Imagine if you will, a place of total comfort, hygiene, dignity, safety and freedom from responsibility. This is what I propose for the elderly demented population, which will include any of us, unless we die of other causes first. Senescent or senile dementia is inevitable, although one may be of centenarian status to join the ranks of the demented. Current facilities are oriented to approach dementia as a disease, offering medical treatment for intellectual impairment and agitation. While some dementias are indeed a reflection of a defined disease state such as Parkinson disease, Pick disease, Huntington chorea, Creutzfeldt-Jakob disease and presenile dementia (Alzheimer disease), the vast majority of demented residents are beyond the usual American life span of 78 to 80 years and are intellectually impaired because of senile dementia, which happens to exhibit the same neuropathology as presenile dementia of Alzheimer.

Recently, the condition known as mild cognitive impairment has been shown, by autopsy study, to be early Alzheimer type dementia. Additionally, patients in this early stage of dementia are at increased risk of suicide, likely because of the horror of the awareness of losing their intellect and the fear of what may lie ahead. At this point in medical history, with an impending upsurge in the total number of demented adults expected as Baby Boomers reach their seventies, such fears are well founded. We do not have an acceptable model of care for demented rock 'n' rollers. The DementoDome could supplant these fears and substitute an eager anticipation of aging with security.

The current proposition at hand is a revolutionary, brave new civilization for the demented person of any etiology, but mainly populated by patients with senile dementia. This civilization will have its basis in the five principles of medical care, especially care of the vulnerable. Comfort, hygiene, dignity, safety and freedom from responsibility will be these guiding principles. The residents of this new civilization will be demented, but dignified human beings, cared for by enlightened and well-paid aides and staff experts from many disciplines: medicine, nursing, the therapies, recreation, law, art, psychology, nutrition, engineering, architecture, transportation, and sanitation.

The civilization would be housed securely in a limited egress facility (a dome),
covering 100 to 200 acres with surrounding support/visitation infrastructure.
Approximately 100,000 residents would be able to live comfortably in The Dome, wandering safely through its confines, encountering an adult playland along the way. Food and refreshment centers (including alcoholic beverages) will be placed at frequent intervals throughout the dome. Sleeping and rest facilities well be generic, spotless and offer window views (one-way glass, for privacy). Any resident may sleep where he/she likes.

Residents will be given GPS locator bracelets so that the response time will be as fast and efficient as possible if an urgent need arises or if medications are to be administered at a certain time of day. The GPS locator system will also facilitate location of the resident if visitation is requested by the family.


Sanitation and waste-removal will be a challenge given late-stage incontinence, but ubiquitous and discreet shower wands and floor drains may be the best solution to this problem, with an advanced sub-floor sewer system throughout the entire structure. Kanamycin-impregnated surfaces will provide contact bactericidal effects.

Recreation and play will be the main goal for the demented elderly, to give them their “Golden Years” even in the form of a second childhood. Within the dome, areas of bumper cars, battle fields, dress-up costumeries, art studios, “mountain” climbing, lakeside camping, old-car washing, wedding chapels, movie theaters, dance floors, and garages for tinkering will be totally accessible to any resident, day or night, for no additional fee beyond the daily charge of 150 US dollars.

The huge layout allows for many play-work stations and will minimize crowding. Superstructure facilities available by elevators will mimic office buildings where residents may go to sit at a desk, read a newspaper, and open mail if so inclined. A faux business district may be well-received by those who desire a “work” break from the continuous play atmosphere below.


The main floor contour will be a gently descending spiral so the weaker ambulatory patients may self-select lower levels with calibrated surface activities as the descent occurs in function as well. They will probably reach the point where they are too weak and disinclined to ascend to former levels of function and elevation.


The central region of The Dome is a tower ascending 50 stories above ground level and beginning 20 stories below ground level. It is around this axis that the floor will gently spiral downward. The tower contains administrative offices, support facilities, power plant, structural control center, recreational areas, and at higher levels above the dome, h otels for visitors, condominia, office space, and at the very top, a restaurant.

Because The Dome has retractable sunroof panels, the views from above would be shielded by rain-trapping eaves of huge proportion to resemble wind-neutral fins which even have a musical tone on windy days. Because many residents would prefer to be sans attire, their dignity and privacy would be preserved by these eave fins. Needless to say, no private citizen of the outside world, or any family members, for that matter, would be allowed free access to the dome proper. Visitation would take place in a concourse surrounding the dome, tower condos, or hotels in the tower or in the surrounding acreage around the dome.


Patients and families would be free to visit one another anytime, day or night if the resident is not sleeping, but the visits would occur in designated areas or off site. Any filming or tours would be carefully controlled and orchestrated to prevent invasion of privacy of the residents.
A modern controversy in nursing home management is how to deal with sexual encounters between the residents. These are very common and may occur in the dome. Sexual expression will be facilitated safely in the dome virtual reality service sectors, which should be instrumental in reducing the agitation which accompanies sexual frustration.


Behavioral observations of demented individuals have been, perforce, contaminated by The Uncertainty Principal–the inevitable in fluencing of the result by the action of measurement. The present proposal would allow an environment of Quantum Realities, which could lend themselves to observation at-a-distance, in a setting of safety, tranquility and pleasure. It is incumbent on us to carefully and respectfully enter the reality of the demented person, so that we may gain insights about natural behavioral tendencies when the executive abilities of the human neocortex are no longer viable and reliable.

This project would assume abundant, reasonably-priced land and ample water supply. Rain and snow-saving technology may mitigate against water requirements; however, water needs will be magnified because of the frequent placement of waterfalls, fountains, and, of course, a calming, shallow man-made stream which accompanies the downward spiral to recirculation pumps.


The funding estimates are predicated on size and services provided as well as maintenance, salaries, and taxes but an initial investment of 5 billion US dollars to 15 billion US dollars would be offset by the projected revenues from a fully-populated citizenry as well as rentals, leases and sales in commercial zones and residential units for those who just want to live in the largest structure ever built. Total annual revenues could exceed 5 billion US dollars and perhaps even more if surrounding land areas are astutely franchised and marketed.