Reinventing Nursing Homes

The Hogewey Model

Those who have read my feature on Vox are aware that my experiences as a healthcare worker have given me strong views about the flawed way that our current system treats the elderly. In the contemporary era, the nursing home system is a corporate mess that packs too many people into a crowded hospital-like facility, with not enough staff to properly cover their needs. The problem is inherent in the design: “total institutions”, as Erving Goffman once wrote in his 1961 book Asylums, are systems that break down the individual in order to better serve the system. A total institution will force people to conform to its rituals instead of adapting to the people within the system.

To fix this, a whole new philosophy is needed. To make nursing homes work in a way that respects human beings, the entire system needs a complete overhaul. Now, after reading this article on The Atlantic, I see that one potential idea for that overhaul has a name: Hogewey.

Hogewey, known as the “dementia village,” takes a creative approach to elder care: instead of packing people into one building and forcing them to follow a routine, Hogewey is designed to be a small, enclosed town wherein residents are given the freedom to live relatively normal lives in an outdoor setting built specifically for their needs.

Hogewey has its own grocery store, a town square, a post office, a restaurant, a theater, and more, which residents are free to walk around in, socialize, and pass the time however they choose. Caregivers wear street clothes, and take on roles such as gardeners and cashiers, though no money is exchanged in the transactions. This freedom is exactly the quality that is so lacking in regular nursing homes, and it allows the residents to truly form their own community.

In addition to the obvious fact that residents are happier, CNN reports that residents require fewer medications, eat better, and live longer. Not surprising, really.

Hogewey’s philosophy is best described on their website:

Hogewey’s view on care is founded in day to day life in society. In normal society living means having your own space to live and managing your own household. People live together with other people sharing the same ideas and values in life. This makes the place where one lives a home. Hogeweyk residents have already lived a life where they shaped their own life, where they made choices about their own household and standards. The fact that a resident cannot function “normally” in certain areas, being handicapped by dementia, does not mean that they no longer have a valid opinion on their day to day life and surroundings. The residents opinion on life, housing, values and standards determine their “lifestyle”.

Hogewey is a brilliant idea, the exact sort of out of the box thinking that inspires real change in the world. While it’s easy to look at the dire state of nursing homes and cry that it’s impossible to fix, Hogewey proves that change is possible: it just requires a little creativity. Hogewey has already inspired similar dementia villages in Ontario and Switzerland, and with any luck, Hogewey’s success will inspire even more ventures. Perhaps someday, the flawed nursing home structure that we know today will be a relic of the past.

Nursing homes have a long way to go, and if things are to ever improve, then there are a lot of battles still ahead. Still, the fact that a place like Hogewey exists gives me hope for future.


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