How the Dementia Village in Amsterdam is Changing Elder Care Around the World

What if dementia care focused less on restriction and more on dignity, independence, and quality of life?

In this episode of Advice From Your Advocates, Elder Law Attorney Bob Mannor and Certified Dementia Practitioner Amy Persails explore the groundbreaking Hogeweyk Dementia Village in Amsterdam, an innovative dementia care community that is changing how the world thinks about elder care, caregiving, and memory support.

Amy shares her firsthand experience visiting the world-famous dementia village, where residents with dementia live in a safe, supportive environment designed to feel like real life instead of a traditional nursing facility. Together, they discuss how care navigation, advocacy, and person-centered dementia care can dramatically improve the lives of seniors and their caregivers.

Whether you are a family caregiver, healthcare professional, or someone navigating dementia care planning, this episode offers valuable insight into innovative elder care models and the future of long-term dementia care in the United States.

In this episode:

• What makes the Hogeweyk dementia village unique
• How dementia care can prioritize independence and dignity
• The importance of care navigation and elder advocacy
• Daily life inside a dementia village
• What caregivers can learn from innovative dementia care models
• Could this type of dementia care work in the United States?

If you or someone you love is facing dementia, Alzheimer’s disease, or long-term care challenges, this conversation offers hope, perspective, and practical insight into what compassionate dementia care can look like.

Transcript

Why We Visited Dementia Village

SPEAKER_01 0:03

You're listening to Advice from Your Advocates, a show where we provide elder law advice to professionals who work with the elderly and their families.

SPEAKER_00 0:11

I'm Bob Manor. I'm a Nationally Board Certified Elder Law Attorney from Manor Law Group in Grand Blanc, Michigan. And today we have a really interesting show for you. So myself and some of my staff have the opportunity to go to Amsterdam to visit something called the Dementia Village. Our law practice is often called elder law. So we do estate planning, we do wills, powers of attorney, trusts, we also do planning for folks that have a loved one with dementia. And that's one of the big uh practice areas that we help families deal with the financial and legal and caregiving issues that come up when you have a loved one that has dementia. So we do long-term care planning and Medicaid and veterans benefits. And so as part of this, we're always looking for different ways to provide the best care to our families and our loved ones, especially when there is a dementia diagnosis. And so we had this opportunity to take three of our members of the firm over to

Elder Law And Care Navigation

SPEAKER_00 1:20

Amsterdam and visit this village they call Hokovic. Joining me today is our Director of Planning Services at Manor Law Group, Amy Percales. Amy, thanks for coming.

SPEAKER_02 1:32

Good morning.

SPEAKER_00 1:33

And Amy, tell the audience a little bit about yourself and what is a director of planning services at Manor Law Group.

SPEAKER_02 1:40

I've been with Manor Law Group for 12 years. And I oversee our Medicaid planning department and also our care navigation department. We help people, just like you said, Bob, loved ones, helping them get the care that they need, making sure that they're taken care of, should they have dementia, Alzheimer's, or any other physical ailments that they need some nursing home care, AFCs, assisted living, or just home care.

SPEAKER_00 2:13

So you mentioned care navigation. So care navigation is a really unique thing that it's very unusual for a law firm to have that. But it's basically advocacy for families through trying to figure out how do we make sure that our loved one is well cared for, that they have the best quality of life, best quality of care, especially if there's a diagnosis of dementia or Alzheimer's or Parkinson's or any of those types of things, it can be very difficult to follow that path to go through what I consider kind of a maze of different options. Can we stay in our home? A lot of people would prefer to stay in their home and get care in their home. Can we have family members help? Well, sure, but often those family members are giving up on being with their own family or working, and maybe is there a way we can compensate them for the care that they provide their loved one? Are we going to pay paid caregivers? Are we going to rely on community benefits and community opportunities? Maybe there's day programs that our loved one can go to. Or then, you know, of course, we can look at independent living, assisted living, nursing home, all those types of things. But in any of those settings, it is difficult to make sure that we're getting quality care and quality of life. And that's what our care navigators do. Many are are social workers in our office. So you don't often find law firms that have social workers as employees, but we do. And it's for the purpose of making sure we help our families get the best quality of care and quality of life. So as part of that, we always look for new things or new opportunities to learn

Expectations Versus US Care Model

SPEAKER_00 3:56

more about how to provide the best care and how to provide the best quality of life. And Amy, you know, I think you and I had both heard about this Hokovic, which is dementia village near Amsterdam for a long time. What were your initial impressions before we got to go there? What were you thinking about Hokovic or the dementia village? We probably didn't even know the name Hokovic at the time. We would just heard about this dementia village. So what before we went, what was your impression and what did you think about it?

SPEAKER_02 4:25

So I interpreted like more of a fake village, I think. You know, a fake bus stop, maybe a post office sign or a restaurant sign, but not necessarily having all of those things. I knew that they had a grocery store, but we didn't know how necessarily it was incorporated. You know, did they just go there and pick out something? Did the family shop there? How did that all work? And we found out a lot of it wasn't fake. It wasn't fake at all. It was all real, every part of it. So it was very uh eye-opening.

SPEAKER_00 4:59

Yeah, it was really interesting. I had, you know, the same kind of impression. I really didn't know what to expect, to be honest. And so what the thing was is that we had heard of this, and I just assumed, okay, well, you get a little bit more of a community feel. It's maybe not that much different than the way we experience the things here, because you know, typically when somebody has dementia, especially if they're getting care outside of their home, but even when we are getting care in our home, much of the focus is on in the United States, we call it the medical model. In other words, the person with dementia is served. They don't do much for themselves. We bring them breakfast, we bring them dinner. Maybe we probably discourage going on walks because what if the person wanders off? We're trying to really contain and and really focus on the safety, which of course we all this is our loved one. We want them to be safe, we want them to be uh protected. And I want to ask your impression,

First Steps Inside Hogeweyk

SPEAKER_00 5:59

but before we get there, I want to kind of tell what this looked like. So we went over with a group of other law firms that do similar things to what we do. And Amy Percelles and myself and attorney Kelly King Penner all went to check this out. And when we first got there, they let us know that this is a community and that we're not to be looking at it as a tourist attraction. So they said, you know, don't get your cameras out. These are people living in this community, and it's kind of weird to be, you know, treating them like a tourist attraction. So they said, Yeah, leave your cameras in your pocket, leave your phones in your pocket. And then they brought us in and they just kind of talked to us about it. But even after we'd walked through a little bit of the village and and then went aside, I still really didn't get it because I had all these questions about, well, you know, boy, this village, it didn't look all that safe to me. I I was worried because there was lots of older folks walking around and it was cobblestone, which is not always even pavement. And I was worried about, well, how do family come visit? And I just had all these questions, and they did their best to answer their questions, but the main answer they said was, we'll just wait and see. I think your questions will be answered once we get a chance to spend some time in the village and just interact with the folks there. So what was your impression once we did have an opportunity to kind of actually go out into the village and and explore and you know interact with the folks that live there and things like that?

SPEAKER_02 7:30

So many things. Uh in particular, we were broken up into groups when we went out and we went with two people that worked there. One was actually a founder, Eloy. And in our groups, we just wandered around the village and it was just it it was refreshing, honestly. It was a beautiful day, and we had this woman that came up to us and started speaking. We were with the other group, so Iris was our tour guide. And the woman that came up talked to Iris and she spoke Dutch. She didn't speak English, she had no uh ability to speak English, she didn't understand it, she didn't know it. So her and Iris spoke for a few minutes. Iris invited her to come with us, and she did. She followed us around for most of the time that we toured and she enjoyed herself. Every time we would stop, Iris would point out something or show us something. She would interact also, and Iris was talking to us in English, but then she would interact with her, and Iris told us, she said most of the time she couldn't even understand what she was saying because you know your words get jumbled up a little bit when you get older and with dementia. And so she was Iris was a native Dutch speaker. Yes, and so she she was having trouble also, but you would wouldn't know that you we never knew that there was a divide there between the two of them. They laughed, they carried on, and then at one point she just went off with another group of her friends from the village and you know, enjoyed the rest of her day. But she had a great time just wandering around with us, going through with the tour. It was just they just could do whatever they wanted to do. It was amazing.

SPEAKER_00 9:27

And that's kind of what was the really the eye-opening thing. This was not a setup. This was where they lived, this is where they interacted, and they encouraged them to be uh somewhat independent. Now, they're not going to be able to be completely independent because everybody, in order to go to Hokovic to be a resident there, you have to meet a certain level of dementia. And so in the Netherlands, it's they had what they called level five dementia, which is pretty far along. This is not the early stages. This is not necessarily where you even remember your loved ones. I think with dementia, sometimes people will will they they'll be able to not recognize their spouse anymore. They might recognize them as a person that cares for them, but they can't necessarily say this is my husband or this is my wife. They might not be able to identify their children as their children. They just know that they're people that are caring, and sometimes they the brain tries to come up with other things, but that's the level of dementia that these folks had. And and so what was interesting about it, it

Independence, Wandering, And Falls

SPEAKER_00 10:29

was just a really a completely different model than what we think about here. And so it took us a minute to actually kind of accept it because, you know, there was all these folks that, you know, when we get to that age and we have some memory issues, maybe we're not so balanced on our feet anymore. I just had a couple of questions as we were going. I'm like, well, you know, what if they fall? And and our guide, Iris, said, Well, do you ever fall? And I was like, Yeah, I kind of do. I'm kind of clumsy sometimes. And they said, well, you know, people fall, right? And I'm like, yeah, well, but we have to protect them. And yes, of course. We're gonna do our best to make sure. And they actually did have some interventions to make it less likely they're fall. They had these weights on their ankles that made it so that they were more secure in their steps, which I'd never seen before. And I've talked to some occupational therapists in the United States, and at least the ones I talked to had not seen that before. But their theory behind it was that if by having these weights on their feet, they're more likely to have a sure step. So they were trying to do everything they could to avoid those falls. But did they say do sometimes people fall? Yes. And and I was like, oh wow, that's a whole different concept. Because I think here we would be freaking out if somebody took a fall and we said, Oh, but that was uneven pavement. How dare we? We probably talk about calling a lawyer or something. One of the questions was, you know, it seems like these folks are just kind of wandering around. What what happened? You know, how do we and there's like, yeah, this is their community. Wouldn't don't you wander around in your community? If you if you had a neighborhood, and and this is, you know, it was very much modeled after a community in Amsterdam, especially one that might have been a few decades ago. You know, some of Amsterdam is a little bit more modern, but it was very traditional Amsterdam, and so it looked like a regular community where people walk around. And in in Amsterdam, I think it is pretty common for people to walk. There's lots of bicycles. We didn't have a lot of bicycles or I don't think there's anybody. Well, there was actually the three-wheel bicycles that they had in in the uh dementia village. But they in Amsterdam there's you know, there's drivers, but there's way more bikes and walkers than there are drivers. And so this was their tradition. And so the idea is, okay, because now you have dementia, you can't walk around your community. And that's completely different because they were walking alone. They didn't have a someone with them. Now it was a a very, I'm not I don't want to say enclosed environment, because it was really a whole community, but there was only one entrance and one exit from this community. And what's interesting is the town around it could come into Hokovic and go shopping at the shopping center. They could go in and go to the bar there or the restaurant. And so it was very much just a real life experience. And if you think about that, that is instead of kind of it's just a whole different mindset of, okay, just because somebody is old and have some memory issues doesn't mean that they can't experience joy from taking a walk and not have to be where there's a caregiver standing right next to them the whole time. Or that they can't participate in an art program or all the different programs that they had. So give us some examples of what you saw as as we were walking around.

SPEAKER_02 13:49

So one of the things that stuck with us was someone walking around with a glass in uh water, uh just walking around with a glass. And I mean, you know, a true glass.

SPEAKER_00 14:02

They don't use a lot of plastic. No.

SPEAKER_02 14:04

It's it's all like uh if you get a soda pop, you're getting a glass bottle. You get glass in everything. There's not aluminum cans or plastic. And she was walking around with a glass, and we noticed her and thought, wow, you know, someone with advanced dementia, which remember that's what they have there. They everyone has advanced stage dementia, and she's walking around with this glass. Well, at one point she did drop it and it did break, it shattered, and it wasn't a big deal. They acted like it was it was not an inconvenience. No one acted like anything was wrong. Someone just came up, swept it up, cleaned it up, and it was over. And you know, it was fine. It was absolutely fine. But, you know, here we would say, okay, no, maybe we should just have plastics, plastic cups. We look at the cost and then we look at what could happen. Just like falling. Okay, they could fall, but they could break the glass. Yes, it could happen, but it's okay. We

A Well-Lived Day Calms Nights

SPEAKER_02 15:07

can get more glasses. And that's their whole outlook on everything. It's okay.

SPEAKER_00 15:12

When we have dementia, there's a lot of times that we hear things in the long-term care community, they you often use the term behaviors. Or you may have heard of sundowners. And we ask about that, and they said, well, you know, here at the Dementia Village, we don't have a lot of behaviors. We don't have a lot of what we would refer to as sundowners, where people get agitated in the evening. And uh their theory was a well-lived day leads to a restful night. And the other part of it is maybe the behaviors are because we're restricting the uh folks' ability to express themselves or to engage in activities and things like that. And I always, you know, kind of joke a little bit. If somebody told me I couldn't just go for a walk every once in a while, I might not be thrilled about that either. And so now we're expecting people that have maybe lived their life a certain way all their lives, and because they have memory issues or because of their age, we're saying, oh no, you can't do that anymore. So I realize how difficult this is to understand it from the perspective here in the United States and kind of our model here. And we'll talk in a minute about some of the ways that they're trying to incorporate this in the United States, but it was just really eye-opening and uh things like using the term behaviors or trying

The Store, The Glass, The Mindset

SPEAKER_00 16:28

to distract the person with dementia. Another example is I saw some people going into the uh grocery store, and I had my question. I said, So sometimes they'll ask a question and then I'll immediately answer my own question. And I did it here and it was wrong. So I asked the question, well, what happens if somebody goes in and they're confused and they kind of shoplift and they it wasn't intentional, they were just confused. And so I said, Oh, I imagine you just have somebody in the store kind of distract them and redirect them. And they looked at me like I was speaking a foreign language, which I mean I was, but they were looking at me like that's not how we handle things here. They said, No, we just deal with it. Uh in some cases, they they have an account and we can apply it to the account. Sometimes it might be applied to their house, uh, which there's multiple houses that they live in groups of like six to six to eight. And then sometimes they might come and put it back later, but they deal with everybody individually, as individuals like we'd expect to be dealt with. They don't use the distraction thing that we often would recommend here, and I had

Meals, Houses, And Daily Roles

SPEAKER_00 17:32

recommended for years. So talk to us about how they do meals. And before you do that, I was curious as to this woman that was joining us and just had a great day, you know, hanging out with the weird Americans that were coming to visit her town or her village. And she had a great day. But then I wondered about okay, I was getting close to lunchtime, what happens? And I we saw she had separated from us for a little bit before lunchtime, and then I saw, and there was a caregiver just casually having a conversation with her, but I could see she was walking her back to her house so that they could have lunch, and it was just very casual and not like, hey, you must move this way. It was, hey, let's have a conversation. Are you hungry? What do you think we should have for lunch today? And and move her back. But how, how, tell us a bit about how they talked about how they prepared meals and things like that.

SPEAKER_02 18:21

So this is something that was very interesting. So, first of all, each house and each area is different. So they have, you know, 188 residents all together, and they have different housing, traditional housing, a contemporary, cosmetal cosmopolitan. So there's different the way you grew up is basically how you're put into your housing. And so in a normal in the house, every morning, they discuss what they're going to eat today. And they get together and come up with a plan for the meal for the week, for the day. And during that time, then every morning they go to the grocery store and they come back and they'll prepare the meals. Well, for dinner, for instance, if they're cutting up potatoes, well, someone that lives in the home, someone with advanced level stage dementia, is probably peeling the potatoes with a knife. And it's okay. Someone is there. First of all, you know, they're overseen, but yeah, I cut my finger when I when I peel things sometimes. And so if they cut their finger, it's okay, they'll take care of it. They have medical staff also, but they let the people do the things that they are used to doing. Laundry, they're folding the laundry, they're cutting the potatoes, they're they're doing the things that make them feel comfortable, which also makes them feel

Could This Work In The US

SPEAKER_02 19:59

included in the house that they're in.

SPEAKER_00 20:03

So the way that medicine is done and long-term care is done in the Netherlands is obviously different than the way it's done in the United States. So there's lots of challenges. So this is a great, interesting concept, and we just learned so much about it from the standpoint of just ideas and thoughts and just different ways of approaching things. And so the one thing on this is that it would be difficult to put that into practice in the United States, as it is there in the Netherlands. And this was mostly paid for by the government. They did have to contribute to it. Each person that stayed there had some some contribution to it, but it was mostly paid for by the government. And so how would that work here? And that there's lots of thoughts and different ideas. And so talk to us, Amy, a little bit about the what we've found out about people that are trying to implement this in the United States.

SPEAKER_02 21:00

Aaron Ross Powell So there are most of the places that have tried to do this in the United States are mostly day facilities. I know that there is a few that are coming up right now. Two in Wisconsin in particular. There is one in Georgia. They're they're all over the United States. I believe there's about six to eight of them, but most of them are like day facilities. None of them are like Hogavic in as far as people living there. There is a facility in the works right now in Wisconsin that will be the most like Hogavik. You will live there, you will have all of your um amenities, the grocery store, a restaurant, everything that you know they currently have. It's a smaller scale. There, I don't believe it would house 188 residents, but they're starting out and And it's being built, and I think that the concept is there. It's on point as far as that will go. I mean, we're we're imagining that it would be private pay, but again, we don't know yet. It hasn't been built. Everything hasn't been finalized. But I look forward to visiting that and seeing how they're doing things and how well it's working. Because I believe that we could do this in the United States. We just have to put our foot forward and you know, get that going. And hopefully this works out.

SPEAKER_00 22:32

Well, so it is interesting to see what happens. And I know that one of the ones in Wisconsin had started off with a big gift from a family that uh just wanted to see this,

How We Help Families Next

SPEAKER_00 22:46

and so that they started off with some financial support. And so these are all just the types of things that we at Manor Law Group always try to learn about, and just trying to make sure we have the best perspective and helping the families that we work with get the best quality of life and quality of care, especially when there's a dementia diagnosis. And so if you enjoyed this conversation, just know that we have conversations like this every other week on our podcast, which is called Advice from Your Advocates, and you can find it anywhere that you find podcasts. You can also find us on our website, MannorLawgroup.com, or on YouTube. So if you have anybody that is in need of guidance for long-term care planning, dementia support, even estate planning, wills and trusts, things like that, feel free to give us a call. You can visit us at mannerlawgroup.com or call our local number 810-6949000. We also have a toll-free number, 800-990-6030. And thank you so much for listening to advice from your advocates. We're always happy to provide information and be a part of your team for the heroes out there that are caring for loved ones, working through the issue of a long-term care need for their parent or spouse has dementia or Alzheimer's, and we can be a guide there. We can be a source of information and uh advocacy so that you can do the best job that you can to get the best quality of life and quality of care for your loved one. So thanks again for listening. And again, uh, this is Bob Manner and Amber Percells from Manner Law Group. We hope that you join us on our podcast, advice from your advocates.

SPEAKER_01 24:37

Thanks for listening. To learn more, visit MannerLawgroup.com.