‘Alternative Reality’ Villages for Dementia Sufferers

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” [1].

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.

Grove Care’s Memory Lane.

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 [3].  A study by the university of Exeter in 2009 claimed that shared reminiscence boosted memories by an average of 12% [2]. 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 [4]. 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 [5].

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 [6].

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 [7]. 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.

References
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

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5 thoughts on “‘Alternative Reality’ Villages for Dementia Sufferers

  1. A very interesting and lateral way of dealing with a disease sadly more common as longevity within European society increases. Without dwelling too much on the ethical considerations any form of non-invasive strategy has to have some form of positive effect on the quality of dementia patients no longer able to cope within modern day circumstances.

  2. If someone asked me to design an ideal environment for those living with Dementia, then this would be it. I cannot understand critics who raise the issue of “lying” to the residents when all best practice, specifically the work of Oliver James in his book “Contented Dementia”, indicates that it is helpful to patients to co-operate with their view of the world, i.e. in response to a fleeting request for “Where is my husband” who may be long dead – rather than cause the patient pain by being told “afresh” as it were, of the death, it’s much better for the patient if staff, reassure “he’s probably still at the office/factory/allotment”.
    This village is something that Dementia suffers in the UK will probably never have, not in this century anyway.
    Congratulations to the instigators for having the creativity and courage to design this village.

  3. Pingback: ‘Alternative Reality’ Villages for Dementia Sufferers | Pawel Debski - SW Development and other thoughts
  4. We’ve just launched a state of the art, UK standard nursing home in Sri Lanka, specialising in dementia care.

    The nursing home is owned and operated by a British healthcare professional with over 30 years UK geriatric and dementia care experience and a sign off mentor for the University of Bradford.

    It’s the first and only one of its kind in Sri Lanka and due to the significant costs coupled with austerity measures, it is aimed at expats from more developed countries looking for cost effective Alzheimer’s and other forms of dementia care without compromising on the standards available at home.

    24 hour care in the brand new facility costs in the region of $1,500 per month as opposed to around $5,000 for the same level of care in the UK.

    The facility is set on over 3 acres of sprawling tropical countryside just 20 mins from the capital Colombo and main international airport, each room has direct access to the secure gardens with vistas for the surrounding rubber plantations and our own cinnamon grove.

    We don’t just cater for dementia sufferers, and being set in such a idyllic location, its a perfect location for those seeking to retire to a warmer climate whilst receiving as little or as much care as is required.

    With the end of the civil war, a booming economy, stable government and significant investment in infrastructure and amenities, Sri Lankan was voted the number one destination by British Airways for 2013.

    It truly is the gem in the Indian Ocean with miles of golden beaches and a comfortable inland climate, it’s quickly becoming a destination of choice for those looking to retire to a tropical paradise.

    We work closely with the Alzheimer’s Society of Sri Lanka who have gained valuable experience in our UK standards and procedures, they are also happy recommend our establishment to clients seeking such care.

    Please see our web site for more info and do let me know if you’d be interested in visiting us/publishing an article in your local journals to raise awareness of lower cost UK standard retirement and care options available in Sri Lanka.

    Cinnamon Care Sri Lanka

  5. Pingback: Fake Dementia Village In Netherlands | The Brain Improvement

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