It takes a village to build one

Friday, March 6, 2026

As reported by Brittney Kenaston, InBusiness Madison

Eloy van Hal lives in the Netherlands, but his vision for reshaping dementia care is taking root across the globe — and on the Agrace hospice campus in Fitchburg, with a neighborhood that will be the first of its kind in the United States.

Van Hal is the founder of the Hogeweyk Dementia Village, an innovative Dutch community designed to provide safe, supportive conditions for people with dementia to live “normal” lives.

In operation for over 16 years, the Hogeweyk houses 188 people in 27 group homes. Residents move freely throughout the gated community with a high degree of independence. They receive individualized support from care staff members dressed in street clothes rather than uniforms, participate in many of the same patterns and activities as prior to their dementia diagnoses and enjoy statistically better quality of life, with less stress, agitation, depression and medication use.

The picture van Hal paints of life in the Hogeweyk is a far cry from what comes to mind for many people when they think of elder care, especially for those with dementia.

Dementia care environments are often hospital- or institution-like, he said, and their regimens and restrictions can inadvertently increase troubling feelings or behaviors among residents. The human element can be lost in facilities that leave limited room for spontaneity, community connectedness and people’s unique life rhythms.

Van Hal advocates for a new industry standard, and that’s what Agrace hopes to establish nearly 5,000 miles away with its own Dementia Village, modeled after the original Hogeweyk and set to break ground this year.

“People, especially from the industry, need to experience (the Hogeweyk model)” said van Hal. “What you see with the other initiatives around the world. … is not always exactly the same, but the principles of offering a normal life and encouraging people to live and not just wait and sit and die, that makes the difference.”

It’s about “innovation, think(ing) outside the box,” said Lynne Sexten, CEO of Agrace. “Don’t do it the way everyone else does it.”

She said just under half of the people in Agrace’s hospice program have some sort of cognitive decline, as do nearly 100% of the individuals who come to its adult day center, and the demand for memory care housing is very much on the rise locally.

“So how do we create an environment where people living with dementia can still be safe but can once again experience those normal rhythms of daily life?” she asked.

Agrace is partnering with local builder JP Cullen and Appleton-based architect Community Living Solutions, which works exclusively with senior living providers, to construct the Dementia Village. It will include a blend of homes and commercial spaces and accommodate dozens of residents.

“JP Cullen has been partnering with Agrace for many years,” said Ben Menaker, the company’s project executive. “This project in particular is such an awesome one with a truly incredible mission. We’re working through some of the unique challenges and intricacies of implementing methodologies based upon a different care model from the Netherlands. … It’s definitely been a learning experience for all of us.”

“What is normal for a person living day-to-day within their home? That’s what we’re trying to create at the Dementia Village,” said Duane Helwig, director of design-housing for CLS. “In today’s memory care vernacular, it’s typical to protect the resident. And obviously Agrace is going to provide a very safe and secure environment for the residents, but they’re going to give them freedom of choice, and that’s taken to the next level.”

Agrace also hopes to partner with local colleges and universities in an arrangement that will provide housing for health care students who agree to work in the Dementia Village and help meet the demand for caregivers.

“It helps us with our workforce issues (and) introduces … health care students to working with people with dementia,” said Sexten. “Hopefully they find it’s something they love.”

The $40 million project will break ground in May, and Sexten said resident move-in could start as soon as September 2027.

Restructuring memory care

As the incidence of dementia increases, so does the need for better care solutions, according to Sexten.

“What we have observed is we’re not meeting the needs in a way that relieves caregiver burden,” she said, “and the solutions that we’ve put in place around memory care aren’t leading to the kind of quality of life that any of us would want for ourselves or our mom or dad.

“That’s not at all to say that the lovely people who work in these environments aren’t doing everything in their power — it’s just the structure.”

Like the Hogeweyk, Agrace’s Dementia Village will restructure traditional dementia care in both a literal and philosophical sense. It differs from other U.S. models, including the Livasu village in Sheboygan County, which was created by nonprofit Dementia Innovations and also modeled after the Hogeweyk.

Sexten said, in her view, the Livasu model is more of “a neighborhood that is very dementia friendly,” and unlike the Agrace village, Livasu is not a state-licensed health care facility.

In addition, Livasu residents will own the homes they occupy alone or with loved ones. At Agrace, residents are only eligible to live in the village with a dementia diagnosis, so spouses without such a diagnosis would not.

One of the Agrace Dementia Village’s most innovative elements will be a lifestyle assessment for prospective residents. They will be asked about their backgrounds, beliefs and experiences, Sexten said, which “increases the chances that people will get along.”

“We’ve done a ton of work assessing the norms and belief systems and lifestyle preferences of the greater Dane County area,” she said. “That has all synthesized down into what we’re going to use — three different lifestyles. Each home will have an assigned lifestyle.”

Residents may participate in the same clubs or activities, or enjoy the same music, TV shows or radio programs. Van Hal said that matching people based on their personal preferences in this way yielded “immediate” improvements in the Hogeweyk.

“It’s not only the bricks and the mortar… it’s the integral approach,” he said. “(It’s) a good living environment, but also about your lifestyle, who you are.”

While the village will replicate typical assisted living models’ self-pay systems — charging residents room and board at a similar price point to those of conventional facilities and billing insurance companies or Medicare for medical services — its neighborhood design replaces the more traditional concept of a large residential facility. Eight homes will collectively house up to 64 residents, and freestanding commercial spaces and other amenities will promote a cohesive community feel and an organic flow of daily life.

Agrace is also relocating its adult day center, whose 40-50 members will be able to visit the village each day, as will its hospice patients and visitors.

“It’s going to make for a very vibrant (atmosphere),” said Sexten. “Friendships will be formed. It will be a bustling village.”

“More people is more fun,” said van Hal, who noted that the incorporation of adult day center members is a unique addition to the model on Agrace’s part. “It brings normal life to your village… and they integrate with the people that live there.”

A normal Madison neighborhood

JP Cullen’s Menaker said one of the challenges with the village buildout is integrating multiple functions into one campus.

“It’s not just one building with traditional access control and monitoring measures,” he said. “Plus, there are other existing operations on the campus that need to be integrated into the upcoming expansion. We are designing the buildings and systems with the mindset of trying to have the day-to-day life of a resident be as normal as possible.”

Strategic landscaping and fencing will ensure that the village remains “contained” without feeling restrictive.

From a design standpoint, CLS’s Helwig said the Dementia Village will be inspired by local architecture to create a “familiar” Madison feel for residents.

Commercial spaces — which will include a grocery store, theater, coffee shop, pub and grill, buildings for various clubs and an exercise room — will nod to the urban look of iconic Madison locales like State Street.

Sexten said it’s important that residents have access to the same kinds of businesses they would if they were living anywhere else.

Meanwhile, homes in the village will draw from the character of small bungalow-style homes in many of the city’s long-established neighborhoods.

Helwig said each home will mirror a typical house’s organization, but with spaces for both residents and round-the-clock staff.

“We’re really trying to be intentional about not making it look like a care environment,” he said.

A small foyer with a closet and bench will lead into a living room with ample seating and a fireplace. The living room will open to a dining area and then a kitchen with a seated island, — a place for all meals to be prepared, which van Hal said is crucial.

“In traditional care, there’s a rigid scheme,” he said. “Everybody must be up at 7, have breakfast at 8, and (be) showered at 9. But why should you do that? Allow people to have their own rhythm. … You have your own kitchen … and you are not depending on a big kitchen that dictates when you should eat … no! It’s your own household.”

Front and back porches will provide a space for residents to spend time outside and interact with neighbors, and the houses’ universal design will ensure residents of all abilities can safely navigate the entire premises.

The workforce housing planned for the village will consist of eight studio apartments. Students pursuing a health care degree will be able to live in these apartments in exchange for working monthly shifts caring for residents.

“I think this is a great idea by Agrace,” said Helwig. “There’s a shortage of affordable housing. … Agrace can get people to work there and also offer them (that).”

Each apartment will have its own bedroom and private bathroom, but workers will share a community kitchen and living space.

Residential and commercial spaces in the village will be connected by outdoor walking paths meant to encourage residents to leave their homes, get some sunlight and fresh air and engage with the community. Firepits with chairs, an outdoor plaza and a playground will provide additional gathering areas, especially for visiting family and friends.

“What’s really exciting about this project for us is that residents, I think, will be able to thrive in an environment like that,” said Helwig.

Sustainability features such as solar panels, which are already integrated into Agrace’s Fitchburg campus, will be incorporated into the Dementia Village as well.

A ‘springboard’ for similar models

When it comes to replicating the Hogeweyk model, van Hal said it’s critical for organizations to give “the vision” the initial priority, focusing on “humanizing the place where people live,” and then determining how financing and logistical considerations will accommodate that concept — not the other way around.

“It starts with … how you look at the elderly in the United States,” he said, “how to support people to live a normal life. That’s the basic. And don’t start talking about money first — that’s what Americans normally tend to do. It’s the money, and risk, the risk (aversion) and the medical system that makes it complicated.

“That’s what Agrace is doing well. They started with the vision … and they accept and discuss and redefine the risks of daily life. … In the end, it’s about money, but there are different ways to make the business work.”

Sexten said she envisions Agrace’s Dementia Village as a “springboard” for similar models from other organizations that she hopes will take up the mantle and help meet memory care needs statewide.

“It’s almost like a proof of concept,” Sexten said. “If we can make this work, then let’s go duplicate it, because we’re only going to be able to take up to 64 people. Our sense is the demand is going to be far greater than what we can accommodate.”

The development is largely depending on local goodwill to get on its feet — and fortunately that has been in plentiful supply. Madison philanthropists Peter and Ellen Johnson kickstarted the project with a $7 million donation after previously helping to fund Agrace’s existing end-of-life facility in Fitchburg, which is named for them.

“We believe that for the city of Madison and Agrace to be the first in the United States to accept this concept — and not only accept it, but do something about it and invest the money to build it — we’re really proud and happy to be trailblazers along with Agrace,” said Peter Johnson in a statement.

The project’s partner companies concurred.

“After my experience thus far being a part of this project, I certainly see how the Dementia Village concept has great benefits in comparison to a more traditional dementia care facility,” said Menaker of JP Cullen, emphasizing the relative novelty of the model compared to other projects he’s seen.

“Over the last 20 years, the Dementia Village concept has been gaining some momentum in other parts of the world, but it is brand new to the United States. … This is also the first time that I have personally experienced a project (where) they’re integrating workforce housing directly into their operations.”

“What I think Madison can get excited about is, wow, we’ve got this in our community. We’ve got access to that,” added CLS’s Helwig, joking, “I might move to Madison in 30 years.”

Fitchburg-based Oak Bank announced in February that it would commit $25,000 to support the Dementia Village, and additional funding is being raised through a $30 million capital campaign. Agrace launched the campaign last April, and Sexten said so far it is going “astonishingly well.”

“We’re already 45% of the way to our goal,” she said. “So many people have been touched by dementia, they know someone, or they’ve experienced it firsthand, that it’s really resonating.”

Johnson highlighted the fulfillment that supporting such a project yields, far beyond the dollars and cents.

“It’s always been important to me to give back to the community where I have enjoyed financial success,” he said. “It’s the kind of exhilaration you don’t normally get from business success.

“It’s something that comes only when you give something you really don’t have to give. But because of the need — because of the community’s need, because of people in need — it gives you a very, very strong feeling.”

Editor’s note: A previous version of this story has been updated to reflect the correct spelling of Lynne Sexten’s name.