The idea of creating memory care villages gets a lot of ink – but not too many bricks.

Ever since the opening of the memory care village “Hogeweyk” in Weesp, Netherlands,  there has been no shortage of news coverage about how operators in the U.S. could learn from it and potentially adapt it for the incoming baby boomer generation. But 15 years after Hogeweyk took the memory care sector by storm, new coverage on dementia villages continues, but the building process largely does not.

That’s not to say memory care operators aren’t trying. Across the country, there are a handful of projects underway to emulate the dementia village in The Netherlands, including one from Willow Valley Communities and another underway in New Jersey from United Methodist Communities.

But the rarity of such projects speaks to the challenge of creating them, and the fast evolution of memory care services as a whole.

Awareness Challenges

Overall, the senior living industry has gained more awareness of the Hogeweyk model in recent years – “and hopefully more depth of understanding,” said Senior Designer Max Winters of Pittsburgh-based RLPS Architects in a recent interview with Memory Care Business.

“But I think unless someone sees it first hand for themselves, it’s hard to ‘believe’ that it has the impact that it claims to,” he added.

Winters co-wrote an analysis on Hogeweyk and dementia villages like it, highlighting the importance of community integration to memory care. Still, Winters acknowledged to MCB that it’s hard to see the dementia village model first hand when there are still so few of them to see.

One reason for that is that there are inherent architectural and planning challenges to translating what a nostalgic “village” means to Americans. “There’s such a wide variety of settings that people come from,” said Winters. “And the idea that you’re trying to build this community that feels familiar and feels normal to such a wide cross section of people is a real challenge.”

‘A bit of ageism, NIMBYism’

One of the reasons dementia villages remain rare is that even a team of crack architects can’t design their way out of the many legal and political hurdles developers need to clear before breaking ground on dementia villages, Winters said.

While many people support the idea of building memory-care communities, fewer are willing to say “yes” to one built in their own backyard.

Winters previously worked on the United Methodist project in New Jersey built to include both suburban and rural-like streetscapes. Although the project was designed with forward-thinking intentions, neighbors have repeatedly challenged its development, and it remains in legal limbo today.

“They don’t really understand what a person living with dementia is,” Winters said of the neighbors who typically hold up dementia village projects. “They have all these kinds of stigma that they’re applying the situation. And so there is a bit of ageism, NIMBYism.”

One solution is to build a village near an existing senior care facility already zoned and approved to house older adults, like Kansas-based dementia village Maggie’s Place did. The mixed senior care and memory care development consists of five houses with units for 12 residents each and sits next to the Colonial Village assisted living community.

But even with neighbor and local officials’ support, there are the additional hurdles that come with many senior housing developments. Winters cited a 64-bed memory care project in Ohio that faced fire marshall requirements to give the town $400,000 for a new ambulance and firefighter to accommodate the anticipated increase in emergency medical services. That is not to mention the fact that new development is simply hard to do in 2024 as lending remains tight.

There is also the fact that memory care is a service with a growing price tag attached to it. The average U.S. monthly memory care costs vary from $6,160 to $8,250 depending on location in the U.S, according to research from National Instute of Aging. Affording memory care even on the lower end of that spectrum is a significant barrier for families, especially now that one in four families report having less than $1,000 in savings.

For all that dementia villages innovate the care and well-being residents receive, they do not appear to solve the financial reality that memory care is geared more toward those with the ability to afford such steep costs.

One Wisconsin dementia village project named Livasu Village appears to be attempting to lower costs in several ways that may offer a model for others. The project is run by a non-profit building 124 homes on 79 acers of land donated by a Milkwakee-based fund, according to Insight Publications. The non-profit is also currently fundraising to cover the costs of capital projects like the community areas in the village.

‘Their own version of integration or dementia village’

Overall, Winters acknowledged that the many obstacles to realizing a dementia village may make the endeavor “too daunting for most organizations,” but he emphasized that retooling their existing buildings to align with the same goals as a dementia village can be a “more attainable incremental step in empowering this group of people.”

Options include working with families already caring for relatives with dementia at home, or adding natural elements like gardens and sundowning-minded lighting to existing memory care facilities as well as tweaking staffing models to reduce stressors.

Not all of these improvements have to be expensive either: Staff at the Kansas-based Maggie’s Place work with residents’ families to create custom music playlists to tap into their memories of youth, per Kansas City Spotlight’s reporting on its 2021 opening.

One of Winters’ main takeaways from learning about the Dutch dementia village that started it all was that Hogeweyk staff iterated slowly towards the village model by trying out smaller changes to improve residents’ well-being and health until they had enough momentum to build something bigger.

“And I think more people could start that journey sooner than they realize, by making changes to policies and roles and how they train their staff, and how much they empower their staff,” said Winters. “And then eventually wind up at kind of their own version of integration or dementia village or whatever their model looks like.”