Dementia Care: 5 Things to Look for in a Good Memory Care Community

Lessons from Hogewey, the Netherland's Dementia Village
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Imagine your loved one with Alzheimer's disease or dementia going about her daily existence -- shopping, cooking, visiting with friends, and enjoying full and active days -- in a safe and supervised village that doesn't feel different from any other town. That's the dream offered by Hogewey, a dementia care community in the Netherlands that's designed and staffed so residents don't even know they're in a care facility. It is being studied as a model of memory care.

At Hogewey, residents live in apartments with up to seven other dementia patients, sharing meals and daily tasks just like roommates in any other group living situation. There are restaurants, shops, a pub and movie theater, a town square, and extensive gardens and parks where residents can wander at will, just as they would do in any other town. But there's a difference: The "shopkeepers," housekeepers, and other staff are actually geriatric nurses and trained staff dressed as fellow villagers.

What does Hogewey mean for you? While such a community isn't available here in the U.S. (at least not yet), Hogewey represents a model of future care, as memory care specialists from around the world study the project for ideas they can bring home to their own programs. Meanwhile, several other concepts, such as the Green House initiative and the Eden Alternative, are also reshaping how memory care is provided. You can use lessons from Hogewey and other model programs to help you find the best memory care community for your aging parent or other loved one. Here are five things to look for in a memory care community to know that it's providing state-of-the-art care.

1. Surroundings That Feel Safe and Secure
People with dementia use cues from the environment around them to orient themselves and feel secure, physically and mentally. And you've probably noticed that when your loved one feels confused or disoriented, she also starts to feel anxious and scared. Therefore, a secure environment and a comfortable, predictable routine are key to helping your loved one stay calm. Also, studies have found that people with dementia don't do well in environments that feel disorganized and chaotic, so look for surroundings that feel peaceful, serene, and uncluttered. There's an additional benefit to feeling safe, too; reducing anxiety and stress decreases agitation and aggression, two of the biggest issues for dementia sufferers. And when you lessen agitation and aggression, there's less need for psychotropic medications.

2. A Philosophy That Fosters a Sense of Purpose
Psychologists know that people who continue to feel useful and involved as they age are less likely to experience depression and are more likely to stay healthy. It makes sense; feeling you have something to contribute is what gives you a "reason to get out of bed in the morning," in the words of Richard Leider, a leader of the Aging and Purpose movement. Research offers plenty of proof for this idea, with studies showing that people who feel a sense of purpose live longer and experience fewer mental and physical health problems compared with those who feel "useless" and isolated. Studies by Patricia Boyle of Rush University Alzheimer's Disease Center show that people who felt strong sense of purpose were less likely to develop Alzheimer's and dementia. And in people who already had cognitive impairment, the disease progressed more slowly in those who expressed that their lives felt meaningful.

Some memory care programs are taking the purpose-driven movement seriously. At Cedar Community, an innovative dementia care community in West Bend, Wisconsin, residents are encouraged to put their talents and abilities to use in service-based activities. Helping others fosters a sense of meaning and involvement, while participating in projects and activities provides cognitive stimulation. The Cedar Community is widely studied by architects, doctors, and dementia care for its focus on the "whole person" and the way it involves residents in giving back to the surrounding community. How do you find a community with this mission for your loved one? Look for one with a philosophy or mission statement that emphasizes service and community and provides a wide range of activities designed to stimulate creativity.

3. A Community Designed for Social Interaction
Residents of Hogewey live in group housing -- and so do those in "Green House" care communities around the U.S., as envisioned by William Thomas, MD, and his Green House Project. Quickly catching on around the country, the Green House model seeks to design -- or redesign -- senior care communities as clusters of small, intimate group homes that mimic the intimacy of family life. In Green House communities, staff are assigned to one community, so that residents have consistency in whom they interact with. You can see how beneficial this would be for those with Alzheimer's, who find it much less stressful to have the same caregivers day after day. And the physical surroundings aren't the only difference; residents of "green houses" are active participants with a say in household decisions and how things are done, not passive recipients of care. Why? Like all of us, people with dementia feel better and more secure when they feel they're being listened to and taken seriously. While the Green House idea has only been around since 2001, studies of communities following this model show that residents are more engaged, happier, and more satisfied with their living arrangements than people in traditional care communities.

4. A Program That Offers Innovative Cognitive Therapies
Two types of therapy used prominently at Hogewey and many other respected dementia care programs are reminiscence therapy and cognitive stimulation therapy, both designed to keep the brain active and engaged. In reminiscence therapy, also sometimes called life-story work, a therapist or other professional will help your loved one recall events, experiences, and relationships from the past, often using photos or mementos as triggers. This therapy may involve helping your loved one compile a scrapbook, photo album, or memoir to put events into a timeline. Usually done in small groups rather than one-on-one, cognitive stimulation therapy (CST) features puzzles, games, and music or language lessons to stimulate mental processes. Other activities might include arts, crafts, dance, cooking, or group discussions of current events.

5. An Environment That Includes Pets, Plants, and People of All Ages
According to the Eden Initiative, another healthy aging movement, we do best if we age in surroundings filled with plants, animals, and people of all ages. While this Garden of Eden ideal may not be entirely practical for many people with dementia, many memory care communities are introducing programs that offer residents a chance to play with pets and interact with people of different generations, including children. And there's no question that having a garden and grounds to walk in is extremely beneficial for all seniors, including those with cognitive decline. Some dementia care programs are experimenting with aromatherapy, doll therapy, and other activities designed to stimulate participants' senses, engage their emotions, and help them remember the things they've always loved and enjoyed. Others have vegetable gardens residents can work in, or pets such as birds and fish residents can help care for. Others have programs that bring young children or teenage volunteers in for shared activities. A few innovative memory care programs collaborate with local preschools, offering residents the opportunity to help care for and play with young children. When visiting memory care communities, keep an eye out for how much and how often the residents get the chance to experience all the joys of the natural world.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio