Dementia affects around one out of four Koreans in their 80s with the nation’s overall dementia rate rising 20-fold between 2002 and 2013. The country is rapidly transforming into a super-aged society with the elderly accounting for about a quarter of the total population by 2030.
Dementia causes memory loss, leads to problems of aggression, finding the right words, recognizing people and things, how to react to a situation, and having trouble functioning with daily tasks, among others. It affects more than 475 million people in the world with 7.7 million new cases diagnosed each year.
It was against this backdrop Yvonne van Amerongen, founder of the Hogeweyk care concept and the “dementia village” in the Netherlands, presented a new approach to dementia care at the Korea Healthcare Congress 2017 in Seoul Tuesday.
|Yvonne Van Amerongen, senior managing consultant and founder of the Hogeweyk and BeSource: Be (the hogeweyk care concept) Homepage|
“We all want a life. It’s not about staying alive, whatever it takes, but what your life is about. [When we first started,] We were not satisfied with what we were providing people in nursing homes. We didn’t think they had a life. We wouldn’t offer the place to friends and family, but we were offering it to those who needed care. We wanted to be different – we looked at a human way of taking care of people. Our solution was to let people have normal lives,” Yvonne said.
In the Netherlands, around 85 percent of people with dementia can cope in their homes with the support of day-care, relatives, and friends. Only about 15 percent of people with severe dementia need in-stay facility care. This is where the Hogeweyk comes in.
The Hogeweyk care concept is a social-relational model that supplements primary physical care with emotional care as the basis of a “human approach.”
“The medical model focuses on taking care of people by giving them food, shelter, care, and medical support. But the problem is we are dealing with people who are anxious. Not recognizing a situation or a person causes anxiety, restlessness, fear, depression, and aggression, commonly seen in nursing homes,” Yvonne said.
Nursing homes in Korea, like those in many parts of the world, are notorious for being low-cost, low-quality, and low-service. Most Korean nursing homes are characterized by routine where the elderly’s day revolves around meal time. Many have pointed to a lack of government funds as the main problem.
What the Hogeweyk concept does is it gets rid of the “institutional” feel of the nursing home. It replaces bland and bleak communal rooms with colorfully decorated ones.
“It’s not all about the bricks, but the bricks are important. Interior and exterior design help those who have dementia to understand what is happening. You cannot offer a normal life confined in a hospital environment. It just confuses people,” she said.
|A look inside the homes of Hogeweyk
Source: KopArt, Amstelveen
“We started with a horror of a building in 1993. We had to get rid of that institute if we were going to change our way to a ‘normal human way.’ People do not want to live in an institute. They want to live in a house with a front door, a living room, and a kitchen – a home furnished in their style,” Yvonne said. “We want residents to be in pleasant surroundings because it minimizes confusion. Residents should be supported by professionals to cope with daily life as usual. That is what a nursing home should offer. We provide this type of professional support because that is what we are paid for.”
Hogeweyk is a specially designed village with 23 houses for 152 dementia patients. The homes are decorated beautifully, tailored to meet seven different lifestyles. The residents manage their households together with a team of regular staff in a way that maximizes autonomy and privacy. Washing, cooking, and other daily chores are done every day in all of the houses. Residents can shop for everyday groceries in the Hogeweyk supermarket.
|A resident (right) of the dementia village pulls out of the supermarket after getting groceries
Source: KopArt, Amstelveen
The overall architecture and interior design are tailored to the lifestyle of the person living with dementia. Hogeweyk offers seven lifestyles for its soon-to-be residents. According to the chosen lifestyle, patients are then placed into houses with the corresponding lifestyle.
Stepping outside of the house, residents can roam through streets, squares, gardens, and a park. They can also visit other facilities such as the restaurant, bar, and theater within the village that spans a total of 15,310 square meters (3.7 acres). Half of the village is outdoors, and half is a built environment because, according to Yvonne, living is about “having a life inside and outdoors.” There have been no bedridden patients since 1993.
Dementia care workers are located inside each home and at various locations within the village to assist residents. They do not wear uniforms. “I do not have nurses at home. Neither should they,” Yvonne said.
|Dementia patients paint outdoors in the Hogeweyk
Source: Irish Times
In the Netherlands, the dementia village, along with other nursing homes, is funded by the state where the income tax rate can go as high as 60 percent. The people who live in these facilities pay to the government, which is given back to the care facility, meaning everyone in the Netherlands has the right for these types of care, according to Yvonne.
When asked about whether Korea could implement a similar system in the country in spite of inadequate financing and government regulation, Yvonne said it is “absolutely possible.”
“I always say gray curtains are as expensive as red ones. It’s what you do with your money. If you need curtains, then, well, buy nice curtains. The atmosphere is better all of a sudden. You have to find out what is really important,” Yvonne said.
“The system of finance is not really the answer. It has to do with what we as a nation have for education, for transport, for healthcare. It’s always too little, the money. When we first started this, we did not have a penny. We only had the money to take care of people. That made us creative. What we do looks much more luxurious and much better than traditional nursing homes in our country, but we do it with the same money,” she said.
Regulation will also be a big hurdle, Yvonne noted, saying that the Netherlands, like Korea, has a lot of regulatory restrictions that did not fit with their new concept.
“You probably have a lot of regulations. That’s when you can say, ‘Well it’s impossible,’ but we did not say that,” she said. “In 1993 when we first started the experimental ward, one of the first things I did was call the health authorities. I said this is what we want to do. What do you think about it? The inspector never heard about it, he said. And I told him yes, that’s because it’s new,” she explained.
There were points where people disagreed and that led to lots of discussions, she added, saying it took over 10 years of talking for it to become a reality. “You have to go on and on. Sometimes you don’t win. It’s not easy. It will never be easy. There is no trick. It’s something you have to work on every single day,” she said.
“We do not solve dementia, but we have seen the quality of these people’s lives improve. We have higher employee satisfaction among residents and family. There is no nursing home stigma, and instead, a sense of normal life,” Yvonne said.
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