Comparisons to The Truman Show do not go down well in the Netherlands’s most innovative nursing home. “I understand why people say that,” Eloy van Hal says. “But they forget this is real — everything here is real.”
Indeed it is real. The barman in our trendy restaurant is real, even if he is trained both in making cocktails and in dealing with severe dementia. The middle-aged woman whose order he is taking is really here for lunch, even if she is also a doctor. The elderly woman with dementia taking her family out for dinner at the next table will, after she has finished, walk down a real street to a real house — that has all the nursing equipment hidden in the living room cupboard.
This is Hogeweyk, colloquially known as Dementia Village, although Mr Van Hal, who helped to set it up, dislikes the term. A casual visitor to the collection of houses near Amsterdam, built around a central street and shopping area, would be unlikely to notice that it has only one way in or out. They would struggle even harder to notice any medical equipment. This is a nursing home for 150 people with advanced dementia, where the idea is to look like anything but. There are medical staff but they don’t wear white coats. There is assisted living but in houses that could be in suburbia. There is a pub, a supermarket and a theatre.
These principles — creating a world as close to normality for people who find novelty confusing — are finding their way into dementia nursing homes elsewhere.
They have, for instance, prompted a Bristol care home to recreate a 1950s street complete with post office and greengrocers. Elsewhere nursing homes try to recreate residents’ previous bedrooms or front doors in their new homes to help them adjust.
None has gone as far as Hogeweyk though— and the success of this experiment means that these days Mr Van Hal no longer runs it, he travels the world advising other countries on how to emulate it.
The idea is simple: why further confuse people who are already confused? “When you walk in a city you don’t see a doctor on the street, or a nurse caring for the person next door,” he says. “So why should you see them here? Traditional nursing homes cause fear, stress and agitation. People are in an environment they don’t recognise, with negative stimuli, and without the social context they had all their lives.”
So what if instead of receiving care in a ward they cannot leave, residents could walk streets they recognised and bump into people? What if instead of eating a meal prepared for them in a hall with 50 people, they ate at a table with the same six people— after helping to peel the potatoes?
That is what Hogeweyk does. With 23 houses, for about 150 residents, it recreates a real community. Mr Van Hal would go further and say it is a real community.
Onstage it is a village, only backstage we have the nursing home. I ask people on tours to see if they can spot the nursing home.
When they opened the project in 2010 there was scepticism that it would work. “Most dementia care departments are on the top floor, with people locked in. They cannot leave because it is unsafe but people get the best care. What is important at this stage in life? Is it important to have best treatment and be sitting in a chair all day waiting for the doctor or is it important to do
things you like to do?”
The biggest surprise for those in the care sector is not that dementia patients are able to walk around without seriously endangering their health. It is that this entire village costs no more than a normal nursing home. That this is possible on standard budgets but is rarely done, says Mr Van Hal, is the “saddest thing”.
There is a supermarket, opposite the restaurant. “What you see really is a supermarket,” he says. “Everything is available, and onstage it’s a little supermarket. Backstage this is the logistics system, the warehouse of the nursing home.” Mr Van Hal needed a warehouse and someone to staff it and maintain stock. Given that, it made sense to equip the warehouse with shopping baskets and make the stock manager a checkout assistant. Then rather than employing someone else to distribute the food to residents, why not save a salary by getting each house to “shop” for it? “If I’m your caregiver, I can invite you and say, ‘Let’s go to the supermarket for groceries for tonight.’ That means you’re not sitting on your butt all day, now you are coming with me, using your muscles. You are physically active, you can complain about the weather— and do something normal.”
Another example is the laundry. Rather than outsourcing it as most do, it is done in each house. This means sheets are never lost, and care workers fit it into their day. More than that, though, residents can help. “Many ladies ran a household for 60 years. They still want to fold towels— so they fold. They are standing, using their fingers, smelling detergent. They are proud, it validates
them as normal human beings. Why take that away?” After all that standing, folding and walking, he noticed another advantage. Most homes that size would need three physiotherapists. They only need one.
Returning to the restaurant, the waiter comes over to ask about coffee. Mr Van Hal confesses to regrets. Members of the public can — and do— come and use the restaurant but he wishes he had added a door so that it was accessible from the town outside. “I was a coward,” he says. Then, he adds, “So, did you spot the nursing home?” I didn’t.