Weeks after opening near San Diego, a model town for treating dementia is set to be replicated around the U.S.
On August 13, a brand-new town in Southern California welcomed its first residents. They trickled through the doors of a generic beige warehouse on a light-industrial stretch of Main Street in Chula Vista, a San Diego suburb. Then they emerged in Town Square®—a 9,000-square-foot working replica of a 1950s downtown, built and operated by the George G. Glenner Alzheimer’s Family Centers. Unlike the businesses around it hawking restaurant supplies and tires, Town Square trades in an intangible good: memories.
The imitation town (which I wrote about previously in The Atlantic) is the biggest U.S. investment so far in what eldercare specialists call reminiscence therapy. In reminiscence therapy, caregivers encourage people with dementia and age-related cognitive impairments to talk about past events and their own life experiences, often aided by old photos, music, and other prompts that stimulate memories. Studies have shown that reminiscence therapy has positive effects on the mood, cognition, and communication level of dementia patients.
Our strongest, most enduring memories tend to be the those formed in adolescence and early adulthood, from roughly the ages of 10 to 30. Reminiscence therapy targets this age range, and for those Silent Generation members now in their 70s and 80s, that means the 1950s. (A person who is 80 in 2018 would have been 12 in 1950.) So the design of Town Square is intended to evoke the years between 1953 and 1961. It’s decked out with touches like a rotary phones, a 1959 Ford Thunderbird, a classic jukebox, portraits of period Hollywood stars, and vintage books and magazines. As the years go by, these will be replaced by more recent, period-appropriate prompts.
The faux town has 14 different storefronts, including a diner, a movie theater, a pet store, a park-like square, and even a city hall (modeled on San Diego’s real county-administration building). Participants—the term that Glenner staff members prefer to the medicalized “patients”—rotate around with an aide in small groups, usually visiting five or six storefronts in a day and doing tailored activities in each one. Most of them have early-to-moderate-stage Alzheimer’s disease, and they’re assessed in advance to determine whether they’re likely to benefit from the experience.
“Every storefront lends itself to reminiscing” at Town Square, said Scott Tarde, CEO of the Glenner Centers. “In the library, they’ll do everything from puzzles to having storytellers come in. In the pet store, animal therapy.” There’s also a sports pub, where Tarde has spotted some octogenarian pool sharks. (“They can absolutely still shoot pool,” he said.)
One month in, Town Square has about 40 frequent inhabitants. (Its population is capped at 75 by the fire code.) “The interest level has been extremely high,” Tarde said—and already, satellite cities are in the works.
Glenner has partnered with the home health-care giant Senior Helpers, which employs some 25,000 caregivers around the U.S., to build Town Squares around the country. Version 2.0 is under construction near Baltimore, in a former Rite Aid in White Marsh, Maryland. Seniors Helpers will own and run that facility, expected to open in early 2019. But franchise sales are under way, and Peter Ross, the company’s CEO, is bullish.
“We’d like to get between 10 and 20 sold the first year,” he said. “We think it’s going to go very well. The sky’s the limit.” The third Town Square (that is, the first franchised location) is likely to be in the Chicago area, according to Ross. Each location will cost $1 million or $1.5 million to build, Ross estimates.
A major difference between the original Town Square and the Maryland one is the setting. Whereas the Chula Vista warehouse is in a light-industrial area, between a tire store and a metal recycling yard, the White Marsh outpost is in a conventional suburban shopping strip.
“We always thought we’d be stuck doing these light-industrial, big warehouse buildings,” Ross said, but “we’re now finding places we thought we could never touch. … We’re in what I would consider a suburbia kind of area, that has its own building with its own signage on a major road.”
The high land prices in Southern California influenced the choice of the Chula Vista location. But as Ross notes, the commercial real-estate market has weak spots. “There are a lot of these 10,000-square-foot facilities that are empty,” Ross said. He expects many of the franchises to open up in places like White Marsh.
If Ross’s confidence is well-founded, dozens of faux “memory towns” will sprout around the U.S. in coming years. Amid a retail meltdown, the malls where teenagers used to hit up American Eagle and Orange Julius could morph into escapist domains for the elderly. It’s not what advocates of retrofitting the suburbs may have had in mind, but it’s a logical outcome of the graying of America, and of suburbia in particular.
The share of the U.S. population that is 65 or older has risen from 12.4 percent in 2000 to 15.2 percent in 2016, and is expected to hit 20 percent by 2030. Suburbia is shaping up to be ground zero for the uptick of the median age: The 65-and-older population in the suburbs has increased 39 percent since 2000. And it’s likely to keep growing. According to the AARP, most Baby Boomers say they want to “age in place.”
You can already see this this demographic shift in the spread of dialysis centers across the landscape. Today, some 468,000 Americans are on dialysis for kidney failure, a nearly 47-fold increase over four decades. As patient numbers have risen, treatment has moved out of hospitals and into office parks and shopping centers. The two biggest U.S. dialysis providers now “operate about 3,900 locations nationwide—roughly the same number of Target, Best Buy, and Publix Super Market stores combined,” according to the New England Journal of Medicine.
Similarly, adult day-care centers have boomed. As of 2014, there were 4,800 nationwide, with about 282,200 participants. The service that Glenner provides at Town Square—and that its franchisees will offer—is a form of adult day care, but in an unusually elaborate, cheerful, and spacious setting. Part of the sales pitch is that family members of people with dementia can feel good about leaving their loved ones for the day to give themselves a needed respite. (Not surprisingly, the extra reassurance comes at a premium; Town Square costs $95 a day, while the average rate for adult day-care centers is $61.)
Reminiscence therapy has been tried in older people who don’t have dementia, with some evidence of mood improvement, and Ross hopes to bring it to a larger market through Town Square. “Any senior who is looking for an interactive program to make their day” might visit one of the future faux towns, he wrote in an email. “They could be dealing with other chronic illnesses as well as just wanting to engage with others during their day. We believe a lot of seniors in their late 70s and 80s will see value in participating in Town Square.”
Ross likened Town Square to Disneyland, a more revealing comparison than it may at first seem. Disneyland, too, is an artificial environment steeped in nostalgia that many people dismiss as cheesy. But it is also a place where Americans can leave their cars behind for a while and explore a traditional “town” on foot (or by wheelchair). In his famous essay “You Have to Pay for the Public Life,” published in 1965, architect Charles Moore described Disneyland as a private version of the urban public realm that the country was losing, and that it clearly missed:
The assumption inevitably made by people who have not yet been there—that it is some sort of physical extension of Mickey Mouse—is wildly inaccurate. Instead, singlehanded, it is engaged in replacing many of those elements of the public realm which have vanished in the featureless private floating world of southern California … Curiously, for a public place, Disneyland is not free. You buy tickets at the gate. But then, Versailles cost someone a great deal of money, too.
The onward march of private or semi-public “nostalgiavilles” (retiree-only communities such as the Villages, Florida, are similarly engineered to evoke vanished small-town life) raises the question: Do people respond to these places simply because they remind them of their youth, or does their form matter, too? After all, millions of Boomers grew up in postwar sprawl, but Town Square isn’t designed to mimic that.
Instead, as Tarde noted, it “really replicates [a] kind of urban experience. You’re going to a movie theater, going to a library, a department store. Engaging in these activities that may not be accessible to these individuals any longer. But they are in Town Square, and it’s safe.” In other words, the principle behind Town Square is the dense concentration of different services, as in a city (although adapted for a vulnerable population).
It’s a sad commentary on our real, full-scale communities that they are so anti-urban by comparison, and so unsafe for the old and frail. Most of the elderly participants strolling these franchised memory lanes will have to be driven to the suburban shopping centers that host them. The recipe for age-friendly cities is not that difficult: walkability, accessibility, plenty of outdoor space, good transit, opportunities for social connection. We shouldn’t have to dodge traffic on an eight-lane road just to get to a simulacrum of an inclusive urban place. The problem is not too much Disneyland thinking—it’s not enough.