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.