Four days a week, 81-year-old Paula goes off to work on a farm near Rotterdam. Depending on the day, she might feed the chickens, assist with chores, or help prepare hot lunches. In many ways Boerderij Op Aarde (Farm On Earth) resembles a typical Dutch working farm, but with one key difference: Paula and most of her fellow workers have dementia. This is one of hundreds of Dutch “care farms” that are operated by people facing an array of illnesses or challenges, either physical or mental. These farms provide meaningful work with a simple philosophy: rather than design care around what people are no longer able to do, design it to emphasize what they still can accomplish. “We don’t focus on what’s missing, but on what is still possible” says Arjan Monteny, cofounder of the farm.



This type of active care can be extremely beneficial, both physically and emotionally. People with dementia are often isolated and less active, so the farm setting provides them with physical movement and social interaction. Care farms also give the participants a sense of purpose, by allowing them the opportunity to make meaningful contributions to the farm’s operation. In traditional dementia care settings the focus tends to be on preventing risk. There’s often a fixed schedule of simple activities like games or movies, and the only choice attendees have is whether to participate or not. On the farm they get to choose which duties they’ll take on, and that’s important, because people with dementia don’t have many opportunities to make decisions in their lives. 



There are about 400 of these care farms in the Netherlands, and most of them include participants of all ages who have needs other than dementia. This system has its challenges, and it isn’t a good fit for people with advanced dementia. But a recent study interviewed thousands of people with early-onset dementia, and found that most of them desire to participate in society. Monteny is inspired by the fact that for those who are still able, “The realization that they like to do useful work, and be valued as contributors, is really important”.