Please note that this interview was conducted prior to the coronavirus outbreak.
Kate – ‘Tell us a little bit about yourself? What is your background?’
Eloy – ‘I was born in 1967 and I studied Consumer science at Wageningen University. I’m also one of the founders of The Hogeweyk and a senior advisor in the Be Advisors team. I have over 20 years’ experience in managing care and more than 10 years in providing strategic and operational advisory services to clients in the public and private sectors. I focus particularly on the elderly care & dementia care sector and community-based aged care. I have worked on a range of projects all over the world, influencing, engaging and advising stakeholders. I have managed several nursing homes and supported living facilities and elderly homes for more than 20 years. I managed the former nursing home Hogewey for several years, before its transformation into the neighborhood De Hogeweyk®. As one of the developers, I was heavily involved in all the stages of development from initial initiative via design, construction, implementation and maintaining and improving the concept. After opening at the end of 2009, I managed The Hogeweyk® until June 2015. There is such a high demand from the world for new solutions in good dementia care that I now often share my knowledge and experience with others as a full-time senior advisor at Be Advisors since 2015.’
Kate –‘How did you come up with the idea for Hogeweyk?’
Eloy – ‘In 1992 the management team of a traditional nursing home, nursing home Hogewey in The Netherlands (Weesp, 15 kilometers from Amsterdam), decided to do things differently. The management team sat down to decide on what should be done to develop a form of care for people living with serious, advanced dementia. The team felt a strong commitment to developing a form of care that would be acceptable to offer family, parents, friends or for themselves in the future. Such a commitment has its foundation in a thorough understanding of the clinical aspects of dementia, how and when individuals with dementia experience stress, and an appreciation of an individuals’ inability to adjust to new or different situations.
In addition, a consideration of both the physical components of a suitable ‘home’ with all of the accouterments one expects in their home, along with a philosophical willingness to abandon conventional ‘wisdom’ in the care of individuals with dementia is a key element of The Hogeweyk. The Hogeweyk Care Concept supports the residents to experience autonomy to make daily choices about every aspect of their routine, their social adventures (theatre, music, crafts, etc.). They are treated as equal participants in their care and daily life. In January 1993 an experimental ward started in the old nursing home building. This experiment was very successful, so successful that the development of the new care model was taken over by all other wards in the old nursing home building. In 1994 the transition to this care model was made throughout the whole nursing home (in total 169 residents, all with very advanced dementia).’
Kate –‘How do you explain the concept to someone who has never heard of it before?’
Eloy – ‘The Hogeweyk is the outcome of the de-institutionalisation, transformation, and normalisation of the institution/ nursing home Hogewey in 1992-2004. The Hogeweyk is technically licensed as a psycho-geriatric nursing home under Dutch law, but there is little to the eye that resembles a nursing home. A social relational concept instead of medical concept. It is a community for people living with dementia, where you get the best and highest nursing home care and support in the most natural and normal way. A community that looks and feels like a normal, dutch urban neighborhood with streets, houses, restaurant, supermarket, theatre, and much more.’
Kate – ‘How many houses and residents are there? What are their ages? Do they decide to move in themselves or are they selected in a particular way?’
Eloy – ‘ We have 27 houses with 6 or 7 residents in each one. In total, we currently have 169 residents. They are between 60 and 100+ years old with the average age being 85. We provide houses in 4 lifestyles. The lifestyles are urban, homely (traditional), formal, cultural (cosmopolitan). These are based on Dutch lifestyles which are founded in research and similar to the lifestyles that can be found in Dutch society. The lifestyles of potential residents are determined by a lifestyle assessment tool administered in conjunction with family input, with an eye toward ensuring resident homes create a socially compatible environment. All Dutch inhabitants with the specific indication/care profile 5 or 7 ‘severe dementia’ can be admitted to the Hogeweyk. This care profile (ticket to enter a nursing home in the Netherlands) is provided by a special indication committee CIZ (representing the government) after an assessment procedure. This means that every Dutch inhabitant with the right care profile can live in The Hogeweyk after following an admission procedure from Government and The Hogeweyk.’
Kate – ‘How was the village designed?’
Eloy – ‘The Village was designed based on our vision and experience (in the old nursing home, see above) together with an architect (who had, in the beginning, no idea what to design, luckily). It was a co-creation in a project team where Jannette Spiering and I were leading.’
Kate – ‘What kind of training on dementia do the staff receive?’
Eloy – ‘All employees are professionally trained people. The care workers in the houses have a vocational education and additional education in specific subjects like vision, behavior, cooking, cleaning, reporting, etc. and other training and guidance on the job. Next to their training each employee and volunteer will receive training on: hospitality, dementia, The Hogeweyk Care Concept and lifestyles. Each house, where 6-7 people live together, has its own team. A team of well-trained staff know the residents very well, knows what is important to them and what the lifestyle means for the daily life in that specific house. In addition, The Hogeweyk has around 120 volunteers, who receive specific training on dementia care. The volunteers always give the extra time, attention and friendships that make life more worthy. Additionally, the volunteers that come in The Hogeweyk bring in the sense of being part of the society outside. Professional staff in this situation do all the ‘official’ work.
Addressing difficult behavioral issues is the focus for the team of social coaches in co-operation with the psychologist, employed by The Hogeweyk. They coach and support the teams in finding the best ways to prevent aggression or solve aggression. Also, the social coaches are there for the family and the resident when the resident moves into the new home in The Hogeweyk. Additionally, when one member of the household dies, other members are supported by the social coaches.’
Kate – What has been the impact of the project?’
Eloy – ‘From 1993 the impact of the project has been enormous. It has inspired new care models in the Netherlands and since 2008 it has inspired the world in deinstitutionalising the care and the way we (society) look at people living with dementia. The evaluation has shown many positive effects for the residents; improved cognitive and functional capacity, reduced aggressive behavior, improved social involvement and reduced use/absence of restraints, no nursing home stigma, a sense of normal life, space to walk around, exercise, more light, fresh air, and freedom.
There have also been many positive effects for the employees including; more autonomy, less stress, reduced physical strain and high satisfaction score among residents and family (8.9 on a scale of 10). We have also noticed that fewer antipsychotics are being used throughout the years, from 1993: 50%, 2013: 16%, 2014: 13%, 2020: 8% and there are now almost no bed-bound residents. The team of nurse practitioners (highly qualified nurses with extra training to take over some activities normally the GP would do) keep “the doctor away” and support and coach the team in all kinds of health issues. They work very closely with the team of GP’s that are employed by The Hogeweyk. Employing GP’s, psychologists, physiotherapists, etc. is normally done by nursing homes in The Netherlands, and is part of the budget.’
Kate – ‘Any memorable stories/statistics you would like to share?’
Eloy -‘We are not that good with statistics (although we have to register a lot like every other nursing home), we are more practical in letting visitors experience what you can achieve. But there is a lot of research available that supports the things scientifically in what we do on a daily basis. The social impact is enormous and we see everyday beautiful social interaction with people, nature, and society.’
Kate – ‘How do the residents interact with the wider community?’
Eloy – ‘The community is open to the wider community. The neighborhood restaurant is open to the public (except for people that come for professional reasons). The neighbors (businesses and citizens) also use the restaurant and theatre. We also have summer markets and the Christmas market. There are music performances, daycare for children and schools in the neighborhood every week. Often the children of the neighbors play in the Hogeweyk.’
Kate – ‘Are there any intergenerational dimensions to Hogeweyk?’
Eloy – ‘Daycare and schools come every week. Schools use the theatre to practice their performances and the residents are the audience. Sadly it is not possible to live in the Hogeweyk as a student at the moment, but we are aiming to make this possible (besides other things) in Hogeweyk 3.0. Mingling generations will be key in the new version. But we had to make the first step from institution to neighborhood first in 2002.’
Kate – ‘How is the project funded?’
Eloy – ‘The Hogeweyk is officially a non-profit nursing home. Most of the services (on care, living, and well-being) are covered by the National Health System of the Netherlands.’
Kate – ‘What are the challenges?’
Eloy- ‘There are many challenges. The medical system and thinking and language are hard to beat. For example using patient instead of person, dementia village instead of a neighborhood, dog therapy instead of having fun with dogs. It can also be a challenge to find enough staff. We also receive exactly the same budget per resident as every other nursing home in the Netherlands, but since we deliver a much higher quality of life than standard, it is always a challenge.
Kate -‘Why do you think there has been so much interest in this internationally?’
Eloy – ‘Why do you think? Come and see it. It is practical, sensible and very visible.’
Kate – ‘And finally. Is Hogeweyk something that should be replicated?’
Eloy -‘There have been news that other countries (including England) are preparing to start something similar. I think it’s important not to replicate, but the vision of normal life and the deinstitutionalisation and transformation and normalisation is a great inspiration for many. Our thinking should definitely be adopted, adapted, and applied in other countries. And we, the Be team of the Hogeweyk can support and advise everybody with this in many ways… there are now more than 40 initiatives in the world that refer to us as inspiration already, and many more that don’t but are inspired by us.’