It’s a village like many others. Street signs, front gardens with little gnome figurines, a restaurant, beauty parlor and supermarket. What is different about it is that the 150 men and women who live here suffer from serious dementia. They can move around freely in the village. But they can’t leave it. This is Hogewey, a nursing facility near Amsterdam that is considered a pioneer in dementia care. Care givers stay behind the scenes, and are dressed like gardeners, hairdressers, and sales people.
Now Switzerland is to get its own “dementia village” in Wiedlisbach, canton Bern. Still in the planning stages, the village will occupy the site of an existing nursing home and will be called the “Village For People With Dementia.” Representatives of the community have already approved the plan. “Right now we’re planning a village for 100 men and women, but later we could expand to 200 or even 300,” says general manager Markus Vögtlin. Construction is expected to last between five and seven years and cost roughly 25 million Swiss francs (nearly $27 million).
Vögtlin, who has visited Hogewey, was impressed by its anxiety-free atmosphere. “People with dementia are often restless and aggressive, but there they were relaxed and content.” A village allows them to pursue the accentuated need for moving around that is typical of dementia.
The architecture and design of the Swiss version will also take into account that people with dementia, though they are unable to remember what is going on in the present, usually have memories of the past. The facilities, therefore, will have a 50-year-old look and fell. This environment makes patients feel comfortable, says Vögtlin, who calls it “traveling back in time.”
In Hogewey’s 23 small houses, residents can choose from seven interior decoration styles, such as homey or craftsy or Indonesian. “Our village will offer two options – country or urban,” says Vögtlin. The houses, which will have no more than two stories, will have saddle roofs and 1950s-style front gardens. In the Wiedlisbach village there will also be a doctor’s practice, a café, a movie theater and a kiosk. Nowhere in the village will there be any closed doors.
Making a case for the “here and now”
Not all experts think the “dementia village” is such a great idea. “The very notion of a village is an attempt to fake the normality that people with dementia don’t have,” says Michael Schmieder, the director of Sonnweid, a home for dementia sufferers in Wetzikon, canton Zurich. The nursing facility, which has 150 resident patients, is considered exemplary because within the facility all patients have freedom of movement. “We have 1.5 kilometers of space for them to wander around in, so patients don’t keep running up against borders,” says Schmieder.
At Sonnweid, 14 million Swiss francs were spent on enlarging the premises without increasing the number of residents. “We offer wellness, just like a four-star hotel. Patients are living in the here and now, not back when,” he says. Schmieder disagrees with the idea of binding them to a past life style.
Canton Bern officials, however, welcome the Wiedlisbach project. “It’s super, I’m won over by the concept,” says Markus Loosli, who heads the department that deals with matters concerning old people and the handicapped. He added that in a village environment people suffering from dementia could live significantly better and with dignity. The references back to earlier times made the patients feel safe and increased their life quality.
But the village concept might not be relevant for all those suffering from dementia, which is to say over half of all nursing home residents. “We also need other ideas,” Loosli said.
Seeking sustainable solutions
In Switzerland there are presently 107,000 people suffering from dementia. The number is expected to double within 20 years. Roughly 60% of sufferers are presently receiving home care, but is that sustainable longer term? Many relatives are already overwhelmed, and the number of singles reaching advanced old age is on a sharp rise.
The Swiss Alzheimer Association has been advocating a national dementia strategy for many years. In Germany, the “Aktion Demenz” strategy is neighborhood care so that confused men and women can live in a place that is familiar to them. A project initiated in Zurich in 2008 called “Hausbesuche SIL” (“Home Visits – Socio-Medical Individual Solutions”) involves relatives, neighbors and friends in the care of dementia patients.
“Different types of care programs are needed,” says Birgitta Martensson, managing director of the Swiss Alzheimer Association, because dementia – the best-known form of which is Alzheimer’s – lasts on average 10 years and there are different phases. “The dementia village is a good solution for people in advanced stages of the sickness,” says Martensson. They can move about freely without anxiety.
But isn’t such a village, closed off from the outside, a ghetto? No, Martensson says. The village offers a protective environment in which residents have lots of space and where they can use whatever abilities and skills they can still access. “It gives them a feeling of self-sufficiency, and makes it possible to put off the day when they won’t be able to do things for themselves anymore and will be fully dependent on care.”
Read the original story in German
Photo - Visentico / Sento