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Dementia care goes Dutch

By Eleanore Robinson
Richmond Villages Willaston has become the first large-scale social care setting to use the Dutch Hogeweyk model.

The facility comprises a ground floor ‘dementia village’ with six households of up to six people, each with their own front door. On the floor above there is a traditional 35-bed care home.

Within each self-contained apartment, residents with mild-to-moderate dementia are encouraged to carry out daily tasks such as cooking or laundry with the assistance of only one member of staff, known as the ‘homemaker’.

Much as they would at home, apartment residents can go outside by themselves in enclosed private patios to do some gardening, and inside, as many household activities as they want. 

The traditional care home is there if required

Richmond Villages Managing Director Philippa Fieldhouse explained: “The idea is we can look after them at the different stages.”

In its two months of operation, the Hogeweyk approach to providing has had a “hugely positive” impact on its residents with dementia, Fieldhouse said. “Individuals are coming back to what their families recognise as a person. It does not feel like a care home. It is just like going into someone’s house.”

She adds that homemakers make a real difference as it looks like they are assisting rather than running the environment.

But could this model become the standard for caring for people with severe dementia in the UK?

Richmond Villages, which is owned by Bupa, decided to take this approach following a visit to the Netherlands see the Hogeweyk model in action.

Here it has been established for several years and residents are reported as feeling less stressed, have less problem behaviour and need less medication.

Frank van Dillen of DVA Dementia Village Associates, who was the main architect of the Hogeweyk project, said: “In general small-scale dementia care is far more beneficial than old fashioned nursing homes.”

He said the model was a different way of thinking by placing together like-minded people with the same background. For instance, residents who lived in a large city like London would be comfortable living in a high-rise block and be placed with people with whom they had shared interests.

Van Dillen added: “It is a human approach, not a medical approach. It is not hospital but hospitality. It is long term care.”

Existing care homes could be converted to create these smaller scale settings, but as the built environment is crucial, the traditional care home model would need to be significantly transformed to suit the needs of the residents in that area. “It is a complete package”, van Dillen explained.

Of course, implementing the model ultimately comes at a huge initial outlay on the property or land, which would ordinarily be recouped in the fees charged.

However, learnings from the Hogeweyk experience in the Netherlands suggests that you can provide these services within the same budgets as a care home, as you can make savings in other areas, for example, the number of staff needed on site.  

Fieldhouse agreed, saying that, while the costs were higher in terms of setting up the village, there were savings as one homemaker looks after the whole household and they have acoustic monitoring at night.  

“The investment really does pay off”, she said. 

Rolling out the model
But how can this model be replicated across the UK, which has an ageing care home stock that is being updated slowly and where larger, traditional dementia care homes make more economic sense?

Property consultants Knight Frank said that converting smaller-scale nursing homes to the Hogeweyk model would not be viable due to the significant amount of land needed to create the village.

Healthcare team associate Mandip Bhogal said: “We are aware of developers and operators incorporating this concept within their forthcoming schemes, albeit a very small number of developers and operators.

“The key constraints are around scarcity of suitable sites and the viability of the concept from a development perspective.

“There also needs to be a higher degree of awareness of the Hogeweyk model within the UK.

“We think that any government incentives towards such schemes would be much welcomed by developers in the UK, given the that projected number of people suffering from dementia is to increase to 1.3m by 2028.”

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