Walking the fine line between safety and freedom
- Ellen van Dijken
- 12h
- 5 min read
Caring for someone with dementia often means walking a tightrope between keeping them safe and allowing them space to live freely. For many families, that tension is uncomfortable and deeply personal. In the Netherlands, care homes have been required since 2020 to move towards an open door policy. This is a process that takes careful preparation. Now, one care home is finally taking that next step by opening the locked doors of its dementia unit.
It’s a move that raises questions about safety, dignity, and how much freedom matters in the later stages of life. Similar questions are emerging in Aotearoa New Zealand, where national standards now require restraint, from medications to equipment to physical barriers, to be used only as a last resort.
As debate continues, these stories invite an alternative way of thinking: safety and freedom do not need to be opposite sides of the coin.
Within a day activity programme, these matters are also relevant. At Home4All, we are conscious to give the participants freedom of choice, and to provide a range of activities; respecting that different people have different interests and needs. The farm environment allows participants to also accept a degree of unpredictability and spontaneity, and a bit more risk, which for many people makes life more interesting.
Please enjoy below a summary of an article as it appeared in the NRC newspaper in The Netherlands, on 15 February 2026. Written by Ingmar Vriesema.
If you would like to read the full article, please click on the link below the blog post to download as a PDF.
Opening the Doors: A New Vision of Dementia Care in the Netherlands
In the Netherlands, since 2020, nursing homes have officially been required to move toward an open‑door policy, allowing people with dementia to walk outside freely and remain part of the community. Yet in many places, the reality still looks very different. Doors remain locked, codes remain secret, and residents spend their final years in spaces designed primarily for safety rather than freedom.
Berkenstaete, a nursing home in the village of Son en Breugel near Eindhoven, is now preparing to change that. Later this year, its secure dementia units, home to 33 residents, will open their doors. Residents will be able to leave the Home, step outside for fresh air, wander to the local supermarket, or sit on a bench by the canal. It is a shift that brings excitement, anxiety, and a lot of soul‑searching.
For decades, residents living with dementia lived behind coded doors, their worlds shrinking to a corridor, a living room, and occasional escorted activities. Staff and family have watched how dementia gently folds people inward, until many retreat into a place where familiarity, comfort, and emotional security matter more than anything else. Weighted blankets, gentle routines, and attentive support help them feel safe in a world that can otherwise be confusing.
Still, not everyone is content to remain inside. Some residents have a natural need to walk. One of them, a man named Albert, managed to slip out twice. The first time, he walked to a bus stop, boarded a bus to Eindhoven, and ended up lost in a busy city. A young woman noticed his confusion and called the police, who eventually reunited him with his daughter. Months later, he disappeared again and was found after a fall along a main road. His daughter described the panic, the fear, and her anger at the facility. For her, safety mattered above all else.
Other families see things differently. Some feel reassured knowing that if their parent wanders, someone in the community will help. They believe that life should include spontaneity and freedom, even with dementia. When Berkenstaete announced its upcoming open‑door policy, these differences became painfully clear. One family described being shaken by the tension in the room - fear on one side, hope on the other.
This debate reflects the shift in Dutch law. The previous legal framework focused heavily on protecting people with psychiatric conditions and not enough on the rights of people with dementia. With the new Care and Coercion Act (similar to Ngā Paerewa Health and Disability Services Standard, Section 6- Restraint and Seclusion), the emphasis has flipped. Restraint, including locking doors, is allowed only when absolutely necessary. Even in advanced dementia, the law recognises residents as citizens with the same freedoms as anyone else. Safety remains important, but it no longer automatically outweighs autonomy.
That doesn’t mean doors will simply be thrown open. Berkenstaete is taking a deliberate approach. Every resident will be individually assessed. Some will be free to walk outside on their own. Others may need GPS trackers or support because of a high risk of falling. A small number might still require restrictions if there is a clear, serious, and imminent risk of harm. The principle is simple: freedom first, except in well‑justified cases; not the other way around.
It’s understandable that this shift feels unsettling. Care staff acknowledge how different things were not so long ago. Some remember when residents were strapped into wheelchairs to prevent falls, or when bed rails were routinely used at night. These practices came from a place of responsibility and care: keeping people safe felt like the most loving thing to do. But over time, professionals realised that focusing too much on preventing harm can rob people of their dignity, independence, and personhood.
Homes that have already opened their doors report surprising results. Instead of chaos, many describe a calmer atmosphere. When residents no longer press against locked doors or feel confined, agitation decreases and the environment becomes more peaceful. The freedom to move, even in small ways, seems to honour something deeply human.
The heart of this transformation lies in a question we all wrestle with when supporting someone with dementia: how much safety is enough, and how much freedom is fair? Is it better to accept some risks if it means someone can enjoy natural light, fresh air, and the rhythms of community life? Or is the possibility of harm simply too great?
There is no easy answer. Every family brings their own experiences, fears, and hopes. Every resident brings their own abilities, vulnerabilities, and desires. What Berkenstaete’s story makes clear is that the era of one‑size‑fits‑all safety is ending. Instead, dementia care is moving toward a more compassionate, more personalised approach; one that honours the person behind the diagnosis.
For families and professionals alike, this change invites a broader reflection: what does it mean to live well with dementia? And how can care homes support not just a person’s safety, but their identity, relationships, and sense of belonging? As Berkenstaete prepares to open its doors, it opens those questions too; challenging us to imagine a model of care where freedom and dignity sit at the centre, even when the path is not without risk.
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