The Hogeweyk Way: Improving Quality of Life at The Dementia Village

March 13, 2023

The Hogeweyk Way: Improving Quality of Life at The Dementia Village

What can a town in The Netherlands teach us about how to treat people with dementia?

Deborah Zisholtz, Director of Aviv Older Adult Services, and Georgia Gunter, Geriatric Care Manager, recently traveled to The Netherlands to find out when they visited The Hogeweyk Dementia Village. JF&CS Atlanta representatives were provided this professional development opportunity through the Network of Jewish Human Service Agencies. JF&CS was one of only two agencies from the United States taking part in this wonderful opportunity.

The Hogeweyk Dementia Village takes a unique approach to care for patients living with Alzheimer’s Disease and other related dementias. Yvonne van Amerongen, Eloy Van Hal and Jannette Spiering started dreaming up Hogeweyk in the early 90’s when working for a traditional skilled care nursing home. At the time she and others she worked with began questioning their facility’s hospital-like approach to care and exploring the idea of a more comfortable and familiar experience for their residents. In December 2009, the new way they imagined came to fruition when they transitioned their facility into what today is the Hogeweyk.

Situated on four acres of land in Weesp, Netherlands, “it reminded me of a college campus,” said Deborah. “The space was beautiful with a park and shops and things you would see in a town center. There are 27 homes in the village with 6-7 residents living in each home. Two dedicated staff work in each household and report to the same household. This arrangement helps staff get to know the residents’ likes and dislikes, as well as the group’s dynamics. Residents, too, feel more comfortable seeing the same staff each day. To create a sense of normalcy, staff do not wear uniforms at the Hogeweyk.”

The residents seemed comfortable and were in environments much like their lives prior to their dementia diagnoses. There are four distinct lifestyles in Hogeweyk (Traditional, Urban, Cosmopolitan and Formal). Their homes are decorated (i.e., furniture, wallpaper) to reflect the environment that most closely matches the environments residents lived in previously. They have their own room they can decorate the way they want. Residents share the home with other residents who have similar likes and interests, making it easier to make friends.

“Until you go over there, it’s hard to picture what it could be like,” added Georgia. “Residents were happy and joyful, and there was so much engagement. We are so task-oriented in the United States, whereas there, we saw more of a focus on supporting residents’ social and emotional needs.” These important needs are met by considering what interests the residents had prior to their diagnosis and giving them the ability to continue exploring those interests. There are 30 clubs and opportunities to participate in a range of activities. As Deborah pointed out, “people are human beings first, and have dementia second. And when communities focus on what they can still do, that leads to the greatest quality of life possible for these residents.”

“It’s almost like getting physical therapy through everyday activities,” added Georgia. “People aren’t sitting a lot, they’re up and moving around.” Residents help staff with everything from cooking to cleaning. They are free to walk around the community during the day and are as active as they wish to be. With so much engagement during the day, residents sleep better at night. Eloy Van Hal reports that most residents take 50% or less medications compared to what they were taking when they first came to Hogeweyk.

There is, of course, concern for individuals living with dementia when it comes to moving around, with fall risk and wandering to be considered. But “at some point,” said Georgia, “it becomes a cost/benefit analysis: risk can be nearly negated by keeping people quiet in their bedrooms or sitting in front of a nursing station, but at what cost to their quality of life?” The village is as safe as possible, with its four acres built to create spaces for residents to freely walk around, and “Hogeweyk’s research shows there are no more falls in this community than in a traditional nursing home.” There is one main door people enter and out of the Hogeweyk, and it is monitored by a receptionist.

Another difference of Hogeweyk when compared to other senior living communities is that residents of their town, Weesp are encouraged to come inside, and not just to visit someone they know. There is a fully functioning restaurant, a pub, a grocery store, hair salon, and theater. “It feels strange to think of someone in the United States going to a nursing home to eat lunch on their break or get a gallon of milk, or a beer after work,” said Georgia, “but at Hogeweyk, it’s welcomed.” School groups even come to visit and eat lunch alongside the residents in the restaurants and do projects with them.

Part of the daily life of patients at Hogeweyk is using these establishments. Residents and care staff shop at the grocery store each day to purchase their food to cook in their homes. They can have lunch and go to the theater, socialize, and do as much as they want and are able to. Family members and friends are welcomed at all times of the day, without restriction.

The village has 188 residents, cared for by 280 full and part-time staff and a large group of volunteers. It is, of course, costly to run an entire village this way but remarkably, Hogeweyk is funded by the Dutch government. The Hogeweyk’s budget is no greater than that of other traditional skilled nursing homes in the Netherlands. On average, residents live in the Hogeweyk for 2 1/2 years and can get end of life care without leaving the Hogeweyk.

It took 17 years for Hogeweyk to go from an idea to a reality, and the model has inspired people in the healthcare industry worldwide. There is even a model being planned locally as part of the community of Serenbe (Chattahoochee Hills, GA) with the Hogeweyk’s consulting group, Be Advice.

Large-scale change takes time and finding ways to improve quality of life for people living with Alzheimer’s Disease and other related dementias is a priority of JF&CS Atlanta. The agency is currently seeking grant funding to help with two objectives: to increase in-home coaching for someone living with dementia and their care partner, a service currently offered as a private pay option, and to match One Good Deed volunteers with individuals living with dementia. Also, the agency is seeking partnerships with senior living communities to bring best practices from Hogeweyk home to our Atlanta community.

Overall, it was “intuitive care,” said Georgia. “There is a misconception that this type of community can only work for individuals living with earlier-stage dementia, but this model was set up to serve individuals that are living with later stages of dementia. The same individuals you see every day in typical US skilled nursing homes.” “Agreed,” said Deborah. “It was very intuitive, and very inspiring to see these people happy. Not just the residents, but the community, staff, and volunteers.”