We have all visited the beautiful hill top villages in France and Italy. They all follow the same basic design. The houses on the outside of the village face inwards. The backs of the buildings are joined to form a protective wall. Within the wall there are other houses, shops, and squares. There is usually a single gate to stop intruders from outside. For centuries they created a safe and secure environment for their residents.
“Dementia Villages” were created first in the Netherlands and follow a similar design. The “houses” face inwards. Their backs create a wall around the “village”. Within are all the facilities of a normal life. There are restaurants, bars, shops, hairdressers and cultural venues. There is indeed a single entrance. In this case the village serves to protect by enclosing. Ensuring that residents do not wander off, but are free to move around within the village. They can live a normal life within a safe environment.
The Oslo Village
I learnt of the new Oslo village at a services marketing conference last week. A group of anthropologists have been studying the translation of the Dutch concept to fit Norwegian culture. Their dementia village has a gross area of 18,000 square meters. It has accommodations for 136 residents. They are divided into 17 shared apartments and a single unit for 22 residents.
It is based on the original in Hogeweyk in the Netherlands which was opened in 2009. It was the first village-type accommodation for patients with dementia. It was designed to transform a traditional nursing home into a more homely environment. It replaced the usual clinical and institutional atmosphere. It is a small community and consists of 27 houses with six to seven residents in each. It provides care for a total of 169 people. The village has streets, courtyards and squares. It offers a diversity of facilities, such as a theatre, supermarket, café and club rooms that organise different activities. Residents will go to the supermarket with their carer. They will shop and check out at the till. No money changes hands. The cashier is trained to deal with people with severe dementia. The Hogeweyk’s vision is ‘living as usual’. Living a normal life but in a secure and safe environment. The village and its care concept have spurred similar facilities in Denmark and Germany. Norway is the latest.
Adapting the Model & Care Workers
The research team studied the process of adapting the concept to fit in to a Norwegian settings. For example in Holland the different houses are each decorated to fit a different lifestyle. There are “houses” decorated for crafts or culture or religion. This is designed to have the residents feel more “at home”. In Norway this was felt not to be appropriate since lifestyles are more homogeneous. They also discovered the need to “frost” the windows that faced the outside world. The windows did not open but some residents found them disturbing.
The adaptation for the care workers has been an interesting journey. In fitting with residents living at home there is a lot of emphasis on changing the model of care. Uniforms are frowned upon. In Oslo no “facilities” were built in for staff members. There were no locker rooms. No private meeting rooms. No desks and no computer screens. This was all designed to foster a different model of care.
Unfortunately the carers are not visiting someone’s home. They are at work and their work is to care for the residents. In the Netherlands there are twice as many carers than residents. These include volunteers. They do need to have lockers. They do need to be able to have private conversations about patients. They deal with drugs. In response the Oslo team have “hacked” the building. They are taken over spare rooms and store rooms. It is a fine line. They do not want to encourage “elderspeak” (Newsletter #097 “Elderspeak” ) . Yet the emotional work of the carers cannot be denied (Newsletter #062 “The Emotional Work of the Consumer”) . Dealing with dementia patients can be emotionally draining. To protect themselves they may need their own space. Their own desk. Without these trappings they could feel emotionally exposed.
We debated in the session whether a Disney model would work. In the Disney theme parks there are two distinct areas. Above ground the team are “on stage”. If they play characters they must be totally in the part. They should not take off the costume heads. One does not want to meet Mickey Mouse in the men’s room! The “below ground “ is as large as the park itself. Team members can be themselves. They can eat, change and prepare to be on show. Within a village this would imply a closed door. “Outside” would be the office, inside they would be in someone’s home. Is it easier to change your working model by being immersed in “the home” or by being able to step outside?
Before you ask. In the Dutch system such care is paid for by the state. The dementia village receives the same budget per resident as more institutional homes.It cost just under €20m to build. CNN have an excellent documentary on the original village if you would like to see it.