Peter Moody always starts his day with a cup of coffee. He then laces up his white Reeboks and heads out the front door for a run. Moody might jog past his neighbour, Bob Beauchamp, walking his black-and-white dog, Lucy. He might pass another resident on their way to buy a few groceries or others sitting on a bench in front of their cottages, enjoying the sunshine. Later in the day, Moody might visit the community centre to listen to music or watch a movie. Or he might go on another jog.
It’s an unremarkable scene, really, except that each of the community’s forty-five current residents lives with some form of dementia: the syndrome where memory and the ability to perform everyday activities progressively deteriorate. The Village, located in Langley, BC, opened its doors last August, making it the first dementia-care facility in Canada that does not identify as a hospital or a care home but a whole town. There’s the community centre, which houses a general store and a hair salon. Residents live in six single-storey cottages, each painted a different colour, with white picket fences. There’s a well-tended communal garden. Tall evergreen trees line the Village’s picturesque perimeter, as does a two-and-a-half-metre-tall fence, built so residents can wander the grounds independently without straying too far from staff.
Dementia has no known cure. Alzheimer’s disease is its most well-known and common form, although it isn’t the only one: vascular dementia and Lewy body dementia are others. Whatever the type, over time, dementia’s progressive nature will affect an individual’s ability to live independently. They might forget how to use everyday objects, such as cutlery or a toothbrush, or they might forget which groceries need to be refrigerated. Maybe they can’t remember whether they’ve taken their medication or the steps to take when showering. Eventually, dementia could also affect the individual’s safety: they might forget to turn off the stove or put on a coat in the winter, or they might get lost while walking in familiar areas. That’s when a care home could be needed—a place where individuals with dementia often live full-time and where staff assist with everyday tasks.
The Village, however, is a far cry from the care homes and dementia units that Karen Tyrell worked at for more than twenty years in Ontario and BC. They looked like hospitals and felt cold and hostile. Mostly, she remembers the locked doors. One afternoon in particular stands out: she had finished her shift and was leaving the facility. The residents saw her walk through the unit’s doors, which clicked shut behind her. Through the window that looked out beyond their unit, they watched her walk away. Behind her, Tyrell heard the residents banging on the locked doors, asking Tyrell to take them with her, begging her not to leave them.
“People with dementia are still human,” she says. “And that way of housing those people just felt so wrong.” These days, Tyrell runs her own Vancouver-based business, Personalized Dementia Solutions, working as a dementia-care consultant and sharing care techniques to minimize the negative behaviours common to those with dementia, like anxiety, agitation, and aggression. In her book Cracking the Dementia Code: Creative Solutions to Cope with Changed Behaviours, Tyrell explains that fear, confusion, and the sense of being trapped can drive aggression as well as the panic and anxiety she saw in that locked dementia unit. Conversely, to minimize those emotions, she adds, caretakers must prioritize a person’s autonomy, individuality, and freedom. It may seem simple, but when it comes to dementia care, it could also be revolutionary.
Between 2002 and 2013, the number of Canadian seniors living with dementia increased by 83 percent, according to the Canadian Institute for Health Information. In 2016, the Alzheimer Society of Canada estimated that more than half a million Canadians were living with dementia and projected that this number would rise by 66 percent by 2031. There is a clear need to consider how to care for this growing population in a way that is both compassionate and effective. Already, other care facilities similar in concept to the Village are beginning to pop up, with communities currently being developed in Vancouver and Comox, BC. All of them are working to answer an urgent question: Could a place where someone has the freedom to live their day as they choose, move around as they like, and walk outside whenever they please be a model for the future of dementia care?
Elroy Jespersen sits on a yellow couch in one of the Village’s sunrooms, a beam of light streaming in. Jespersen helped found the Village. Before turning to this project, he worked in the senior-care industry for thirty years in cities across Canada. In a wavering voice, he explains one of his motivations for the project: in 2014, his wife’s aunt began showing symptoms of dementia and was placed in a care home. There, she often left the facility and sometimes got lost while walking around West Vancouver. Her dementia progressed, she continued her walks, and she continued to get lost. She went from freely walking kilometres each day to no longer being able to do so safely. Jespersen felt that he couldn’t provide her with what she needed most: a sense of self.
He considered the possibility of a better way of care. First, he turned to the US nursing-home culture-change movement, which pushes for traditional institutional models to be replaced with environments that look, feel, and operate like actual homes. The movement, which has been gaining ground since the late 1990s, advocates for better quality of life and care that goes beyond a person’s basic physical needs to also consider their identity, their values, and their interests. The movement stresses the importance of autonomy, meaningful activities, and close social interactions—all things that make anybody’s life, no matter their age, worth living. For seniors, particularly those with dementia, such factors can be especially crucial.
American geriatrician Bill Thomas came to such a conclusion when he first accepted a job in a care home, in the early 1990s. There, he witnessed what he describes as endemic loneliness, helplessness, and boredom among residents. He now calls these feelings “the three plagues.” Instead, he sought to foster an understanding of well-being that included autonomy, connectedness, and a resident’s source of joy and identity—whether they enjoyed walking, baking, or gardening. Thomas’s philosophy challenges that of traditional care homes, where care is often centred exclusively on mitigating physical decline. For Thomas, good dementia care—as well as good care for seniors without dementia—is about ensuring the whole person is nurtured so they can continue to live a meaningful life.
In 1994, Thomas co-created the Eden Alternative, an international nonprofit that works with seniors’ organizations to help them implement a holistic approach—one that focuses on eradicating the three plagues. Recent data collected by the Eden Alternative found that the populations of American care homes that switched to this approach required 26 percent less antipsychotic medication within the first year. Another study found an 18 percent decrease in the use of restraints at Texas-based homes that used the approach. And one Kentucky-based organization found the communities that embraced the Eden Alternative approach saw a reduction in falls, weight loss, nurse turnover, and antipsychotic medication.
The Village doesn’t adhere to one care model. Jespersen also borrowed from other approaches around the world, including De Hogeweyk in the town of Weesp, in the Netherlands, and the Green House Project in the US. Both are community-like care homes that prioritize residents’ freedom of movement, and each also offers homey environments instead of institutional ones, providing residents with autonomy. For Jespersen, the result is a unique combination of existing best practices meant to focus on a person’s remaining abilities, not on their decline.
Adrienne Alford-Burt, the executive director at the Village, recalls one late evening at work. Before heading home, she stopped by one of the cottages, knocked, and waited to be invited inside. She remembers the smell of fresh baking filling the air. The residents, she says, had decided to host a high tea the next day and, with the help of a staff member, were busily preparing homemade pastries, egg tarts, and cookies. For Alford-Burt, this is just one example of what makes the Village different. “A misconception about people living with dementia is that they can’t learn or can’t be productive,” she says, adding that, in her experience, “in a traditional setting, you’ll see baking listed on the recreational activities board, and a group of residents sit around and watch the staff do the work.” But not at the Village.
Alford-Burt argues that business-as-usual methods will not meet the growing demand for dementia care, and she worries people will be warehoused in institutional facilities. So do federal policy makers. Last June, the government of Canada released its first national dementia strategy, which was created to influence how the country approaches the expected dementia boom. The strategy explicitly outlines a need to focus on dementia care that is holistic and respectful of individuals’ dignity, and it acknowledges that, currently, there is a lack of both access to and awareness of such care. It also warns that, considering Canada’s aging population, access to good dementia care will only become more challenging, and the availability of good care could decline if changes aren’t made to meet future demand.
Jespersen and Alford-Burt both see what they’ve created as a starting point, not the end solution, when it comes to supporting Canadians living with dementia. For one, the Village can be a challenging template to follow. It sits on 2.8 hectares of land, and this property’s availability, area, and location were pure luck. Jespersen happened upon an ad selling a former elementary school site in 2016. That much space is hard to come by in urban centres, and real estate costs can be prohibitive. So, too, can patient costs. Monthly fees for the Village range from $7,300 to $8,300, an all-inclusive rate Alford-Burt says is consistent with the industry average. Still, because the Village is a private care facility, there are no government subsidies available. Residents must pay 100 percent of the fees out of pocket, hindering equal access.
But, even if replication is difficult, both Jespersen and Alford-Burt want the Village to inspire others providing dementia care. Those unable to build new structures or renovate existing ones could work to shift culture, for instance, by focusing on giving residents the freedom to live on their own terms. Even incorporating more colour by painting over the institutional whites and greys or hanging artwork on the walls, suggest Jespersen and Alford-Burt, would be a step in the right direction. “I hope to see the day when we don’t need dementia villages, but that’s not today,” Jespersen says. “There needs to be change, both with the design of our cities and in society as a whole. But, until that happens, this is a whole lot better than the options out there.”