Adding Life to Years: What Dutch Care Models Taught Our Students About Living with Dementia

By Franco Taverna, PhD, and Raza M. Mirza, PhD

This summer Franco Taverna, a professor in the Human Biology program in the Faculty of Arts & Science, and Raza Mirza, an Assistant Professor (Status Only) and Sessional Lecturer at the Factor-Inwentash Faculty of Social Work and Institute for Life Course and Aging, taught a course for University of Toronto Students on Dementia Care in The Netherlands in collaboration with the University of Amsterdam. They co-authored an article on the experience to share their reflections and the deep learning that took place throughout the course.

In Canada for the past several decades, dementia care has taken place in institutional settings such as long-term and group home care. Prior to 2020, institutions started adopting person-centred approaches to care,  but the pandemic exposed serious deficiencies in both medical care and person-centred quality of life. A re-emphasis on medical safety has brought the focus back to ‘adding years to life’— but is the life we are extending worth living?

That tension and uncomfortable thought sat with us for four weeks this summer as we co-taught a group of University of Toronto students and travelled to the University of Amsterdam and through the Netherlands as part of HMB395Y, Living with Dementia: Innovations in Dementia Care and the Determinants of Well-being. It is a course built on a simple but stubborn premise: that dementia care in Canada is too often organized around risk medical tasks and risk mitigation (e.g “bubble wrapping” to prevent falls) to prevent liability, at the expense of the thing that should matter most: quality of life. What we actually end up preventing is the person’s ability to live meaningful, authentic and enriching everyday life. The Dutch, by contrast, have spent decades building models of care that start from a different question entirely: not how do we keep this person safe and alive, but how do we help this person keep living a good life.

The key takeaway from this course was that there is a difference between adding years to life and adding life to years.

Emancipating the Person Living with Dementia

The best-known stop on our itinerary was De Hogeweyk, the “dementia village” outside Amsterdam that has become internationally famous as a proof of concept. From the outside, it doesn’t look like a care facility at all, it looks like a mini town, with streets, a supermarket, a theatre, a restaurant, courtyards and squares. Roughly 170 residents with advanced dementia live there in small households of six or seven, grouped loosely by lifestyle and background, and supported by staff who dress as neighbours and shopkeepers rather than as clinicians.

What struck our students was not only the design itself, but also the philosophy behind it. De Hogeweyk is built on the idea that a normal life with everyday meaningful activities are the foundational elements that care should be built on. Each resident lives in a human scale home, not an institutional style residence. There is a kitchen, eight-person dining table and living room in each home. A resident can help with meal prep and cleanup, laundry and other chores. They can leave the home and walk to the store, sit in the sun and even smoke a cigarette outdoors. They can simply be a person moving through an ordinary day, rather than a patient being managed inside an institution. The course materials we use to frame this visit describe conventional long-term care as institutionally organized around a “surplus of safety”, a phrase that, once you’ve seen and walked through the alternative where life and care is deinstitutionalized, is hard to unsee back home where doors are locked and residents are often overmedicated and bed bound.

Dementia Care Grown from the Ground Up

The focus in the Netherlands is not just on de-institutionalizing care, but also on de-standardizing care, because, as should be obvious, the experience of dementia is unique to every individual.

Our second field site was Zorgerf Buiten-Land, a rural care farm and day program outside the city, one of dozens of small-scale farm-based facilities scattered across the Dutch countryside. Here, residents garden, tend animals, and move through a working landscape rather than a clinical one. The therapeutic logic is different from De Hogeweyk’s village model, but the underlying commitment is the same: dignity and purpose over “containment.”

There was a trampoline, and for students the care farm made visible something that’s easy to lose in a Canadian long-term care conversation dominated by staffing ratios and infection control: that meaningful daily activity, real work, real weather, real animals, and even a few minutes jumping on a trampoline in the rain is itself a form of care, whether you have dementia or not.

It’s also, notably, a nature-based intervention that costs a fraction of what a locked ward does, which raised uncomfortable policy questions about what Canadian systems choose to fund and why.

Personhood and Living Inside Memory

Our third stop, Huis van de Tijd (House of Time), is a Dementia Day Program Centre found in the heart of a small city (Haarlem). It approaches the same problem from yet another angle, using reminiscence and familiar environments embedded right within the everyday life of the community to reduce the disorientation and distress that so often accompany dementia, rather than relying on medication or restraint to manage it. Where De Hogeweyk rebuilds the outside world around the resident, the House of Time reshapes the immediate environment to meet residents where their memory already lives.

Together, the three sites gave students a kind of triptych: village, farm, and memory-environment, three different architectures pointed at the same goal: don’t forget the person, even if the person is forgetting who they are.

In all cases, the built infrastructure is a “favourable environment” that significantly facilitates normal, meaningful, enriching and healthy daily activities. Along with the philosophy of living/care and trained staff, the facilities serves as the foundation for life enrichment — without added staffing costs.

Profs Raza Mirza (left) and Franco Taverna (right) with Master of Public Health student Alexis Hart, the onsite coordinator for the program

The Mirror Back to Canada

That reframing landed differently depending on which discipline a student came from. The class had the privilege of having a graduate trained clinician as one of the students. Master of Social Work student Sevinder Kaur brought years of social work practice across dementia care and older adult services into the course, and she put it this way: “effective dementia care requires more than compassion — it requires specialized knowledge, critical reflection, and strong social work advocacy.” For her, the value of the course wasn’t just seeing new models, but the chance to interrogate the assumptions behind her own practice: “practice often teaches us what to do, while specialized education challenges us to ask why we do it,” she said.

That distinction between the what of practice and the why behind it is, in many ways, the whole premise of this course. It’s easy to learn the mechanics of person-centred care: the language, the checklists, the models. It is harder to continue to sit with why Canadian systems so rarely build for it (especially when comparing the alternatives) and to walk away from that reflection still committed to change. Seeing our students, regardless of discipline, arrive at that same question — why do Canadian systems rarely offer person-centred dementia care? — independently was, for us as professors, the clearest sign the course was doing what we had designed it to do.

None of this was presented to students as a simple “the Netherlands does it better” story. We put the Dutch system into context: it has its own funding structures, its own history, and its own trade-offs that don’t map cleanly onto Canada and the ways in which we approach dementia care. But the comparison is exactly the point. Students spent the first week of the course grounding themselves in the neurobiology and lived experience of dementia. They spent the last two weeks building a “Mini-Capstone”: a design for person-centred care for a real or composite individual, translating a Dutch principle into a specific Canadian context. It forces the question: what, specifically, is stopping us from building this care here? Is it funding? Regulation? Policy legacy? Culture? Fear of liability? Usually, it’s some combination of everything — and usually, avoiding “risk” is doing more work in that answer than it should.

That’s the hook we keep coming back to. Dementia care in the Canadian context, for good reason, is deeply preoccupied with risk — falls, wandering, infection. Those are real hazards and real responsibilities. But a system that optimizes exclusively for the absence of harm will, almost by definition, produce environments that are safe and empty — and arguably doing more harm. De Hogeweyk, the Zorgerf care farm, and the House of Time are not reckless. They are, if anything, more thoughtfully designed than most Canadian facilities and just designed around a different first principle. They start from personhood and work backward to safety, instead of starting from safety and hoping personhood survives the process.

Rethinking our First Principles

The experiential learnings throughout the course were underscored when Teun Toebes, the trained nurse, Dutch dementia activist and influencer known internationally for moving into a nursing home as a young student and living there as a housemate rather than a caregiver, joined us during the final days of the course and screened his award-winning documentary, Human Forever. Watching the film alongside the students, in the same country where the ideas in it were filmed, gave the course’s central argument a face and a voice beyond the facilities themselves. Toebes has spent years making the case, on a global stage, that people living with dementia are still people first, entitled to friendship, purpose, and joy, not just supervision, risk prevention and disease management. Hearing that case made directly, by someone who has lived it from the inside, was a powerful field experience in itself and effectively brought everything together.

Observing a group of twenty-something-old students, most with some personal connection to a loved one with dementia, but little to no professional experience in gerontology or geriatrics, let alone with dementia care specifically, walk through settings built for people living with severe dementia, and watching them come out the other side asking why we don’t build things this way at home is, we think, the whole argument for taking a course like this abroad in the first place.

You can teach the concept of person-centred care in a Toronto classroom. But there is something different about standing in a courtyard in Amsterdam and realizing that the choice between safety and a life worth living was never actually a choice we had to make.

We just haven’t built the systems that let us avoid making it.

Franco Taverna is a Professor, Teaching Stream, in the Human Biology program with the Faculty of Arts & Science at the University of Toronto. Professor Taverna is widely recognized as a leader in experiential learning and online teaching. He has designed popular experiential learning courses that help students connect their classroom learning to the lived experience of community members. Students in his Health in Community course become immersed within communities and collaborate with community organizations, such as Access Alliance, Down Syndrome Association of Toronto, and The Alzheimer Society of Toronto to meet community informed needs that support health and well-being. He also developed an international course module excursion to The Netherlands for students to visit and learn about innovative long-term care models such as The Hogeweyk, the internationally acclaimed “Dementia Village”.

Raza Mirza is Chief Operating Officer (COO) with HelpAge Canada, and Assistant Professor (Status) and Sessional Lecturer at the University of Toronto’s Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging. He also teaches the experiential “Intergenerational Class” on Aging and Health as part of the undergraduate Public Health Sciences Program at the University of Toronto. His areas of expertise and teaching interests include research methods and evaluation, medical decision-making, the socio-behavioral determinants of health in persons aging with a chronic illness, aging-in-place, and factors such as social isolation and loneliness influencing late-life social, mental and physical well-being. He has been an invited speaker at national and international gerontology and geriatrics conferences, workshops and symposiums, and has consulted with various levels of government on diverse issues related to an aging population.

HMB395Y, Living with Dementia: Innovations in Dementia Care and the Determinants of Well-being will be offered again May to June 2027.