Article in The Southland Times
It takes a village? For aged and dementia care, maybe it does.
What if a walk down memory lane became a lifestyle in a memory village?
The $31 million not-for-profit Hawthorndale Care Village planned for Invercargill will be unique in its way, but it is modelled on the Dutch De Hogeweyk dementia village that has drawn international attention since its inception in 1993. A fundraising campaign was launched in Invercargill last night to meet a shortfall of just under $14m. The goal is to replicate everyday community life, rather than leave it behind for an institutional reality of long corridors leading to bedside visits./ Instead, small homes where a sense of the everyday, or a remembered version of it, is easier to maintain. Where people can walk around and take part in everyday life decisions like going to the shops.
“We have to leave the old institutions behind us,” De Hogeweyk creator Jannette Spiering said when she visited New Zealand last year for the opening of Rotorua’s CARE village, the first in this country to use the model.
Hawthorndale won’t simply be a cookie-cutter version of either of these, however. Rotorua’s is developing piecemeal. Hawthorndale would be opening complete, the full village experience operational from day one.
And unlike De Hogeweyk itself, which is solely for people with dementia, Hawthorndale will have a wider gamut of care, so people’s changing needs can be met without them having to undergo the often traumatic business of upping sticks to move into increasingly, and distressingly, unfamiliar environments.
Some might arrive for the fully independent lifestyle of the retirement village units, later moving into the rest home care.
There is a limit – this isn’t a facility that will cater for psychogeriatric residents. But those with the increasingly common issues of age and memory will still able to make their own lifestyle choices in the context of a village that resonates with familiarities.
And because what’s familiar varies depending on our individual backgrounds, different parts of the village accommodation are themed accordingly. Instead of the approach taken in many places of grouping people by the severity of their illness, the Hogeweyk figures it out according to lifestyles.
The Dutch break it down to seven: Urban for former city dwellers; Artisan, for people who had a trade or craft; Homey for homemakers; Cultural for those who especially loved the theatre and cinema; Christian; Indonesian; and Goois (Puzzled? It’s a wealthy area near Amsterdam, distinctive enough in its way to justify its own grouping.)
There’s hardly a strict segregation policy; the idea is that people in each of these mini-communities are free to move around internally and mix socially.
For Hawthorndale the groupings aren’t shaping up to be quite so distinctly defined; more a general sense of likemindedness. But there would be, for instance, some urban-rural distinctions. Those with dementia will not be in some sort of separate wing, says project team member Paddy O’Brien. They’ll be “fully integrated as part of the wider village”. Freedom within the village, with reasonable bounds of care, is a daily priority. Someone takes it into their head to step out for some shopping in the wee small hours, then why not? They might decide to stock up at the 24-hour supermarket – nobody will especially expect them to pay – and if some of the food turns out not to be needed for the household meals, it will be quietly returned to the store.
Not that it’s some sort of playstore. It’s where each little community within the village will do its own shopping, preparing its own food to its own taste. The neighbourhood will have a village square accessible to all residents, a hall, hairdresser, garden and vege garden, a playground for visiting kids and a cafe for residents and visitors alike. (Southland project members who travelled to De Hogeweyk came back reporting that they couldn’t tell the residents from the carers and visitors.)
In Australia where a Korongee village north of Hobart has been under construction, the design is based on a typical Tasmanian cul-de-sac. The small house model is key, Glenview Community Services chief executive Lucy Flaherty told The Senior, because “In large buildings, the sense of institution is unavoidably present when you walk through the front door and any well-meaning ideology can easily be lost.”
Calvary Hospital is the initiator and driver of the Hawthorndale project and manager Margaret Brown says that amid the comings and goings, people with dementia will be able to move freely within the village but not get out. Buildings will form a natural boundary and as for the controlled entrance/exit way, specific technologies will be worked out nearer the time “because it changes so rapidly.”
The ambition, however, is that the dementia residents will find the comforts and stimulations of their environment enough to minimise the desire to venture afar. “Because there’s going to be so much to do within it, we are looking to make it so they won’t want to go further.’ The village is not designed to keep the real world at bay. It’s to create an environment that makes sense for people who have lost some of their past, but hold other parts of it dear. Reminders of each person’s individual formative years, says O’Brien, invokes “a sense of comfort, security and purpose.”
Wee question: Could those with dementia and those without it be happy together? Hold that thought because it relates to far more than this village. We need to find ways to achieve that for strong demographic reasons. With populations rapidly ageing, cognitive impairment increasingly commonplace worldwide. “A huge percentage of people over 85 live with some form of cognitive impairment,” says Brown. “And because we’re living longer there’s going to be more and more like this.” True that. Almost 70,000 New Zealanders are living with dementia today, according to Alzheimers NZ, and by 2050 that figure is predicted to hit 170,000.