Serene village in China’s Xi’an offers new approach to Alzheimer’s care

SINGAPORE/XI’AN – Nestled amid the verdant forest parks and mountain springs of the Zhouzhi Louguan eco-cultural tourism resort zone in Xi’an, China, is a one-of-its-kind village for seniors.

Here, mornings are unhurried. In the centre of the village, a man-made lake mirrors the daylight, with the sound of water gently lapping against stone. A short stroll along the lakeside brings seniors to a bright, spacious dining hall, where breakfast is served.

There is quiet chatter – even laughter – as friends greet one another, some for the third or fourth time that morning.

Afterwards, a few residents go for a light workout in a tree-lined gazebo, while others head to a calligraphy or music class.

If the place looks like a typical quaint Chinese village, that is because it was designed to mimic one as much as possible. 

Clues like a post office that does not send or receive actual mail, a convenience store that uses fake currency, and bus routes that loop endlessly around the tiny compound give away the nature of the village.

Spanning over 43,000 sq m, or about the size of six football fields, the compound is an Alzheimer’s disease village – a first for China. It is run by real-estate-turned-healthcare company Perennial Holdings.

Earlier in June, the Singapore-based company took journalists to tour the compound along with its healthcare facilities in other Chinese cities. 

The innovative care model in the Perennial Alzheimer’s Care Village Xi’an is designed for those living with a disease that progressively robs them of their memory, thinking and reasoning.

The illness is the most common disease that causes dementia, an umbrella term for symptoms ranging from confusion to changes in behaviour, to problems with language. 

Instead of confining sufferers behind locked doors or restricting them to rigid routines, as in traditional eldercare facilities, the village offers an environment that meets them where they are – one built on safety, dignity and choice.

Residents can move about freely and interact with one other. Staff such as doctors, nurses and physiotherapists also aim to be part of the residents’ lives, engaging with them like friends or family members on top of being medical professionals.

The care model was first popularised by the Hogeweyk dementia village in the Netherlands in 2009. More than a decade later, similar villages offering inclusive and small-scale communities for dementia patients have been set up in countries like France, Canada, Norway and Switzerland. 

When setting up the Xi’an project, the Perennial team visited some of these villages to learn from their experiences. 

Today, the Xi’an village comprises a dementia care home with about 450 beds, a nursing care hospital, a rehabilitation hospital and an international eldercare research institute. 

Since it opened progressively from March 2024, the village has hosted over 50 residents, with 26 still residing there currently. 

Dr Song Xiangying, dean of the village, said the majority of the patients, who have medium to severe symptoms, have become less agitated, happier and calmer since they were admitted to the facility.

She cited the example of a man who, during his first few days after admission, would insist on going home after his meals. 

Instead of trying to convince him to stay, she waited with the man at one of the “bus stops” in the compound. 

“We chatted about how long it would take for him to go home and even walked to another bus stop when we had waited too long,” said Dr Song, adding that going along with the man’s version of reality helped to calm him. After a few days, he stopped wanting to go home. 

Dr Song also said no resident has wandered out of the compound. Such behaviour, known as elopement, is common because patients may be disorientated or have a desire to fulfil former obligations or unmet needs. 

While the patient and understanding staff play a key role in its success, the facility is also equipped with high-tech security measures to prevent residents from wandering off.

“We use facial and video recognition to monitor the residents’ whereabouts, so they do not need to put on wearable devices like bracelets,” said Dr Song.

All staff, including security guards and cleaners, know residents by name and keep a watchful eye on them, she added.

Among the residents is Madam Wang Lai Fei, 76. While she had displayed early signs of Alzheimer’s disease since 2023, her condition deteriorated in January after her husband died. 

Her daughter-in-law Lu Jing said the elderly woman had wandered out on her own and got lost twice. Ms Lu then decided to admit Madam Wang to the facility as she was stressed from caregiving. 

“Now, her condition is stable and she has even gained weight. She is very comfortable here, with a group of friends she can chit-chat with every day,” said Ms Lu. 

Assistant Professor Saima Hilal, from NUS’ Saw Swee Hock School of Public Health, said that since dementia is a progressive condition with no known cure, the success of dementia villages should be measured not only by clinical outcomes like slowing of decline, but also, more importantly, by indicators of well-being and quality of life.

Some useful benchmarks include engagement in daily activities; reduced reliance on antipsychotic medication, physical restraints or hospital admissions; and cost-effectiveness over time, especially when factoring in fewer emergency admissions or complications.

Singapore tried to pilot its own dementia care village in 2020 in Buangkok Green, but the project attracted only one bid – a joint one by Perennial Holdings subsidiary Pre 11 and nursing and personal care operator Orpea. 

Ultimately, the project was shelved because the Government found the bid of $15 million to be too low. 

Perennial chief executive Pua Seck Guan said that if Singapore were to revive the project, the company would be “happy to explore” opportunities, but he also cited high land costs as a challenge. 

Prof Hilal noted that besides land costs, operational costs for such care models would also be higher due to the need for trained staff and low resident-to-staff ratios. Another challenge is the limited public-private investment, as the business model is not yet fully proven in South-east Asia.

Therefore, instead of replicating large-scale dementia villages, hybrid models could be more feasible in Singapore, she said.

These include embedding dementia-friendly design features in HDB estates and active ageing centres, setting up smaller cluster-living homes using under-utilised community spaces, and training neighbourhood volunteers and caregivers to support dementia-inclusive communities. 

“These steps are more scalable and culturally appropriate for Singapore’s high-density environment, and can deliver many of the same benefits as full-fledged dementia villages,” said Prof Hilal.