Last week I posted about the Eden Alternative and its attempt to reenvision nursing home culture. Another example, particularly for dealing specifically with the needs of residents with dementia, is De Hogeweyk, an innovative nursing home in the Netherlands. Over the past few years, media coverage of De Hogeweyk has increased as facilities based on its model have opened in other countries. De Hogeweyk underwent a radical change in the late 2000s from a “traditional” nursing home to a “Dementia Village.” Instead of an institutional setting, the innovators at De Hogeweyk created a secure, walled community, with houses instead of nursing home wings, where residents cook, clean, and go about normal daily activities.
 

In October, I was fortunate to attend an event, Exploring Innovative Residential Options for Persons with Alzheimer’s Disease, which was co-sponsored by the NYSBA Elder Law & Special Needs Section and the New York City Bar Association, where I was able to learn more about De Hogeweyk. Eloy van Hal, Founder and Senior Managing Consultant of De Hogeweyk, had traveled to New York to share with us the principles behind De Hogeweyk and how they turn those principles into a community. The goal was to learn about De Hogeweyk and see if it is possible to replicate some or all of its principles in the United States, New York City specifically.

The main idea that drives the De Hogeweyk model is that residents should be in homelike units of 6 to 7 residents that replicate their lives before needing to enter a nursing home as much as possible, and that all the residents of each unit should share that lifestyle. The belief is that people will be happier and there will be less conflict and agitation if the surroundings feel familiar and they are living with like-minded people. De Hogeweyk used to have seven “lifestyles“:

1. Stads — Urban, casual.
2. Goois — Upper class
3. Ambachtelijke — Working, farmers class
4. Indische  — Indonesian/Dutch East Indies
5. Huiselijke — Homy
6. Cultural — Arts and culture
7. Christelijke — Christian

De Hogeweyk has since reduced the number of “lifestyles” to 4,
cosmopolitan, nature-oriented, well-to-do, and traditional Dutch. Within the Village, there is a supermarket, restaurant, parks with fountains, and a theater square where residents are free to go about living their lives instead of staying in their beds or sitting in a day room watching television all day. The quality of residents lives has skyrocketed since the transition. In 1993, when it was still a “regular” nursing home, 50% of patients were being given antipsychotic drugs. In 2015, only 8% were.

In the weeks since the event, I’ve thought a lot about the barriers we would face here in New York City, and the US, to replicating De Hogeweyk. In New York City, where do you find the space to build these villages? Perhaps we could create vertical “villages”, where instead of having separate houses, each floor of a high rise building was redesigned into a full floor apartment, with enough bedrooms and bathrooms for 6 residents and staff, a kitchen, living room, dining room, laundry, etc. Or to create an enviroment more familiar to residents used to living in a house, duplex or triplex units could be created within a high rise. Shops, restaurants and activity spaces could occupy the lower floors, and the roof could be used to create outdoor space. In keeping with De Hogeweyk’s practice of having intergenerational programs and activities, a daycare/preschool could be located in the building, making it easy for the children and the residents to share activities together.

One of Hogeweyk’s principles that strikes me as particularly problematic to replicate in a place as diverse as New York City is the division of residents into “lifestyle houses.” I have difficulty seeing how the myriad cultures and lifestyles in New York City can be reduced to a small handful of residences.
De Hogeweyk no longer has a Christian residence, but would a facility run up against anti-discrimination laws if it created residences based on characteristics like ethnicity, religion, or sexual orientation, even if doing so was demonstrated to benefit the residents? De Hogeweyk’s model presents a host of possibilities and challenges I will explore further in subsequent posts.