The northern Europeans have set the bar for long-term care innovation with their approach to universal design specifications for senior housing and their community based--home care service delivery models. The Dutch Apartment for Life model is designed so residents can age-in-place in an adaptable residential apartment. Care services ramp up as the competency of residents decline. The coordination of these two strategies along with a philosophy that stresses self-supportive behaviors allows the vast majority of residents to avoid institutionalization. Small-scale dementia clusters and adult day care programs are often embedded in these housing developments to deal with this particular population. Dementia care has evolved in many ways--the Hogewey is another example of how the Dutch have combined small group living with a more engaged "village-like" community context. The Dutch and their northern European neighbors have much to offer the US and Asia, as we contemplate a future with many more older frail constituents.