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.

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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.

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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.


This article was also published on Medium.

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38 thoughts on “Hogewey: A Better Kind of Nursing Home

  1. The mental health system is just as bad, even though it’s supposed to be better now that it’s not institutionalized. I worked in it for far too long. Hopefully all systems for the disadvantaged will improve one day.

  2. I so love this story. What seemed so obvious to those who have fought so long a system of systematic conformity and cruelty in method..this is Hope..in tangible.
    Thank you for sharing. A bright smile admist clouds is indeed lovely 🙂

      • In this we both and “hopefully” many will.

        Though in reality it seems..it will take the powers that be..to make monies on such this..our firmly held to heart.. ideals ..
        This too.. A price held.
        I hope not too high.

  3. I followed the link and had a look at the article you mentioned. The place sounds amazing. Furnishing homes in the style of particular decades to help relax the residents? Wow!

    Hogewey sounds amazing, but I guess the creation of places like that are just what happens when we start thinking about patients as actual living individuals rather than simply numbers on a spreadsheet.

  4. Even for a ‘lay carer’ like me, the possible benefits of such a set up are incredible. Preserving the freedom to be and manage their own lives as far as is safe for each individual must surely preserve more than ‘just’ independence.

    • Oh yeah, absolutely. The struggles of having such a cognitive disorder are already immense, and the deeply flawed traditional system only makes that struggle harder; hopefully someday, places more like Hogewey can become the norm.

      • I would like to hope so. I car for a son with some cognitive impairment through brain injury. His own home, independence and autonomy encouraged his recovery no end, rather than the other way around. I know, all too well, that dementia is not the same, even though the outward form may be similar… but I would hope that the common sense and sanity of Hogeway might appeal to planners… one day.

        • Oh yes, you’re absolutely correct about that, and it sounds like he’s been incredibly fortunate to have you there for him.

          That is exactly the sort of environment that best encourages recovery, by allowing the person to regain their independence as much as possible. I’ve cared for a number of younger people with traumatic brain injuries and other forms of cognitive and/or physical impairment, and the ability for them to have that autonomy is SO crucial.

          • I can quite understand the official take on health and safety… but frankly, normal life and growth is a series of risks taken when we stretch our boundaries. So, I feel, is recovery.A bit of common sense goes a long way.

  5. Hogewey sounds like such a brilliant idea, it treats the patients like real people, not just another number. Let’s hope this sets a standard, and perhaps one day become the model of care for nursing homes in the future.

  6. Are your nursing homes run by private businesses? Over here we have had so many problems with the state of the ‘industry’. I imagine Hogewey to be like a more benign Twin Peaks…or The Prisoner. Great article by the way, very insightful.

  7. Nicholas, thank you so much for sharing your beautiful mind, man. I think it’s brilliant and if only the Hogeway were embraced by much more compassionate people, the elderly would be happier with a better way of life.

    • Thank you for the kind words Dustin, I’m honored. And thank you for coming here and commenting, your insights are always appreciated.

      Regarding Hogewey, I agree entirely; something like this could really be revolutionary for the entire field, especially if the right sort of people get behind it.

      • You’r welcome. Your insights are also appreciated.:)

        It sure would change a lot of lives. Quality of life is important, more important than a lot of professionals think, apparently. But the sad part of it is, we wouldn’t have to come up with solutions (as cool as Hogeway is,) if nursing homes were as run as they should be. You know?

  8. Yes indeed brilliant! I would just add to the solution is to eliminate the need for the care to begin with… Our diseases begin long before we are diagnosed.. The choices we have made contribute to our poor state of health towards the later years of our life, and sadly many diseases once associated with the elderly are becoming more and more prevalent in younger and younger ages…

    The ultimate solution would include empowering and mentoring others long before a disease can take hold… prevention is still the best solution…

    But what to do while we wait for those who have taken prevention to catch up – Hogeweys model seems to have the greatest potential!!

    • Yes, completely agreed with that. There’s so much in the standard western lifestyle that needs to be worked on — and the pharmaceutical industry is making everything a lot worse, as well.

      It’s a tough battle ahead, but I do think that things are starting to slowly come around.

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