At the country’s first dementia village, residents will be able to wander down to the sports bar for a drink, buy their groceries from the supermarket, and meet family and friends in the cafe. They will live in households with like-minded people and participate in running their household. It all sounds a far cry from the secure dementia units with which we’ve become so accustomed.
The village, which is expected to open in Rotorua in May 2017, is the vision of manager Thérèse Jeffs and her team at Whare Aroha CARE, an aged care facility in Rotorua wholly owned by the Rotorua Continuing Care Trust, a not-for-profit charitable trust. Thérèse’s quest for better care delivery at Whare Aroha took her on a journey that led her to the renowned dementia village De Hogeweyk in The Netherlands, from where she took her inspiration.
In search of better care delivery
Thérèse says the concept started with a general dissatisfaction with the way care was delivered. She felt there was a lack of emphasis on the person receiving the care. A resident’s background, preferences, needs and wants were often forgotten in the process, and with everything done for them, a resident could become institutionalised very quickly.
“Everything gets taken from you – you can’t make a cup of tea because of the Health and Safety police; you can’t cook a meal – your food just appears; you can’t do your own washing. People are plonked together and treated as ‘a people’, not individuals.”
Thérèse makes the point that we’re all very different and that huge assumptions are often made about what is best or appropriate care for individual residents. She gives the example of giving residents fish and chips to eat out of the newspaper, when many were probably brought up to eat fish and chips off a plate with cutlery.
This desire to do things differently prompted Whare Aroha to pursue elements of the Eden Alternative philosophy.
Yet they were still limited by their old building, located adjacent to the lakefront near the Rotorua CBD. With the lease expiry looming, they needed to think about finding a new site and building a new facility. Approximately 80–90 per cent of residents across all levels of care at Whare Aroha have fairly advancing dementia, so dementia-friendly designs were top of mind.
A visit to the Hammond Dementia Design School in Australia was a source of inspiration. They looked at a range of different designs and ideas, but the De Hogeweyk concept “just felt right”.
Following a trip to London to see family, Thérèse added an excursion to De Hogeweyk to her itinerary. The visit proved to be invaluable.
The De Hogeweyk concept
De Hogeweyk is part of the Hogewey care centre in The Netherlands. Its 23 houses accommodate 152 older people living with dementia.
Perhaps the most interesting aspect about the structure of De Hogeweyk is the way the houses are differentiated by seven different lifestyles, allowing residents to live in a manner to which they are accustomed. Groups of six to eight residents with shared values, interests and backgrounds live together in a lifestyle-group.
The ‘homey’ lifestyle allows residents to participate in housekeeping tasks, like folding the laundry, for example. The residents of these households might enjoy old-fashioned games and traditional Dutch cuisine, whereas residents in the ‘gooise’ (upper class) lifestyle will tend to eat fine French food and attend classical concerts. The design and decoration of the homes reflect the various lifestyles. So while the ‘gooise’ homes are elaborate and classical, the ‘homey’ homes are more solid and traditional in design.
In addition to the ‘homey’ and ‘gooise’ lifestyles, there is also an ‘artisan’ lifestyle, for residents whose lives revolved around their trades; a ‘Christian’ lifestyle which is based on the Dutch Reform Church; an Indonesian lifestyle initially created for those who had returned from the Dutch colony in Indonesia which is slowly being phased out as fewer residents now fit this profile; an ‘urban’ lifestyle; and a ‘cultural’ lifestyle.
While some argument could be made as to whether it is appropriate to segregate people in this way, the lifestyle approach means residents find comfort and familiarity in their surroundings, allowing them to remain active in daily life. With the help of staff members, the residents manage their own households together, taking care of washing, cooking and cleaning themselves.
The Hogeweyk approach draws inspiration from everyday life. Residents have already shaped their own lives, making decisions along the way about their own household and standards. While dementia may prevent them living as they once did, it does not follow that they no longer have a valid opinion on their day-to-day life and surroundings.
The public spaces of Hogeweyk village offer the residents privacy and autonomy. The village has streets, squares, gardens, water and a park, with much emphasis on green spaces to enhance the wellbeing of residents and provide them with a recognisable setting. There is a supermarket, a restaurant, a bar, a theatre, shops, healthcare facilities and others. Residents can roam freely around the village, but they remain inside the protected environment.
Building a New Zealand version
Following her visit to De Hogeweyk, Thérèse and her team attended a Dementia Care Innovations Conference in Sydney, where they met with the managing director of De Hogeweyk, Janette Spiering and co-founder, Yvonne van Amerongen. Thérèse expressed their interest in creating such a village in New Zealand.
“They gave me the plans for De Hogeweyk but said ‘don’t build this, you need to build a New Zealand version’,” says Thérèse.
And so began the process of working out what a New Zealand dementia village should look and feel like. They secured 1.4 hectares by Lake Rotorua in Ngongotaha, approximately 10km from their current location. They gained resource consent for a one-level village to house 80 residents.
With Ignite Architects on board, the plans for the village are coming together, although they are subject to constant tweaking. Essentially it will reflect a typical small Kiwi town made up of streets and houses, with shops and facilities including a supermarket, a cafe, a sports bar, a hairdresser and a library. It will have gardens, squares, and promenades, and features commonly found in a New Zealand town, such as street furniture, seating, post boxes, and street signs. There will be a strong emphasis on the village’s proximity to the lake. The village will have secure, light fencing with one access in, one access out.
The accommodation will be divided up into households. Each household will have six or seven people in it, as well as one key person (a member of staff) who will help with cares, household management, budgeting, and so on. Thérèse acknowledges it will be quite a different sort of role for many staff and says staff are very excited about the prospect.
Perhaps the most difficult aspect of replicating the concept in New Zealand is how to group people according to lifestyle and shared interests.
Upon entering the ‘gooise’ house during her visit of De Hogeweyk, Thérèse commented that she could imagine her mother being happy here, but was appalled to be told it was the ‘upper class’ household.
Indeed, it is hard to envisage such class segregation working in New Zealand.
The University of Auckland is helping Thérèse and her team with this complex task. There are crude assessment tools available to help group people, but it will need to be more finely tuned for a society like New Zealand.
Thérèse says households won’t be formed on the basis of ethnicity. Nor will they be defined by the level of care. Therefore each household will be equipped to accommodate people at rest-home level, dementia level, and hospital level, including end-of-life care.
Funding for the various levels of care will not change, although Thérèse suspects the contracts held with the Ministry of Health and the District Health Board may need altering. She says they will probably have to look at certification a little differently as well, and auditors will have to think differently about the model of care they are offering.
Thérèse says that while the ‘front of house’ may look different, the ‘back of house’ will still look the same in terms of financials, quality, staffing, care hours, and so on.
It is a huge project and there is a long way to go, but the prospect of taking dementia care to a new level is exciting.