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In de media 17 Oct 2019

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 Hogeweyk co-founder Jannette Spiering

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.

By far the majority of the many thousands of New Zealanders living with dementia do so in their own homes and good on them, for as long as this can be made to work.. But the pressure on them, and their families, can be enormous. Alzheimers NZ insist the services and support for them is woefully inadequate. If we’re not entirely comfortable with ever increasing numbers of large institutional facilities then we’re going to need to figure something out. The main collective focus internationally, and in New Zealand, is on making our existing communities more dementia-friendly. The case for this is, in itself, strong.

What we have with the Hawthorndale project though, is a model purpose built, from the get-go, for people’s changing needs. It’s been a longstanding Calvary initiative and, for the record, Calvary doesn’t have dementia beds. But that can be a matter of formal assessment; something that families may feel they have good reason not to seek, especially if people can be accommodated, without disruption, where they are.

Project team leader Sarah Hannan says the early financial modelling for the project was to make sure that, under a not-for-profit model, the fundraising for capital investment was self-sustaining. The answer came back, eventually, that it was.

“Then we did a market research project to really answer the question would the market accept this model, and looked at pricing options to ensure we were getting the balance right. It stacked up. Partly because land-banking by Scott and Joc O’Donnell meant they could build on a greenfields site. The potential for the Hawthorndale village to serve as a study model for the wider community is something its proponents enthuse about strongly. To this end, the plan is to invite scrutiny from other providers, academics, anyone who might put the information to good use. Says startup group member Frank O’Boyle: “Hopefully this becomes the new norm.” Margaret Brown: “We don’t claim to know it all, or that the village is going to be the perfect place for everybody .But we truly believe this is a better way to look after people than what we’re doing now.”

Paddy O’Brien: “Together, as a community, we must set the bar higher. We have an opportunity to redefine aged care in New Zealand, starting here in the south.”

The facts

  • The spectrum of residential, dementia and hospital-level care will be offered in 12 homes each with seven beds.
  • Each home has separate bedrooms, a shared living and kitchen area where meals are cooked for each house, from food available from stores on the site, creating a more normal scale of living.
  • Ten independent living units will also be available.
  • The focus is on continuous care as residents’ needs change, all within the one shared environment.
  • The site is about 25,600 square metres and has access from both Tay St and the quieter Fairview Ave

Funding so far

  • The project development cost is $31.5m
  • Working capital $1.5m
  • Calvary capital $4m
  • Community grants $1m
  • Debt funding secured $12.5m
  • Balance fundraising target $14m.
  • As a not-for-profit entity it will have no servicing of investors/shareholders.
  • Ongoing operational activity is planned to generate a trading surplus and retire the $12.5m debt within 12 years.

The process from the concept design phase to resource consents, full design, but would take everybody from Calvary if they choose to come,” Brown says.

The Southland Times is media partner in The Hawthorndale Care Village campaign

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