A well-known dementia village in the Netherlands not only serves as a global standard for person-centered care; it also challenges US operators to change their mindset on the delivery — and very definition — of memory care.
As the first and most well-known dementia village in the world, the Hogeweyk is situated in a small town in the Netherlands just outside of Amsterdam. The care community for individuals with dementia opened in 2009 and houses over 180 residents in 27 homes that are divided by lifestyle, down to the decor in the homes and the food preferences shared by residents.
A group of senior care experts and operators who visited the Hogeweyk earlier this year shared their perspectives on the dementia village model and how aspects of it could be incorporated into the US memory care model during a recent panel discussion hosted by Viking Pure.
For all of its fame, the panelists said that several misconceptions exist about the village, including that it is a full-blown skilled nursing facility. The Hogeweyk is considered a neighborhood that is part of the town where it sits, and it operates under three guiding principles of deinstitutionalizing, transforming and normalizing care.
Because the government pays for care, individuals must be assessed for eligibility to live in the community, which cares for residents living with moderate to severe dementia who have complex medical needs and in need of high levels of support and supervision.
All staff members are generalists, with everyone responsible for the well-being of the residents, regardless of their role. Nicole Will, founder of the willGather podcast, found the model in sharp contrast to the US staffing model, which she said is “hung up on titles and positions and seniority.” There are no uniforms, no name tags, creating a community where everyone is made to feel welcome, she said.
Learning through sharing
As a business owner and operator in the world of dementia care, Lee said that American operators can learn from the concept of sharing their discoveries.
“Their mission is to help other organizations to create their own versions of innovation,” said James Lee, CEO and co-founder of Bella Groves, a dementia education and care support organization in Texas. He added that the Hogeweyk isn’t trying to help anyone copy and paste its model into somewhere else, but it is available to advise.
Adria Thompson, a speech-language pathologist and founder of Be Light Care Consulting, echoed that sentiment, saying that the community doesn’t claim to have the answer for dementia care, but people there are willing to share what they’ve learned and help others translate the best practices into their own operations.
“They know the model they created in 2009 is not going to be the answer for dementia care forever,” Thompson said. “It was innovative and brave at the time — and it still shows inspiration — but no one is claiming this is the answer.”
A different perspective on dementia care
What makes the Hogeweyk special, the panelists said, is its view of dementia care. The village focuses on living in the moment and living in full joy.
The way most people perceive dementia care is staving off decline as much as possible, Lee said. The general premise being that as someone ages and moves closer to dying, their quality of life slowly degrades.
In the Hogeweyk, the goal is to maintain someone’s quality of life as high as possible for as long as possible, knowing that a steep decline at the end of life will occur — with four days being the average length of time someone spends in the active stage of dying, Lee said. The concept avoids efforts to prolong life in exchange for maintaining quality of life and providing dignity in the final days.
One way the village provides that quality of life is through freedom. Carrie Aalberts, also known as Dementia Darling, said that the residents of the Hogeweyk don’t feel confined. Instead, she said, residents are involved in the community, families come and go, and the vibe is of a life being lived.
The Hogeweyk created opportunities and environments with the intention of allowing residents to do what they normally do everyday, including going to the grocery store, having coffee or watching a movie at the theater. Rather than creating the facade of a village, the Hogeweyk is a two-story village that has a restaurant, a grocery store, a pub and a movie theater that anyone in the greater community can visit.
“There is such a feeling of joy, bustling and a fire that naturally lends itself to engagement and going about daily life,” Will said, adding that residents with dementia typically have high stress levels because they don’t know what to do with their time and don’t have natural ways to engage.
That freedom, however, carries inherent risks of everyday living, such as the second-level walkway with a railing and the ability of residents to wander anywhere they choose. The focus, according to the Hogeweyk, is on abilities, not disabilities. That focus, she said, is an argument for more of a social model of care.
Lee said his takeaway from the visit was that US operators focus entirely too much on risk, opting for a medical care model. He said it’s time for US senior living operators to challenge their own thinking and have tough conversations about what they are doing right and what they should rethink.
“We don’t create safety. We trade for safety,” he said. “We give things away to have more safety. We give away agency, autonomy and choice.”
