Hogewey: Dementia Care Done Differently
This is the fourth blog post in a series about cutting edge elder care in the Netherlands. In this blog post, we take a closer look at the Dementia Village at Hogewey.
During my recent trip to the Netherlands, I traveled thirty minutes southeast of Amsterdam to the city of Weesp. There, I visited Hogewey, the Dementia Village. Hogewey is pioneering an exemplary care model, in my view. Since my visit, I have thought a lot about life in the village. In this blog post, I will describe Hogeway and why I hope that we see more villages like it around the world.
According to the World Health Organization, around thirty six million people worldwide suffer from dementia. This figure is likely to double by 2030 and triple by 2050. In one way, dementia is an anonymous disease. Few people who suffer from later stage dementia can argue for their care rights – the rights to a normal life, social interactions, and friendships. Dementia makes it difficult to maintain relationships and to maintain your social network. Close relationships suffer tremendously. Dementia makes it hard to articulate your needs, and your rights.
Despite these challenges, life with dementia can still be good. The right type of care can help you maintain your bodily functions, help you feel safe, reduce your anxiety, and instill some sense of normalcy into your daily life. Hogewey helps those with dementia do just that: live normal lives.
Caring Not Curing
Dementia is a chronic illness. Researchers and academics have yet to find a cure. Since we cannot treat dementia, what can we do? We can delay the development of the illness through various drug treatments. We can maintain active lifestyles and exercise regularly. An active lifestyle has been shown to postpone the onset of Alzheimer’s disease. We can use the reminiscence therapy, where we try to evoke memories from earlier years, to prolong the development of dementia.
How can we develop care homes and approaches to care that help individuals with later stage dementia? Since we cannot treat disease, we should focus on caring for and supporting the individual. We can look toward palliative medicine for inspiration. We can study examples like Hogewey for guidance. Palliative medicine places as much emphasis on quality of life and symptom reduction as does a good dementia care model.
About the Village
Established in 2002, Hogewey houses 152 residents in twenty three small houses, with around six people to a house. Research has shown that smaller groups enhance quality of life for those who suffer from dementia. Smaller groups create familiarity and a calm environment while still providing valuable social contact. The residents of each house share a similar lifestyle. A caregiver is responsible for cooking and managing the lifestyle of the house. The concept behind the village is about twenty years old. The village welcomes about forty new residents each year. Most stay for around three years. All residents of Hogewey have been diagnosed with advanced dementia. The concept is unique in the Netherlands, though other care organizations have adopted similar features.
Hogewey is an open village. Only the external door to the village is locked. Hogewey residents are free to move around, not only inside their homes but also outside, throughout the village. The village is not a nursing home. The ability of residents to walk outside their rooms and houses is a key component of the philosophy of care at Hogewey. If you are able to walk outdoors, sit in the garden, and come and go as you want, you may feel more at ease than sitting inside your room in a nursing home.
Care at Hogewey is flexible. Residents can choose to have breakfast at different times. Lunches and dinners are more structured. Residents can join an activity club for free. If residents wish to participate in a wider range of activities, they can choose to pay for extra club memberships, such as classical music societies and gardening clubs. There is also a pub where residents can socialize. The village provides social connections. Residents move freely in and out of one another’s houses, visit a hairdresser, go the supermarket, eat in the restaurant, go to the theater, or join excursions.
Hogewey attracts many volunteers from the surrounding area. Some of the village facilities, such as the theater, are available for rent to outside companies. The restaurants are open to the public. Interaction with the world outside the village creates an atmosphere of normalcy.
Each house in the village consists of a hallway, kitchen, large living room, two bathrooms, and six bedrooms. The hallway, where residents hang their coats, has a front door that leads to an outside garden. Each side of the house is lined with three bedrooms. This arrangement provides a balance between privacy and community. Residents are free to decorate their rooms however they like, with their own personal belongings, and choose their own rhythm of life.
In the kitchen, the caregiver prepares all of the meals for residents of his or her house. Many residents also help to prepare their own meals. Residents accompany their caregiver to the supermarket to pick up groceries on a daily basis. These normal daily routines are part of the care philosophy.
The living rooms range from seventy five to ninety square meters. The private bedrooms are around twenty square meters. Each bedroom is equipped with a sink where residents can brush their teeth and wash their faces. There are two bathrooms in each house. Caregivers manage behind the scenes care from a nursing desk. This work includes managing distribution of medications and patient journals. The desk is discreetly placed inside a cupboard that can easily be closed so that nothing in the house resembles a care facility.
Only the waitresses and the maintenance teams in the village wear uniforms. All other members of staff wear normal clothing. The staff members do not emphasize their roles as caregivers or nurses. The staff assists residents if they get lost in the village.
When a resident moves into Hogewey, the staff asks a number of questions to identify which lifestyle will be the best fit. There are several different lifestyles at Hogewey, including the Indonesian house, the artistic lifestyle, the city living houses, and the traditional Dutch lifestyle. The furniture and interior design of each house is chosen to reflect the selected lifestyle. The houses are equipped with audio recording equipment and sensors to detect movement. In the evenings, the caregiver leaves the premises. A central team listens to the audio and helps residents when necessary.
When Hogewey was transformed from a traditional nursing home into the village it is today, the founders sought to create an atmosphere that resembled normal living. The founders wanted to focus on quality of life, not quality of care. The founders realized that dementia care is just as much about wellness and lifestyle as it is about the medical management of the disease.
Hogewey focuses on the interests of each individual person rather than assuming commonalities due to dementia. Just because you live in a house with a traditional lifestyle does not mean that you live your life the same way as your neighbor lives hers. There are a wide array of dementia types, with different symptoms and wildly different impacts on individuals’ lives. To say that you have something in common just because you suffer from dementia is like saying you have something in common just because you have a chronic illness. Two people with dementia may not share the same experiences, or even get along with one another.
There is a nursing home behind the scenes at Hogewey. The nursing home adheres to all the standards of care established by the Dutch government. The nursing home is staffed by nurses, rehabilitation teams, and psychologists.
The front end of the village focuses on managing the wellness and social aspects of care. Attention to the overall wellness of the residents decreases the need for medications and for medical care. Dedicated teams of six work in each house to ensure continuity of care and that a caregiver is on duty throughout the day, every day.
A full time geriatric specialist assists residents with any medical needs. The village also employs a physical therapist. While a traditional nursing home would employ several physical therapists, Hogewey intentionally allocates funding to encourage lifestyles and activities that reduce the need for physical therapy. When residents are active and walk to the grocery store every day, they have less need for physical therapy. A psychologist is also available for about twenty hours every week. Two social workers trained in lifestyle and behavioral aspects of dementia care assist the psychologist.
Most of the employees report satisfaction with their roles at Hogewey. Either you embrace the care concept and carry out all the different wellness and care tasks every day or you dislike the care concept. Only employees who favor this care concept stay, over the long run. A trained nurse may not want to do grocery shopping and go for walks with residents. This is a personal choice.
In my opinion, caring is so much more than providing medical care. That walk to the grocery store offers the nurse an opportunity to assess how well a person walks. The walk strengthens the resident’s balance and provides an opportunity to exercise. A nurse that can perform different tasks is a more agile nurse. The activities at Hogewey enable caregivers to provide better care simply because they can observe residents as they move around different environments in the village.
Hogewey is financially sustainable. The village is reimbursed by Dutch insurance providers. The village receives the same level of reimbursement as other nursing homes.
Other countries and elder care providers abroad should first understand fully the concept of care at the Hogewey Dementia Village in the Netherlands and then adapt the concept to local circumstances. The focus should be on care, wellness, and social relations. The focus should not only be on medical care. The village management team is careful about cautioning others: Anyone who is interested in the Dementia Village should study the village model, and then adapt it rather than copying it.
I hope this blog post explains a little bit about the life in the village and the many advantages of this type of dementia care. I think one must go to the village to understand the concept as a whole. I hope that some of you will have the opportunity to do so, and be as inspired and encouraged as I am about the future of dementia care.