Is it right to deceive people with dementia about their reality?
Weesp, Netherlands near Amsterdam is the location of the pioneering dementia village Hogewey, a new alternative to the standard nursing home. Established in 2009, 152 people with severe to extreme dementia are the inhabitants of the private village, which boasts a café, restaurant, theatre, mini-market and beauty salon. The 25 clubs allow residents to keep busy day-to-day, with activities such as painting, cycling, and baking as well more domestic tasks like gardening, shopping and laundry. Hogewey information officer, Isabel Van Zuthem points out that these small jobs are those that can make a person feel “they still have a life” .
There are no nurses in the village, so to ensure the safety and well-being of residents, specially trained health workers take the roles of neighbours, shop workers, assistants etc. For instance, if someone were to forget to pay at the mini-market, shop assistants would simply fix the payment with the health workers at the residential apartments. It is forward-thinking initiatives like these that have led to some ethical concerns on the false environment of the residents, as many of them will not be aware that the place in which they live is a care home. However, Van Zuthem stresses that this is, in fact, the point. The dementia village’s principal aim is to reduce conflict and confusion by providing the most realistic yet “safe and non-threatening version of real life”.
If you were constantly being told that the way you perceive the world is wrong, it would naturally upset and confuse you. So, reminding a person with dementia of the ‘truth’ of their situation may actually cause them more harm than good. Hogewey treats dementia differently and as a result people can enjoy their lives there, avoiding the conflict and confusion of living in the outside world. Having said that, this isn’t a fake or virtual village; many of the health workers also live there themselves as the amenities are all real and functional.
The decor of the residential apartments is another method used to make residents feel comfortable and reduce confusion. By recreating the atmospheres of the homes in which people would have lived in the past, allows the residents to feel at ease. On the other hand, in a hospital environment, they may think they shouldn’t be there as they don’t feel ill, so try to escape and return to their real home. The apartment blocks differ in decor styles for residents who lived in different styled homes prior to Hogewey. Examples are shown in the video below.
The notion of recreating personal past environments is based on reminiscence therapy. This is thought to aid short-term memory by sharing recollections from long-term memory; familiar objects, photographs and music can trigger the recollection of past events and experiences . A study by the university of Exeter in 2009 claimed that shared reminiscence boosted memories by an average of 12% . There is also evidence that reminiscence therapy improves cognition and mood in dementia patients 4-6 weeks after intervention, with dementia patients’ care givers reporting lower strain . Although reminiscence therapy is one of the most popular psychosocial therapies in dementia care, recorded improvements in memory are not vast, and the degree of efficacy in dementia patients is not fully understood .
Taking inspiration from reminiscence therapy and Hogewey village, the Grove Care nursing home in Winterbourne, Bristol have developed ‘Memory Lane’; a recreation of a 50s high street within the care home including a Post Office, pub, bus stop, phone box and shop windows full of memorabilia .
There is also a plan for a new dementia village in Wiedlisbach, Switzerland near Bern, scheduled to open in 2017. Like Grove Care, the project will be a recreation of a village in the 50s, yet designed in the image of Hogewey . Despite the rather large budget for the Swiss project (€20m/£17m), Van Zuthem explained that the dementia village in the Netherlands cost no more than a normal nursing home, but took more time to develop. This could be a major factor in the potentiality of more nursing homes adopting a village structure, enabling residents to experience more independence in their day-to-day lives.
Of course there will always be opposition to these new methods of dementia care. Michael Schmieder, director of Switzerland’s Sonnweid home for dementia patients said of the 50s village plans:
The very notion is an attempt to fake the normality that people with dementia don’t have.
The directors of the dementia villages insist that they do not lie to their residents. Chris Taylor of Grove Care said:
It isn’t about lying to anyone. But if a patient says they have to go and catch a bus, we can sit [with them] at the bus stop and say: “Tell us about the buses you used to catch”.
The idea is to view dementia differently, giving the 35 million people worldwide who suffer from dementia a chance to enjoy their current life more, rather than emphasis the life they no longer have and even increasing their distress and confusion. Find out more about dementia and care in the UK in a previous post.
1. The Guardian. The village where people have dementia – and have fun
2. BBC Radio 4’s From Our Own Correspondents. Dementia Village
3. Able Community Care. Reminiscence Therapy
4. Woods, B. et al. (2009). Inconclusive evidence of the efficacy of reminiscence therapy for dementia. The Cochrane Database of Systematic Reviews: Plain Language Summaries.
5. Woods, B. et al. (2005). Reminiscence therapy for dementia. The Cochrane Database of Systematic Reviews., 2005; (2) Cochrane AN: CD001120 Electronic Publication.
6. The Telegraph. A welcome trip down Memory Lane
7. The Independent. Switzerland’s ‘Dementiaville’ designed to mirror the past