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In de media 24 apr 2012

Article in The New York Times

Taking On Dementia With the Experiences of Normal Life

WEESP, the Netherlands — The sparkling-new 23-unit Hogewey complex here is virtually indistinguishable from other residential developments in the area. The apartments open onto a courtyard with benches, ponds and fountains, with beds of flowers in season (this is the Netherlands, after all). One kidney-shaped pond planted with reeds and other vegetation occasionally attracts wild ducks.

There are plenty of amenities: a small supermarket, a theater and a restaurant and cafe that attract people from around the area. Again, nice, but nothing out of the ordinary. The residents can also participate in a variety of activities, like clubs for music, baking, painting and gardening.

Yet, if Hogewey does not sound all that different from a typical residential complex, that is exactly the point. The residents are older men and women suffering from severe dementia, but instead of being constrained in a typical nursing home, they live here for $6,555 a month, six to eight to an apartment, where they are cared for by two or more trained professionals.

The residents are confined to Hogewey for their own safety. But within the complex they are allowed to move around freely, to the extent that they are able. On a recent unseasonably chilly afternoon, the residents of one apartment, designated as “urban” to reflect its residents’ tastes, gathered around a dining room table for tea. Most sat quietly, smiling, some in wheelchairs. Jo Verhoef, a woman known as Aunt Jo, sat upright in a comfortable armchair.

“Sometimes we shop, sometimes we listen to classical music,” she said with a smile, summoning her high school English to converse with a visitor. “My father liked classical music. My father was the music man.”

Theo Visser’s wife, Corrie, who uses a wheelchair, does not speak, but she enjoys the company. Mr. Visser, 81, said conditions could be difficult, as when a staff member fell sick last year and a substitute took over. “Now, there’s more togetherness,” he said, though he admitted that his wife’s inability to talk made it hard for her.

The idea behind Hogewey developed over the last 20 years. But it was only after the new quarters were built in 2009 that it began attracting attention as a humane and cost-effective response to a disease that is claiming an increasing number of victims as life expectancies in the developed world continue to rise.

In a report released this month, the World Health Organization forecast that the number of people suffering from dementia would double by 2030, to more than 65 million, and triple by 2050, as the world’s population ages. The increase comes as governments everywhere struggle to contain the runaway costs of health care.

“We are receiving attention from our German colleagues, from England,” said Jannette Spiering, the director of Hogewey. “Everyone is struggling with the same problem.” So strong has the attention become that the complex has hired a public information officer to channel the flow of visitors.

Ms. Spiering first began working with dementia patients in a conventional multistory high-rise next door to where the apartments now stand. Over time, she and her colleagues came to feel that their patients would suffer less stress if they were in more familiar surroundings and kept as active as their condition allowed.

So they began rearranging the rooms in the building, creating living spaces and dining areas with mobile kitchens so that the patients, living together in small groups, might experience the smells and sounds of a normal household. “We installed a little supermarket,” said Yvonne van Amerongen, who helped Ms. Spiering in the early days and is now responsible for quality and innovation. “Shopping is part of the daily routine.”

They also created lots of communal spaces. “A demented person,” Ms. Amerongen said, “doesn’t like to sit alone.”

When the home’s operator, a government-owned nursing home group called Vivium, decided to build new facilities, the design reflected those changes. The 240 staff members wear street clothes — there are no white lab coats — but the work is never-ending, as they cook and care for the 152 residents, bathe them and organize their activities. “For the people who work here, it is hard; they are on their own,” said Marjolein de Visser, 23, one of four social workers who make the rounds of the apartments.

She and her colleagues also assist family members. “There’s a lot of guilt, because you’re not taking care of them,” she said.

Dr. Anneke van der Plaats, a geriatrician and adviser to Hogewey, likes the way residents are urged to help with the cooking, with the laundry or with one another. “If you are demented, it is great if you can help other people,” she said over coffee in the complex’s restaurant. “A demented person doesn’t have to sit alone.”

Money has been an issue from the start. When the apartments were built, the cost was estimated at $25.2 million, of which the government put up $22 million. “We had a deficit, and we were creative in closing the gap,” Ms. Spiering said. To generate income, she opened the restaurant and cafe to the public and began renting out the theater for conferences and performances. “We are not a rich nursing home,” she said.

For about a year now, Christian Zierleyn, a former computer consultant, has been responsible for health care in the city government of Weesp, population 18,000. He appreciates Ms. Spiering’s approach to finance, but even more so her opening the complex to the wider public.

Mr. Zierleyn, 42, recently encountered the chief executive of a local bakery goods company, Bakels Senior, which was holding daylong training sessions for customers in the theater, with lunch in the restaurant and a drink in the cafe. At a five-minute walk from the company’s headquarters, it was very convenient.

“He told me his customers were quite suspect at first,” Mr. Zierleyn said. “But in the end they were all very enthusiastic.”