With echos of the Truman Show, medical staff pose as neighbors and bartenders in this groundbreaking Dutch institution to treat dementia.
WEESP — Inside the local shopping mall, an elderly woman is humming under a large umbrella. She just came out of her music club, and walks cheerfully past the supermarket and café that has set up small tables and an ice-cream stand near its entrance. The woman then steps outside into the damp air where a theater, hairdresser and physiotherapist office share the sidewalk.
As normal as it looks, this is not a regular neighborhood, but a pioneering retirement home complex. We are about 20 kilometers outside of Amsterdam, where the De Hogeweyk home takes in elderly people suffering from Alzheimer’s, or other advanced forms of senility and dementia, without a single lab coat in sight or smell of disinfectant in the air.
The red-brick complex is located in a residential area in the small Dutch town of Weesp where, after walking through a glass-door, you enter a curious town-within-a-town. Its streets, squares, benches and fountains, its park and low-rise buildings arranged around walkways, patios and terraces are welcoming and encourage the residents to spend time with their neighbors.
At the same location, there used to be an ordinary six-floor retirement home whose staff, one day, asked themselves the right question: “If our own parents suffered from dementia, would we want them to live here?”
The (negative) response was as unanimous as the desire to invent another model, where the quality of life and the consideration for the person would be as important as the treatment provided; where daily life would be as similar as possible to past normality to give their days meaning again. This collective thinking led to a secured village that follows the required health standards, almost entirely funded by the state (17.5 million euros, plus two million euros more in sponsoring). The first inhabitants arrived in December 2009.
“People suffering from senile dementia are capable of "operating" quite normally when they are in a normal environment,” De Hogeweyk’s manager Jannette Spiering says.
This artificial kind of normalcy features cashiers, bartenders, hairdressers, all staff members trained for Alzheimer’s disease. A “permanent reality-show” described in the presentation brochure: “Everything is done for the inhabitants to be able to familiarize with the created reality and be in control of their daily life. Is it fake? For a person suffering from senile dementia, not at all.”
Choose your atmosphere
The 152 residents, with a median of 83, live in groups of six or seven, in around 20 vast apartments managed by nurses who take their shifts in turns from early in the morning until late in the evening. They take care of the residents as well as chores — at night, an alarm tone allows the staff to guide those walking around outside back to their living quarters.
The organization of the apartments does not depend on the illnesses, but on the patients’ former lifestyles and cultural preferences that their families, after answering numerous questions, have helped define. Seven atmospheres have been reproduced. They combine attachment to tradition, culture and religion, to rural and urban environments, foreign origins or domestic and family pleasures. Everything is done to avoid frictions such as arguments between those who prefer keeping the TV on all day and those who cannot stand it; such tension is amplified in dementia, which generally removes any inhibition.
Patients do not adapt to the institution — the institution adapts to them. There is no fixed schedule to get up, to eat or to go to bed. The residents may go out into the village whenever they want; there are no fixed visiting hours, relatives are always welcome.
In the “bourgeois-style” apartment, the crystal chandeliers, the chimney, the bread baskets on the table, the classical music as background music, are all as well thought-out as the behavior of the medical staff, who avoid any familiarity and can even play the role of domestic staff.
Compared to this, the “urban lifestyle” atmosphere is less stiff. Four residents are watching a DVD, sitting in large soft armchairs, surrounded by nursing staff and relatives.
Theo Visser, 82, wearing a checkered cardigan and a tie, tenderly holds the hand of his wife, who is staring in the distance. She has lived here for five years. Five years during which she has not spoken. “Things are never easy, but I’m satisfied. She’s not treated as she would be in a psychiatric institution, and she feels at home here,” says Theo.
Rum and Coke
Alie De Vlught, 83, seems to enjoy having her bedroom door open to talk. She still remembers working in fashion but not how long she has lived here. “It’s not like at home”, she says straight away, “but it’s still good. We walk around and meet people.”
A nurse smiles: “She enjoys drinking a little rum and Coke at the restaurant, every afternoon, with a fellow resident.”
All the patients are encouraged to stay active, to take part in domestic chores, whether it means peeling a few potatoes or stirring a sauce. “If they can no longer do that,” Jannette Spiering adds, “they sit in an adapted armchair surrounded by the others, the daily life, the kitchen or laundry noises and smells, which are reassuring because they’re familiar. Even ironing has a smell …”
Because not feeling trapped decreases anxiety, and thus their need for medicines, the residents are free to come and go within this micro-society: take a walk, drink a coffee with a friend, visit one of the 25 leisure clubs — of which the music, dance and bingo clubs are the most popular.
They are also free to change anytime they want. “Your mother used to live like a "lady" but now enjoys sipping beer while listening to folk music? Let her do so, what she enjoys is good for her”, one staff member says they tell families.
But families also have to accept the extra liberty here: An elderly mother, for example, may stay in the rain for a few minutes before being asked to put on a coat. A father may buy three bottles of wine at the supermarket before the cashier calls the nurse and asks for him to be brought back home gently.
With illnesses matching their age, residents of De Hogeweyk live two-and-a-half years longer here than elsewhere, the institution boasts. As for the price of this retirement home belonging to Vivium (a foundation that reinvests all of its profits), we are told it is no higher than that of other Dutch institutions for elderly people: 2,200 euros per month, which is mostly covered by social security.
“The medical and social support is almost the same”, the manager says. “We have just chosen to restrict the managing team and make the employees in the apartments multitask.”
The village of De Hogeweyk likes to think it is as open as possible to the outside world, with its upmarket restaurant, its concerts and exhibitions. Relatives, however, do not visit as much as the project’s developers had imagined, when they put the finishing touches to the place. The aesthetics and apparent normality of the center cannot change everything. Not being recognized by a parent is sometimes too hard to bear.
On the other hand, people come from all over the world to see this pioneering model. Still, only two other similar projects are being set up in Switzerland and Germany. No more. “Abandoning the classic model is complicated and frightening,“ Spiering explains. “And retirement homes have so many people on their waiting lists. Why would they do things differently?”
Pascal Champvert, who manages several French elderly institutions and home services, says France should learn from this Dutch model. “Absence of freedom is something humans will always feel,” he says. “But we are a lot more focused on the security aspect and keeping up standard requirements. Nobody wants anything to happen to their mother. So nothing happens at all.” De Hogeweyk’s little rum and Coke shared between friends still seems far away.