ANS -- The Dutch Village Where Everyone Has Dementia

This is an upbeat story of a new way to treat patients with dementia and Alzheimers.  We couldn't do it in the US because of fundamentalist capitalism, but it's a lovely idea for a more sane place. 
Find it here:  http://www.theatlantic.com/health/archive/2014/11/the-dutch-village-where-everyone-has-dementia/382195/?single_page=true   
--Kim

The Dutch Village Where Everyone Has Dementia

The town of Hogeway, outside Amsterdam, is a Truman Show-style nursing home.
Josh Planos Nov 14 2014, 7:20 AM ET
 
Gabriel Rocha/Flickr

When Yvonne van Amerongen received a phone call from her mother two decades ago, relaying that her father had died of a heart attack­sudden and painless­one of the first things she thought was, Thank God he never had to be in a nursing home.
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Van Amerongen was working as a staff member at a traditional Dutch nursing home at the time, getting a front-line view of what she never wanted for her parents. That call from her mother spurred Yvonne into action as she became committed to making nursing homes more livable and less of a departure from reality for their residents. She envisioned a setup as far away as possible from the nondescript buildings and polished floors of her workplace, where everything carried the scent of a dentist's medical cabinet. Over the next 20 years, she worked to secure the funding she'd need to make the idea a reality.

Today, the isolated village of Hogewey lies on the outskirts of Amsterdam in the small town of Wheesp. Dubbed "Dementia Village" by CNN, Hogewey is a cutting-edge elderly-care facility­roughly the size of 10 football fields­where residents are given the chance to live seemingly normal lives. With only 152 inhabitants, it's run like a more benevolent version of The Truman Show, if The Truman Show were about dementia and Alzheimer's patients. Like most small villages, it has its own town square, theater, garden, and post office. Unlike typical villages, however, this one has cameras monitoring residents every hour of every day, caretakers posing in street clothes, and only one door in and out of town, all part of a security system designed to keep the community safe. Friends and family are encouraged to visit. Some come every day. Last year, CNN reported that residents at Hogewey require fewer medications, eat better, live longer, and appear more joyful than those in standard elderly-care facilities.
There are homes resembling the 1950s, 1970s, and 2000s, accurate down to the tablecloths.

There are no wards, long hallways, or corridors at the facility. Residents live in groups of six or seven to a house, with one or two caretakers. Perhaps the most unique element of the facility­apart from the stealthy "gardener" caretakers­is its approach toward housing. Hogeway features 23 uniquely stylized homes, furnished around the time period when residents' short-term memories stopped properly functioning. There are homes resembling the 1950s, 1970s, and 2000s, accurate down to the tablecloths, because it helps residents feel as if they're home. Residents are cared for by 250 full- and part-time geriatric nurses and specialists, who wander the town and hold a myriad of occupations in the village, like cashiers, grocery-store attendees, and post-office clerks. Finances are often one of the trickier life skills for dementia or Alzheimer's patients to retain, which is why Hogewey takes it out of the equation; everything is included with the family's payment plan, and there is no currency exchanged within the confines of the village.

Residents are only admitted if they're categorized as having "severe cases of dementia or Alzheimer's disease." Vacancies are rare, given that a spot only opens when a current resident passes away, and the village has operated virtually at full capacity since it opened in 2009. Hogewey was primarily funded by the Dutch government and cost slightly more than $25 million to build. The cost of care is nearly $8,000 per month, but the Dutch government subsidizes the residents­all of whom receive private rooms­to varying degrees; the amount each family pays is based on income, but never exceeds $3,600.

To put it into perspective, a private room at a U.S. nursing home cost an average of $248 per day in 2012, or more than $90,500 annually­a figure that's even more staggering when applied to the rapid increase in dementia patients globally. By 2030, the number of people suffering from dementia around the world is expected to hit 76 million, which some estimate will cause an 85 percent increase in dementia-related healthcare costs worldwide. By 2050, the U.S. alone will pay a projected $1.2 trillion.

Often, nursing homes are linked to poor quality of life for their residents: Issues of patient mistreatment and low levels of morale have plagued U.S. assisted-living facilities, and a recent report from the Dutch Alzheimer's Association found that nursing-home residents in the Netherlands go outside for an average of just 96 seconds per day. By contrast, Hogewey's staff promotes an active lifestyle for residents.

"The environmental approaches to reducing both cognitive and behavioral problems associated with dementia are really the key to improving quality of life for these patients without excess medication," Dr. Paul Newhouse, director of Vanderbilt University's Center for Cognitive Medicine, told ABC News in 2012.

The act of engaging in community isn't just about promoting better healthcare; it's about developing a more personable and comprehensive way of treating disease. Often those with the most severe mental-health issues end up being isolated, so that less complicated cases can benefit from institutional resources. However, a study from the journal Nature Neuroscience found that isolation actually reduces the production of myelin­a fiber that maintains our nerve cells­meaning these segregating treatments may only make mental illness worse. The countless studies reinforcing how many dementia patients feel lonely or isolated, juxtaposed with Hogewey's considerable success with these residents, call into question how much of dementia is a result of disease, and how much is a result of how we treat it.

In traditional nursing homes, with their clinical appearance, the situation is openly communicated to residents­you're sick, you can't take care of yourself, you're forgetting things again. But in Hogewey, the residents live in a place that looks and feels like home, even though it's not; what others know to be a façade, they see as reality, which may help them to feel normal even in the midst of their disease. Psychologist Donald Spence defines the concept of "narrative reality" as the ways in which stories and places help link the "true" world to one that a person is better able to understand, using storytelling as a vehicle to understand the truth­you're in a place that's holistically normal, you're not lost, etc.
How much of dementia is a result of disease, and how much is a result of how we treat it?

In the years since Hogewey's founding, dementia experts from the United States, United Kingdom, Ireland, Germany, Japan, Norway, Switzerland, and Australia have all flocked to the unassuming Dutch town in the hopes of finding a blueprint for handling the global problem. While dementia-only living facilities have been created outside the Netherlands, none of them have offered the amenities or level of care per patient that Hogeway provides. Last year, inspired by Hogewey, a nursing home in Fartown, England, built a 1950s village for its residents; a similar project is underway in Wiedlisbach, Switzerland. But because cost is one of the greatest barriers to making self-contained villages the standard in dementia care, it would be extremely difficult to implement in a non-socialized healthcare system­meaning that in the U.S., a facility like Hogewey might be impossible for the forseeable future.

A few years ago, I watched my grandmother's memory erode in a nursing home of the kind that Yvonne van Amerongen had tried to get away from. My grandmother had the medicine cabinet of a septuagenarian, and the progression of her dementia was predictable and not altogether different from the experience of numerous others. But she spent her last days in a nondescript building where doctors told her what she wasn't, rather than what she was. She couldn't live on her own, but she decimated us at Scrabble (like always) a few days before she passed away.

Glimpses of lucidity like that make the relatives of people with dementia yearn for an environment built around life rather than death. Hogewey hasn't found a cure for dementia, but it's found a path that's changing ideas of how to treat those who can no longer take care of themselves.

"This is a terrible disease, but this place makes me a little less scared of it," Elly Goedhart, the daughter of a Hogewey resident, told Time in February.

Sometimes it truly does take a village.