In the Dutch municipality of Weesp, not far from Amsterdam, sits the village of Hogewey. At first glance, it looks like any other village, with shops, restaurants and a movie theater. Apartments surround a courtyard complete with rippling ponds, trickling fountains, vibrant seasonal flowers and benches perfect for enjoying a sunny afternoon.
This village, however, is quite unusual. Hogewey, sometimes referred to as "Dementiaville," is an ongoing, 20-year-old experiment in cutting-edge dementia care. Home to 152 men and women living with severe dementia, the community has 23 residential units, each shared by 6 to 8 residents. Around-the-clock care is provided by 240 full- and part-time "villagers" who are actually trained geriatric nurses and caregivers dressed in street clothes. The staff takes care of everything from cooking meals and planning activities to assisting with bathing, personal care and medications. Even the individuals staffing the various village "businesses" are trained in dementia care.
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Eloy van Hal, a facility manager for Vivium Care Group, the parent company of several senior care facilities, including Hogewey, says its founders' vision was of a more humane, engaging dementia care community. "They wanted to make it a place where you want to be," he says. Residents can experience life as they once had, making their own choices, performing everyday tasks and socializing with people who share similar interests.
Hogewey was originally a single, enclosed building, but its operators became convinced that smaller, separate, more open buildings would serve patients better. Yvonne van Amerongen, one of the founders, adds: "It was 1992 and Hogewey was being run as an ordinary care home: wards, common rooms where 20 people sat watching TV, doing nothing, waiting for medication, for meals. It wasn't living. It was a kind of dying."
Despite opposition from some critics who thought the creation of an illusory village was immoral, Hogewey's founders went ahead with their plans. Now residents are not required to follow a set daily schedule. They can choose their routines for breakfast, coffee, lunch and dinner, although each house plans its meals, shops and cooks together. There are also 30 social "clubs," catering to interests in classical music, baking, walking and others, and providing residents the opportunity to do some of the things they did before they became ill.
The Co-existence of Freedom and Security
To ensure patient safety, Hogewey is a secure, closed community, but within its confines residents are free to roam and explore as much as they wish. If they get lost or confused, there is always a "villager" nearby to provide assistance.
Regular reminiscence therapy is one of the keys to the Hogewey approach. The staff strives to place residents in realistically constructed environments that allow them to relive their memories in a calm, peaceful and safe atmosphere. Caregivers work to bring back fond memories of earlier life through food, music, home decorations and other stimulation. (Styles from the 1950s through the '80s are predominant.) Residents "eat dinner at a table with normal plates and enjoy the smells of food cooking in the kitchens of their homes," van Hal says. "When they step out in the rain, they are outside, as cold is a part of normal life." The residents still get the care they need, he says, but by having the staff adjust to their daily rhythms, Hogewey has found a way to provide "something special in a normal way."
The approach, Hogewey management believes, limits the types of behavioral issues often found in traditional dementia units. With relatively less agitation and aggression, there is also reduced need for psychotropic drugs. Hogewey's team feels it provides residents a sense of purpose – something often absent in a traditional nursing home environment.
Not everyone adapts well to life at Hogewey, though. "About once a year there’s not a good match," van Hal says, usually the result of psychiatric problems or the fact that "not everyone is good in small-scale living."
A 'Normal' Life Can Be Costly
Some critics continue to oppose the idea of creating a "fantasy" world. But proponents tout the village as the most compassionate possible form of dementia care. The homelike setting, they say, allows residents to live as normal a life as possible, eating dinner family style, visiting with friends, stopping by the barbershop or going for a walk whenever they wish.
As you might imagine, money is one of the greatest barriers to making self-contained villages like Hogewey the standard for dementia care. The cost to build the community was slightly more than $25 million, $22 million of which was provided by the Dutch government. Residents pay approximately $7,000 monthly and there is a waiting list for admission. Still, officials from nations across the globe have studied Hogewey and are examining how to replicate at least some elements of its vision; a larger version of the village is slated to open in Switzerland in 2017.
While Hogewey does all it can to create a sense of normalcy, its caregivers have no illusions about the reality they face. "The people who live here are deeply demented. They need 24-hour care. Everyone who lives here eventually dies here," van Amerongen says. "At the end, it’s every bit as tough as you can imagine."