Grocery store in Hogeweyk, Amsterdam
Imagine this . . . you have a friend named Sally who is in the advanced stages of dementia. She getsup in the morning, and wanders out to the supermarket in her nightgown. She passes others with dementia on the sidewalk, but doesn’t take much notice. She doesn’t know why she is there. She sees her friend, Francine, but doesn’t recognize her. A woman helps her find the store, the clerk helps her get something for breakfast, and another worker walks her home. Her husband makes his daily visit. He plays some music for her, and she seems delighted. A nurse calms her down when she gets angry. She sleeps for a while and wanders out again, but is escorted back to her home. The day mimics most days of her life. At least since she’s resided in Hogeweyk, Amsterdam, in a specially designed village with 23 houses for 152 dementia-suffering seniors.
In Hogeweyk, residents (all of whom have dementia) live in houses differentiated by lifestyle, as follows: Goois (upper class), homey, Christian, artisan, Indonesian, and cultural. The residents manage their own households together with a constant team of staff members. Washing, cooking and so on is done every day in all of the houses. Daily groceries are obtained from the Hogeweyk supermarket. The village has streets, squares, gardens and a park where the residents can safely roam free. Just like any other village, Hogeweyk offers a selection of facilities, such as a restaurant, a bar, and a theatre. Everyone who works in Hogeweyk, from the hairdresser at the local salon to the chefs in the restaurants, carry out their regular jobs, in addition to being trained as specialized health workers. The facilities can be used by Hogeweyk residents AND residents of the surrounding neighborhoods. Everybody is welcome to come in!
The concept was introduced by two Dutch nurses who decided to conduct an experiment: build a cutting- edge medical village for people with dementia. Hogeweyk is the only place of its kind, on its scale, anywhere in the world (There are currently two other smaller-scale versions in Rome and Canada.) The media is rarely allowed inside Hogeweyk, in an effort to minimize the disruption of the residents’ daily lives, but Dr. Sanjay Gupta of CNN was granted access. Based on his visit, he shared some insights about dementia that are important for anyone who has a loved one with the disease, whether they live in a specialized village, at home, or a nursing home, as follows:
1. Safety should always be a first priority:
Six of out 10 people with Alzheimer’s disease will wander and become lost, according to the Alzheimer’s Association. Fortunately, at Hogeweyk, getting lost isn’t a concern. There’s only one way in and one way out of the village — and that doorway is kept staffed and locked 24 hours a day.
Yvonne van Amerongen, one of Hogeweyk’s founders, said that the residents “aren’t necessarily trying to leave.” Like many people with dementia, they simply see a doorway and want to walk through it.Most of the time, all a staff member has to do is suggest to the resident that the door is broken, andperhaps they should try another. Gupta witnessed with his own eyes as residents simply turned themselves around and walked back in the other direction. This may be a good technique if you see a loved one with Alzheimer’s trying to leave through a door.
For tips on how to improve safety in your home for a loved one with Alzheimer’s or another type of dementia, please see NIH’s new guide, Home Safety for People with Alzheimer’s Disease, which identifies potential problems in the home and offers possible solutions to help prevent accidents.
2. Music brings joy to those with dementia:
Long after patients with dementia lose the ability to carry out a conversation, they can still nod their heads, clap their hands, and stamp their feet to music. How? It’s been shown in study after study that music is processed differently in the brain than many other sounds. The words and lyrics are activated on the left side of the brain in the language areas, while the tune and melody are more right brained.
In Hogeweyk, Gupta encountered a quiet man, Ben Picavet, who suddenly started singing along to some traditional Dutch music while his wife, Ada, played the piano. “We can’t talk anymore about everything, but with singing… you can make a good concert together,” Ada said. “For me, that’s very important.”
3. Try not to correct a person with dementia:
Gupta describes the toughest conversation he had while at Hogeweyk. It was with a resident named Jo Verhoef. At nearly 90 years old, she was still under the impression that she held a daily job, though she couldn’t recall what it was.
“Tomorrow,” she told him, “I’ll know it, and I’ll have to go to it.”
She was also under the impression that her parents were still alive, and that she had just seen them the day before.
Resident social worker, Marjolein de Visser, described her strategy when it comes to correcting confusion like this.”It depends on the phase of dementia,” she said. “In the beginning, you can ask, ‘Well, how old are you?’ And someone says, ‘I’m 84.’ You say, ‘How old would your parents be?’ And they can think, ‘Oh, that doesn’t make sense.'” Marjolein said the one absolute no-no when dealing with people with dementia is correcting them, because they just don’t understand. She explained how their memories are fading and their sense of judgment and logic has become impaired.
She gave the example, “If one person is having breakfast and they already had breakfast but want it again, you can’t say, “No, you can’t. You’ve already had breakfast” He won’t know, so why would you say it?” she said.
4. Always keep up appearances:
One of the most productive things you can do to help keep a person with dementia from feeling lost, frightened, or agitated, is to help them live as familiar a life as possible. For example, in Hogeweyk, residents are scheduled for regular appointments with the village hairdresser, Ingrid Scheermeijer. She explained that when the residents simply get their hair combed, it has a calming effect. They feel as if they’re being cared for and pampered. “Sometimes I have customers that come in very unhappy,” she told me. “They look in the mirror, and they feel good. I think it’s very important.”
5. Hand holding is good for the heart and head:
Gupta spent the majority of his time at Hogeweyk with two couples, Ada and Ben Picavet, and Corrie and Theo Visser. Throughout his interviews with each pair, they sat holding hands. It’s not possible to talk about everything (anymore),” Ada said, “but we still have this possibility.”
“It’s the way we communicate,” Theo said. “She squeezes whenever she sees something or feels something. We spend the whole day like this.” Theo told me his marriage is the best it’s been in nearly 60 years!”
Medicaid Asset Protection
Living in a town like Hogeweyk isn’t an option for most of us, since there are very few places in the world like it. So, what should you do to make sure your loved one with dementia is safe and well cared for, without going completely broke (Nursing homes in our area cost $10,000 – $14,000 a MONTH!)
At Farr Law Firm, P.C., we are dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones. We help protect the family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance. If your family is facing an aging crisis, please call us as soon as possible to make an appointment for an initial consultation:
Fairfax Dementia Planning: 703-691-1888
Fredericksburg Dementia Planning: 540-479-1435
Rockville Dementia Planning: 301-519-8041
DC Dementia Planning: 202-587-2797
About Evan H Farr, CELA, CAP
