Dementia Village: Holland’s civilized approach to treating the elderly

The Netherlands has a novel approach to treating dementia. And it’s called “Dementia Village.”

The reality of Alzheimer’s Disease

I wrote a bit earlier on Alzheimer’s Disease (AD), a type of dementia. I discussed how Alzheimer’s is a progressive, ultimately fatal, disease that causes a number of problems including memory loss, confusion and some others.

Millions of Americans have Alzheimer’s, and other millions will get it. (And there are other kinds of dementia people suffer from as well.) There is no good treatment to stop or even slow the progress of Alzheimer’s.

Let’s take a look at what could happen to the “average” Alzheimer’s patient.

Currently, diagnosis is almost always made after the patient begins to display symptoms. Often it starts with memory loss. At first, the patient may just need to leave himself reminders to do things like keep appointments, refill prescriptions and pay bills on time. With progression, he may need someone else to help provide reminders. He may become disoriented and get lost. He may become more irritable and withdrawn. He may start to hear voices, or see people who aren’t there, and may become suspicious of family members. He may eventually need help with activities of daily living (ADLs) like bathing, dressing, eating and using the bathroom.

As the disease progresses, he’ll usually need more and more assistance from others. Often these others are family members, a spouse, children, siblings and other relatives or friends. As the dementia worsens, he may need someone available around the clock to make sure that he doesn’t wander off or injure himself (some patients, but not all, may spend a good part of the night wandering around the house, while sleeping during the day — making it even more stressful for family members). At this point, it sometimes becomes too much for the family members to take care of him. They may need to hire an outside caregiver to help the patient and provide a break for the family. With continued progression, the patient may need to be placed in a nursing facility.

The nursing staff in such a facility has a limited amount of time to spend with each patient. Patients with dementia (and not just Alzheimer’s patients) can easily require a lot of time per patient. One reason may be that the patient with dementia often gets up and wanders. The nursing staff then has to guide him back to his room. The patient may be interested in TV or a movie, but often only for a short time. Then, becoming restless, he’ll be on the move again. In a nursing facility, the number of things available to distract or entertain dementia patients is limited. The patient, and staff, can become frustrated.

Dementia Village

There is an alternative care setting available in the Netherlands. It’s called “Dementia Village” (De Hogeweyk).

Dementia Village is an area set up in a small town, where Alzheimer’s patients, and other patients with dementia, live and receive care. Instead of being set up like a nursing facility, the patients live in apartments, on landscaped grounds. The “village” also has a supermarket, and other shops, a theater, bingo hall, coffee shops, a cinema and other places for the patients to visit. The whole area is discretely walled off so that the residents can’t wander off the property.

A room at Dementia Village.

A room at Dementia Village.

The residents live 6 to 8 each in a large apartment. There are several different themes for the apartments to try to make them more home-like for the patients. The nursing staff, during their shifts, actually lives in the apartments with their patients. They’re not at a nurses’ station that may be far away from the patients’ rooms. The nurses and nursing assistants wear street clothes.

They encourage the patients to interact with each other and the staff in the apartment. The patients who can, are encouraged to help with tasks like cooking, cleaning, bed making and other things that they would normally be doing at home. The patients are free to leave the apartment and meet with other patients, or visit them in their apartments, go shopping, have coffee at a cafe, get their hair styled, see a movie or do anything else that the “village” offers.

A room at Dementia Village.

A room at Dementia Village.

All of the shopkeepers and other employees at the village are trained to deal with demented patients. For example, if a patient says he is buying dinner at the supermarket, and then selects inappropriate foods, the shopkeepers will remind him of what he needs to buy. Or the merchant can call the apartment where the patient lives and a nursing assistant will come to help.

Visitors are permitted to see the patients any time, and can stay for as long as they want to stay. They can visit in the apartment or take the patient out into the village to play bingo, watch a movie, go for a walk or do something else. Administrators at the village say that they are disappointed that not as many visitors come as they would like. That may be in part because it can be difficult to visit a relative who no longer remembers you, or who forgot your last visit entirely.

The cost for living in the village is approximately what it would be to live in a nursing facility. Most of the cost is covered by the Netherlands’ version of Medicare.

Some other countries in the EU are looking at opening similar villages as long-term care facilities for those with dementia. It may be something that might get copied in the US, as well. Certainly this seems like a more comfortable and humane way to treat dementia patients than to keep them in a nursing facility.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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