A HOME WORTH REMEMBERING

by Women's Brain Health Initiative:A stroll through the Dutch community of De Hogeweyk is a journey to what could be the future of dementia care. Located within the small town of Weesp, just outside of Amsterdam, De Hogeweyk is a tiny enclave that houses 152 men and women who all suffer from severe dementia and require around-the-clock care. On the surface, this village appears no different from any other neighbourhood in the Netherlands.The village is comprised of various restaurants, cafés, shops, a movie theatre, gardens, and a town square. However, apartments and buildings surround the entire community and fully enclose its inhabitants, with the exception of a single entrance that is monitored day and night. While the residents are free to roam within the village on their own, they remain under surveillance at all times and if they get lost or confused, there is always a “villager” nearby to provide assistance. Even the people who work in the various “businesses” are trained in dealing with people with dementia who help ensure that the village is constantly a secure place for its residents.De Hogeweyk has been dubbed the world’s first “dementia village.” Its co-founder, Yvonne van Amerongen, had worked in a nursing home for decades and throughout her career became increasingly aware of the need for alternative ways of providing care for those suffering from dementia. Rather than a traditional care facility, residents of De Hogeweyk live in a house with proper living rooms and bedrooms that hosts six to seven people with dementia, plus caregivers. The houses are categorized into four design styles: “Goois” (upper class), “traditional,” “urban,” “cultural/cosmopolitan.” Recognizing the diminishing short-term memories of its residents, there are homes that are styled as they might have appeared decades ago. Sometimes referred to as “reminiscence therapy,” the goal is to provide a sense of comforting familiarity to individuals whose dementia can create confusion and anxiety.De Hogeweyk opened in 2009 and will celebrate its ninth anniversary this year. There is a perpetual waiting list for the 152 positions, as residents typically only leave when they pass away. Although the cost is quite steep (approximately C$8,000 per month), the residents pay no more than approximately C$3,600 per month to the government, which in turn tops up the amount that the government pays the non-profit organization that runs De Hogeweyk.Some critics oppose the idea of creating this environment, arguing that residents are being misled. In a 2013 interview with CNN, van Amerongen disputed a reporter’s suggestion that there is an element of deception.“Why should they feel they are fooled? We have a society here. That supermarket is not a show. It’s a real supermarket,” she said. “Maybe we’re fooling them when we say, ‘It’s okay what you’re doing,’ but that’s because we want to help people enjoy life and feel that they are welcome here on this earth.”Proponents of De Hogeweyk, which include geriatric care experts from around the world, tout the dementia village as being the most compassionate type of dementia care offered anywhere.“It’s just so welcoming, warm, and human,” said Dr. Megan Strickfaden, a design anthropologist with the department of human ecology at the University of Alberta. She has visited De Hogeweyk twice and interviewed many of the residents, caregivers, and families.“You can feel that people are comfortable, that there’s a sense of well-being and belonging that you cannot feel in a typical care home environment. It’s a dementia-friendly community on a micro-scale.”Dr. Strickfaden’s admiration is echoed by Alex Mihailidis, Scientific Director of AGE-WELL, a federally-funded research network that is exploring and promoting the development of new technologies to help older Canadians stay independent longer. “The beautiful thing about this concept is providing that sense of freedom (for residents) but in a controlled way, while still giving the care that they need and ensuring that they’re safe,” said Mihailidis in an interview with Mind Over Matter®.Dr. Strickfaden also disagrees with the notion that De Hogeweyk is an illusion. “I’d say quality of life has been designed into the spaces – the smell of cooking creates the opposite of illusion, it creates the feeling of a home,” she said. “You could call it a ‘hyper-reality.’”In 2014, a smaller-scale version of De Hogeweyk was opened at the Georgian Bay Retirement Home in Penetanguishene, Ontario. There is 25,000 square feet of space indoors and outdoors, with the design being retro 50s and 60s – the idea being to make dementia patients feel comfortable in an environment that evokes the familiar setting of their youth.The residents can enjoy all the meaningful activities of everyday life, including a grocery store, barber shop, coffee shop, beach, bowling, movies, and even a garage with a vintage car (1947 Dodge) to trigger fond memories.Another project inspired by the De Hogeweyk model has been recently announced for Langley, British Columbia. Comprised of six, single-storey cottage-style homes and a community centre, “The Village” will be home to 78 individuals with dementia and 72 specially-trained staff. The Village will have a similar design to De Hogeweyk, but in a rural setting on five acres of land. The residents will be able to shop, have a coffee, walk their dogs, and take part in activities such as gardening by themselves. An eight-foot perimeter fence will surround the site, and be designed to blend in with its surroundings. The developers, Verve Senior Living, hope to have The Village completed by April 2019. They estimate that it will cost between $190 to $245 a day per person (or $6,000 to $7,500 a month) to live in this privately-funded project. Verve Senior Living has indicated that they would be open to working with the government to make The Village more affordable so that there is a real community of people of different income levels.Aside from these two Canadian projects, the De Hogeweyk model has not been widely copied in North America – even if the concept is widely admired. Cost is one of the greatest barriers to making self-contained villages like De Hogeweyk the standard in dementia care. The cost to build the community was slightly over $25 million.Mihailidis believes that the long-term social benefits might outweigh the up-front expenses of building such a project, and Dr. Strickfaden suggests that the monthly costs for residents are not far out of line with current Canadian facilities. “I don’t think there’s an economic barrier. There may be an ideological barrier. Just in how we think about care provision for people with dementia,” she said.Dr. Strickfaden said that she regularly receives inquiries from people who want to learn more about De Hogeweyk. She believes that many facilities are taking inspiration from the Dutch model and are adopting key elements of the village, even if they are not building full-scale imitations. The success of the dementia village model is generating ideas in other countries across Europe, and similar villages have opened in Rome, Italy, and in Switzerland.Indeed, the extraordinary community on the edge of Amsterdam is proving to be quite influential. As society struggles with an impeding wave of dementia, and the inherent challenges of caring for an ever-growing cohort of vulnerable people, it is comforting to think that this unique care model may ultimately catch on worldwide.Source: MIND OVER MATTER V6Photo Credit: De Hogeweyk