Sunday, September 25, 2022

VISITING THE WORLD'S FIRST DEMENTIA VILLAGE


September is World Dementia Awareness Month. I am reminded of my visit to Hogeweyk in 2015. It was definitely an eye-opener. What prompted the visit was my interest in dementia, in particular, Alzheimer's Disease (AD). My mother was diagnosed with AD in 2011 after a fall. She had fractured her hip and was in hospital for surgery. During her stay there the doctors noticed certain signs of AD in her, and advised me to send her to Dr Philip Poi at UMMC for a diagnosis. That marked the start of my caregiving AD journey with my mom. She passed away in Feb 2021. 

In recent years there has been much attention given to raising awareness of AD, the early signs and how to care for persons with dementia (PWD). There are now a few purpose-built daycare centres for PWD. The majority are in aged care centres and nursing homes. A big Thank You to Alzheimer's Foundation of Malaysia (ADFM) for playing a huge role in educating us on AD, and pioneering the first dementia daycare and residential care homes in KL and Selangor. Also for creating a much-needed support network for AD carers. 

Let me share this article below written in August 2015 after my visit to Hogeweyk. I haven't been back for a second visit. 
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Thanks to an unexpected birthday gift of a return air ticket to Amsterdam, I had the opportunity to visit Hogewey Village. It has been on my wish list since I first read about the place two years ago, and watched CNN's Dr Sanjay Gupta's insightful documentary 'Dementia Village' (video below). Now I can happily strike Hogewey off my wish list.

The prime mover behind this innovative concept is co-founder and former nurse Yvonne van Amerongen. I had emailed her earlier requesting permission to visit the facility with Marianne Abbink Lankhorst, my Dutch friend. She wrote back to say we were both welcomed to visit anytime. Excellent!

So there we were at Hogewey on a warm Thursday afternoon of 29 July 2015. Visitors enter and exit via the sliding door which is controlled by the receptionist. The door remains closed to the residents. They are not allowed out of the facility on their own.

We were given a map showing the layout of the place, and several information sheets about Hogewey. We had the freedom to move around and explore but were reminded to respect the privacy of the residents. In other words, no peering into their living quarters or taking their photos without their permission. But we were welcome to use the information and images provided on the Vivium website. (Select the option of viewing it in English.)

Front view of Hogewey
The homes and the courtyards. So much greenery and flowering shrubs, and benches everywhere.


The Indonesian lifestyle corner. Indonesia was once a Dutch colony.
As we had no access to the homes, this composite image is taken from internet sources. It gives you an idea of the different lifestyle settings. Residents are housed in groups according to the lifestyle they are familiar with. 

Hogewey is the world's first village built specifically for people in the advanced stage of dementia. The concept for it is based on the belief that dementia patients can still enjoy a relatively normal life if they live together with like-minded people in an environment that is familiar to them.

Residents share a common dining room and living room (Images: Daily Mail)

There are currently 152 residents at Hogewey, with six to seven housed in each of the 23 homes. grouped into seven distinct lifestyle settings: urban, homely, cultural, traditional, Gooi (well-to-do), Indonesian and Christian. Residents have their own bedrooms but share a common living room, dining room and kitchen. Each home has one or two staff to look after the residents and do the cooking.

Another view of the homes. 

The staff at Hogewey outnumber the residents 4:1. You will see them as housekeepers, shop assistants and minders, but you won't find them in staff uniform. Volunteers are identified by a nondescript badge they wear. Hogewey takes great pains to avoid any resemblance to a hospital or a nursing home. Instead, it strives to make Hogewey as close as possible to a small gated neighbourhood complete with its own supermarket, cafe, restaurant, beauty salon and theatre. There is a large central square and smaller ones or courtyards with benches and chairs where residents can sit and soak in the sunshine, weather permitting.

(When we were there, there was intermittent rain. That explains why you don't see any residents outdoors in the photos.)

Join me as I take you on a tour of Hogewey.


The main boulevard, with shops flanking both sides.
The cafe is the first outlet you see on your left as you walk along the boulevard.
This is probably where the residents go to work their muscles and limbs.
There's even a repair shop in case anything needs fixing.
Inside the beauty salon. We didn't get to enter so this image is taken from the Daily Mail.
This is The Passage - a spacious hall where the residents gather to enjoy group activities. There is always music playing in the background as the elderly love music from the old days. Expect to see some of them dancing too. We did.


That's Marianne at the door of the Rembrandt Room. This is where the residents enjoy art and craft activities.

The supermarket at Hogewey is well-stocked. Every item carries a price tag. The cashier issues a receipt for purchases but no cash changes hands. All transactions are covered in the residents' payment scheme.


There are no locks anywhere. Doors and elevators open and close as you step on the weight-sensitive floor panel. Residents have the freedom to move around and participate in the daily programme of activities if they wish to. The objective is to make life in Hogewey as normal as possible, and as close to what they are accustomed to.

No need to press any button or turn any door knob. Doors open when you step on the floor panel in front of it.

According to Yvonne in the CNN interview, the concept works. Residents do not need as much medication, they seem happier and are living longer. The Hogewey model has been replicated in Canada, Switzerland and the UK, and that's evidence of its success, aside from the awards it has won since 2010. Apparently those on the waiting list have to wait at least a year before there is a vacancy. That only happens when a resident has passed on. Hogewey is where those with severe dementia come to live out their remaining years in peace and with dignity.



The residents I met while strolling around Hogewey gave me friendly smiles and nods. Except for one resident in a wheelchair cuddling a doll, visitors would not know that the elderly folk enjoying activities in The Passage have Alzheimer's. A group was happily playing a board game, another was setting up pins for bowling.

To the outsider, Hogewey is a microcosm of a make-believe world. But to the residents, it is a reality that is a continuation of life as they know it, in a setting that they are familiar with.

Programme of activities in Dutch, of course.

The burning question readers might want to ask is: How much are the fees? Around USD3600 per resident per month. It's heavily subsidized by the Dutch government, otherwise it would cost upwards from USD8000 a month. At such figures, only the super rich with dementia in Malaysia and Singapore can afford to live out their final days in this utopia.
 
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As far as I know, there are no dementia homes or daycare centres set up by the government here, only aged care centres and welfare homes for the elderly. Privately-run nursing homes accept PWD, but this is not ideal as the care of PWD differs greatly from that of other diseases or illnesses. Malaysian Healthy Ageing Society (MHAS) is one of several NGOs that conduct training courses for caregivers. In Singapore, such courses are open to domestic helpers. 

Wednesday, August 31, 2022

TO FULLY RETIRE OR CONTINUE WORKING? THAT'S THE QUESTION

We need to have at least RM240,000 in savings by the time we retire at 55, so we have been told. With prices escalating and inflation showing no sign of abating, for those living in the urban areas, this figure is grossly inadequate. Long term age care alone will swallow up a sizeable chunk of our savings. 

Here's a guide from the Employees Provident Fund to help us with some estimates:

(Above adapted from Panduan Belanjawanku.)

That's why more and more retirees are returning to work life almost immediately after retirement. With longer life expectancy and the ever rising cost of living, most retirees simply cannot afford to enjoy full retirement. Would a 60-year old retiree have accumulated enough in his EPF to support him for the next 15 to 20 years? The answer is an absolute NO.

What is the solution? Go back to work? Easier said than done. Retirees face age discrimination in the workplace. Unless they have skills that are highly sought after, and unless the government offers a helping hand to retrain and upskill older workers, many will have difficulty re-entering the job market.

But thanks to enterprising young individuals like Jasmin Amirul, looking for re-employment is now a lot easier. Today the hire.seniors website is the go-to place for seniors looking for employment. The company conducts workshops for those who register with them to upgrade their skills including teaching them to write a cv and helping them be work-ready. 

Jasmin Amirul, co-founder of hire.seniors

Not all retirees return to work to generate an income. Those who are financially comfortable wouldn't mind doing gig work or part-time work with flexible hours. They do so to keep active and remain socially connected. The extra money doesn't hurt. James Quah (pic below) is an excellent example. He has been featured in several festival videos and commercials playing the part of an elderly father, a resident at an assisted living facility and various other roles.

With the growing interest in the seniors market, there is a demand for seniors to promote products and services. TV agencies and production companies are always scouting for older models for their clients, e.g. fashion houses, healthcare companies, retirement homes, to showcase their products. The pay can be quite good.


If you don't fancy working for someone else, you can always start your own business and be your own boss. This involves taking on some risks, especially financial ones. If you are unable to secure a loan or find partners, would you have the business acumen and confidence to inject your retirement savings into the venture? How good is your appetite for risk-taking? Do the research and tick all the relevant boxes before you take the plunge. 

But having said that, data shows the highest rate of entrepreneurship worldwide is in the 55-64 age group and the over-50 age group is twice as likely to be successful. Although data is not available for Malaysia, a simple survey among my network of friends seem to support this trend. As early as 2014, The Star did a cover feature on the "Rise of the Older-preneurs". Here are some current examples.

(Source: https://mothership.sg/2020/11/1degreec-retrenchment-interview/ )

Richard Koh, 56 and his wife Ong Bee Yan, 66, took the bold step when they started their 1degreeC Cold Brew Coffee. Through sheer resilience and determination, the couple overcame the initial challenges. Today, their business has taken off. Not only that, Bee Yan is now a professional model who has graced the pages of fashion magazines including Harper's Bazaar. Based on her own experience of not finding clothes that was age-appropriate and yet stylish, she decided to team up with Yacht21 to start their own line of trendy clothes called Y21 X grey_evolution collection. You can read more about it HERE.
(Photo: Y21 X grey_evolution)

Retirees have a wealth of working experience and knowledge in specialised areas. One of the most popular encore careers (second career on retirement) is to set up a consultancy in your field of expertise. If you don't want the stress of setting up your own company, you could operate a simple home-based business making use of your skills and passion. Many of my women friends enjoy cooking and making handicrafts. Some have started providing homecooked meals on order, others deliver personal home services e.g. physiotherapy, manicure & pedicure, tuition. 


(Pic above: Jacey Choo has a passion for cooking and baking. She also runs a business in renting out traditional wedding costumes at Lady JC Enterprises, and is an instructor in floral arrangement at University of the Third Age, KL & Selangor. Truly an enterprising senior!)

With the country reaching aged nation status by 2040 when 15% of the population will be aged 60 and above, it makes good sense to cater to the needs and demands of this demographic segment of the population. Indeed retirees and older people are a fast growing market that is often ignored. Those who see the opportunities and are prepared to invest time and money in the emerging older consumers market will reap the benefits, like Ken G, a certified senior fitness specialist. He has established himself as a fitness trainer for senior citizens. He also does physiotherapy for older clients at their homes.

If you are seriously considering turning entrepreneur, but unsure of what to go into, the diagram below may help. I am sure you would have heard of the Japanese 'ikigai', or purpose in life. Finding your ikigai will help boost your chances of succeeding in the business you want to get into should you plan to return to work. Leverage on your vast working experience, skills and interests.