselves to complete basic tasks such as bathing, eating and dressing, they may require long-term care.
Dementia villages are designed to prioritize patients’ safety and support without compromising their autonomy and community. Besides receiving high-quality care, residents are free to roam around the village and join a variety of recreational activities. This innovative model of memory care began in the Netherlands in 2009, when De Hogeweyk opened its doors to patients living with severe dementia. The idea for a dementia village came when staff at what had been a long-term care home asked themselves, “Is this a place I would want to bring my parents?” Since their answer was “no,” they came up with this idea to continue “life as usual” for patients. The village takes a social and compassionate approach that ultimately leads to better health outcomes for patients, who have been reported to be more physically active and take fewer medications.
A decade later, The Village Langley in British Columbia became the first of its kind in Canada, built to include a store, a hair salon and a local cafe for residents to enjoy. Monthly costs for memory care cottage-style suites at The Village Langley start at $8,300. Since residents must pay 100 per cent of the fees out-of-pocket to access this private care facility, it is largely unaffordable to most people.
However, construction is currently underway in Comox, B.C., to open the country’s first publicly funded dementia village. Together By the Sea, on track to be completed by next summer, will include 155 resident rooms, each with its own bathroom, community gardens, an art studio, a bistro, a chapel and even a unique space to honour Indigenous culture. Monthly long-term costs for residents will be the same as at any other publicly funded long-term care home in B.C., based on 80 per cent of a person’s after-tax income, subject to a minimum and maximum monthly rate.
Delusion and distortion of reality are inevitable for patients living with dementia
“This new model of care is focused on providing people with dementia a sense of familiarity, family and friendships,” says Leah Hollins, Board Chair for Island Health. The $60.5-million project is financed through BC Housing with a 25-year operating agreement with Island Health.
Critics of dementia villages have pointed out that their “controlled aesthetic” is deceptive and that although concealing the nature of medical interventions may create a sense of calm in some, it may cause anxiety in others upon sudden or unexpected awareness of the illusion that everything is normal.
However, delusion and distortion of reality are inevitable for patients living with dementia. The goal of a dementia village is to provide patients with comfortable and compassionate care. Traditional hospitals and institutions can seem cold and impersonal, causing patients to feel a sense of stress and meaninglessness. On the other hand, social interactions with other patients and support from trained staff, such as those taking place within a dementia village, can positively impact their quality of life. If we just ask ourselves what we would choose for our own parents, the benefits for their everyday living and well-being may very well outweigh the occasional negatives of not knowing.
Feasibility is the other factor to consider because building a dementia village is no easy feat. Properties are hard to come by, particularly in urban centres and their alarming real-estate costs.
While these specialized villages are not going to spread across Canada anytime soon, there are important lessons to learn from this innovative model for memory care.
To encourage greater engagement with the arts, long-term care homes with dementia patients can consider renovating their spaces by painting colours over shades of gray and hanging paintings on the walls. Patient autonomy can also be improved by providing them with more opportunities to walk around and explore the outdoors, which would warrant more space and staff supervision.
In 2019, the Government of Canada released its first national dementia strategy, highlighting the importance of having inclusive access to high-quality and holistic health care that respects people’s dignity and keeps up with the country’s growing demand.
Although there is still a long way to go before we build more dementia villages, continued collaborations across sectors in government, health care, and design will guide us in the right direction toward improving patient care.
Correction: Pauline Tardif is the former CEO of the Alzheimer Society of Canada. An earlier version listed her as the current CEO.