Table 2 Overview of ‘Intervention unadapted’ and ‘Intervention Adapted’

Construction of the building

As determined prior to the start of the study, the nursing home was going to be structurally reorganised in multiple ways

First, the old building (± 25 years old) was to be demolished and rebuild into 150 individual apartments in several buildings. Part of these buildings were going to be realised by the housing corporation. In-house sensors, innovative wearable sensor technology were going to be installed in all buildings as part of usual care to ensure the safety of older persons with dementia.

In the new buildings, persons with dementia and persons without dementia will be living together. Older persons from the local community could live in one of the apartments even when no care was required or when they wanted to accompany a spouse with dementia that is admitted to the nursing home.

Furthermore, an open long-term care environment was to be created that gives all residents the opportunity to leave the building independently en roam freely on the surrounding grounds and neighbourhood. Residents would uphold their own individualised daily schedule, group activities would be optional.

The new nursing home, that was part of the rebuild, has been opened in November 2020 and currently provides long-term care for residents with and without dementia. Residents live in large spacious individual apartments with innovative technology. The old building is not yet demolished and the building of the individual apartments for persons -with and without care- on the grounds has not started.

The open long-term care environment has been realised, meaning that all doors are open for residents and they have the freedom to leave the facility independently and roam around the park and surrounding neighbourhood. Despite the original plan to let persons with and without dementia live next to and amongst each other, these groups are currently clustered on separate floors. This limits the social interaction between residents with different care demands.

Persons living in the nursing home without dementia have the opportunity to choose their own individual daily schedule. Yet, the persons with dementia spend the majority of their day in shared living rooms that uphold a daily time schedule and structure, mostly focusing on group activities.

Grounds surrounding the building

The facility grounds with an area of 6 hectares, were going to be restructured into a green park to make it attractive for residents and people from the surrounding neighbourhoods. The park area aimed to provide meeting opportunities for residents with dementia and people from the local community through the realisation of broad walking paths, benches, fishing pond, playground for children and a day centre for community members in need of care. Moreover, the existing allotment gardens would be renewed and the bee keeper -already on the grounds- would be preserved. The municipality had decided that some elements should be retained. These included the cemetry for former priests and the old lane of trees, that was used for prayer. The vegetation of the park would be improved by placing many bushes, plants, greenery and large old trees

The park area was to have no external barriers and be freely accessible for all to stimulate interaction between residents from the nursing home and people from the local community.

The surrounding grounds have been turned into a large park-like area with new allotment gardens and green house, a fishing pond, walking lanes and a few benches for visitors to sit. The bee keeper, cemetery and trees on the grounds are preserved in accordance with the plans.

However, there is limited additional vegetation and not all areas of the park and walking paths are accessible for persons with physical disabilities. A very small number of residents leave the facility independently and visit the park area. The interaction between nursing home residents and community members in the park is limited.

The use of the Chapel on these grounds

The chapel was to be rebuild into a restaurant for both residents with dementia and persons from the local community. The restaurant aimed to have a terrace, employ a permanent chef and serve both lunch and dinner. The chapel is to be visible from all corners of the grounds and serve as a central meeting place for both residents and people from the community.

The chapel has been renovated and was turned into a restaurant that opened in March 2019. The chapel serves both lunch and dinner for residents and community members, has an open terrace near the front door of the new nursing home and employs a permanent chef

Residents visit the restaurant often with family members and visitors. Also the care organisation uses the restaurant regularly for smaller and larger meetings with external partners and nursing staff and large events.

The care organisation has created multiple ties with local associations that repeatedly use the restaurant for their meetings and rehearsals.

Place in the community

In the initial stage, the care organisation had a strong focus on social ties with the community and social entrepeneurship. As the facility is situated within a small rural village, there is a strong social cohesion within the community resulting in extensive involvement of volunteers and mutual relationships between residents and people in the community. The care organisation wanted to broaden this social network and create a dementia-friendly community with the nursing home at its core, with a focus on well being for both residents and persons in the community.

The original involvement of volunteers and family members has been preserved and multiple collaborations with local entrepreneurs are still in place. Yet, the involvement of the community is not intensified and the aim towards a dementia-friendly society has been realigned.