Tour: De Hogeweyk
For the last 15 years, the management team of the Vivium care group has been rethinking the delivery of care in their dementia-specific long-term / palliative care residence, De Hogeweyk. At the helm of changing the philosophy of elder care at this residence was Eloy van Hal, one of the founders of De Hogeweyk in its current form. As the former facility manager of the original building and the current senior managing consultant of the Be Hogeweyk care concept team, Eloy provided me with an in depth tour of this renowned residence, illuminating the key care concepts and resulting architectural translations which Vivium has developed over the years.
Before its redevelopment, De Hogeweyk was representative of the typical, institutionalized long-term care facility one would find in the Netherlands. Beginning in 1993, however, the management team began to shift their approach towards care provision, focusing on resident abilities and normalizing the resident experience at De Hogeweyk. What they soon realized was the significant impact spatial reconfigurations had in this new philosophy of care provision. Ideas of normalization necessitated a reduction in scale, allowing residents to commune in spaces that were more recognizable for human-scale interactions. Finding ways to engage residents with aspects of their former daily living activities also triggered novel concepts in spatial planning.
The team tested these ideas in pilot projects, working with the existing building of De Hogeweyk. For example, resident group sizes were minimized to 10 people and the idea of a “house” per floor was introduced. Grouping residents in the various “houses” according to their interests also came as a natural progression. Storage space at the lower floor was turned into a “market” to allow caregivers the opportunity to bring residents shopping for their daily needs.
Seeing that each test made over the years had yielded significant positive changes in their residents, the team was encouraged to consider redeveloping De Hogeweyk, as an embodiment of their revolutionary care concept. Vivium collaborated together with Molenaar&Bol&VanDillen architects to translate their ideas into a larger architectural vision. The concept of the house, which was developed in the original De Hogeweyk, was a key feature of the newly imagined complex, reintroducing independence back into the residents’ lives. In this new configuration, residents reasserted agency over their daily activities which brought them out of the house and in negotiation with all which that entails. This helped to reinforce the care team’s focus on what residents can still do independently.
Originally, 23 individual houses were built, with 6-7 residents per house. However, in 2017, 4 additional houses were constructed, bringing the total to 27 houses. The form of individual houses redraws the boundary between living and work space in a care environment. Whereas in typical care settings, these spaces were often overlaid, the conscious act of entering and leaving the house has reassigned hierarchy to resident privacy in their living space. Small details such as the care team ringing the doorbell before entering the house form significant strides towards maintaining dignity. Overnight supervision is carried out only through acoustic sensors in resident rooms, which are monitored by night staff at the entry reception building. They are supported additionally by 5-6 staff throughout the complex. Only the front door of each house is locked overnight. Offering spatial variety within the house also promotes residents’ control over their independence, while fostering social interactions. Layers of private, semi-public, and public spaces allow for this type of control seen in the transitions from living room, dedicated outdoor space adjacent to house, and outdoor public spaces and gardens.
Following from what Vivium discovered in their pilot projects, residents are grouped according to their interests, with the interiors of each house designed to reflect their lifestyles. Through observation, the care group recognized that residents were more relaxed when they were around similar people and engaged in familiar activities. They found that having similar interests in food and surroundings helped ease residents’ frustration and underlined the importance of maintaining a social life, whatever one’s age. From their demographic group, Vivium decided to represent 7 different lifestyles: Artisan, Christian, Cultural, Gooise, Homey, Indonesian, and Urban. While there are rare cases where individuals have not fit the lifestyle to which they were originally thought to have belonged, adjustments are possible when space is made available.
Each of the individual houses are configured around 6 courtyard spaces which form key landmarks for wayfinding. Much attention was given by the landscape architects in creating differentiated outdoor spaces, serving as diverse backdrops for resident walks and family gatherings. Instead of securing residents in wards, which has been the tendency in other care residences, the provision of generous outdoor spaces allow wandering behaviour to occur in a more natural and purposeful manner, making it a distinct feature of De Hogeweyk. While at De Hogeweyk, I was truly impressed with the atmosphere this freedom unleashed. Sitting and observing at the town square, I found that I was unable to distinguish between resident, care staff, or family member.
The covered, public spaces at De Hogeweyk play just as an important role as the courtyards. The main covered hall serves as the atrium space for the restaurant, pub / cafe, and market on site. They also function as points for community integration as the restaurant, bar, and cafe are open to the public. The atrium features a piano which has found use by residents as well as neighbourhood visitors. In addition, a theatre is also found in the complex, which is used once a week for concerts to the residents. It is also leasable to outside organizations, which together with the restaurant and bar /cafe, help offset operating costs.
As found in other projects, programming forms a vital part of the residence. At De Hogeweyk, a separate team is dedicated to organizing activities, in the form of “clubs”. Residents only sign up for the activities in which they are interested. As Eloy explained, each resident receives one complimentary activity per week, with any additional activities desired to be paid separately. Clubs offer differing levels of participation according to a wide range of interests including arts and crafts, fitness, music, and film.
While the success of De Hogeweyk is no doubt a reflection of well-considered design (of both care and environment), it is important to note that it is a state-funded residence, receiving the same operating budget as other care homes. Often, there has been the presumption that this model is possible only as a result of increased costs to the resident. Instead, implementing this innovative care concept required rethinking resource allocation to ensure its financial viability. For example, the concept of the supermarket is merely a rethinking in logistics regarding storage and redistribution. Instead of having storage rooms and utilizing separate staff to distribute items, these functions are taken over between caregiver and residents in their daily activities. To minimize the number of medical experts on the team, Vivium has prioritized their primary role as advising and coaching caregivers, who in turn manage residents during their day-to-day interactions. With this shift in approach, the care group have found strategic ways to deliver extraordinary care, on budget.
Despite the fact that their novel approach to care and care environments have made a significant positive impact on their residents, the care group has also had a chance to reflect on areas which they would like to grow as they move forward. One of the main objectives Eloy shared with me is increasing the connection of the residence with its surrounding community. This could be achieved by firstly creating a more inviting exterior facade and finding a way to create a more visible connection between the restaurant and the street. Currently, as one approaches the complex, it appears very closed off. This is reinforced by the singular, controlled point of access at the reception area. Integrating programming with the greater community has also been discussed. Diversifying the use of the complex through the addition of a daycare or kindergarten could be a way to improve connections with the residents.