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Nursing Review reports on Professor Jenny Carryer’s recent study trip to the Netherlands to find out more about the Dutch approach to caring for older people – including the acclaimed De Hogeweyk dementia care village.

It sounds so simple – a woman wandering into a restaurant and joining a group for a drink – but it was the sheer normality of it that made that Jenny Carryer cry.

The setting was a dementia care facility and the woman, who was welcomed by facility founder Eloy van Hal to join the group of New Zealanders he was briefing,  was a dementia care resident. Carryer says the natural inclusion of the woman captured perfectly the essence of the acclaimed De Hogeweyk dementia village.

It also captured its uniqueness, highlighted by residents who were observed at the three conventional care facilities visited during the intense, five-day Netherlands study trip showing the ‘conventional’ dementia behaviour that was notable for its absence at De Hogeweyk. 

At De Hogeweyk the 152 dementia residents live in groups of six to seven in family-style homes clustered in a village-like environment that receives the same funding as the conventional facilities. But despite the newer of the conventional facilities trying to be more ‘home-like’, the contrast in behaviours was marked: De Hogeweyk residents wandered freely, did housework and socialised, while the ‘conventional’ facility residents were seen to be agitated, pacing and shouting.

During the study trip the research team participants also met with university and research centre staff working in the area of older people’s health, visited a ‘senior-friendly’ hospital and were briefed on the Netherlands’ health care inspectorate programme of residential care. 

Carryer says the team came away with a sense of the shared challenges faced internationally around managing the escalating levels of dementia and addressing the needs of increasing numbers of older people at the same time as facing a contracting workforce and resources.

The Netherlands’ population of 17 million includes 2.6 million aged over 65, with 100,000 living in 3,000 ‘assisted living’ homes (nearly half are due to be closed following a new government policy focused on home-based care), 50,000 in nursing homes and 200,000 living with a diagnosis of dementia.

Carryer says she was particularly impressed by the attention that the Netherlands places on person-centred care in aged care and their use of multi-disciplinary teams in assessing and planning individualised care for older people. 

But she also came away thinking that the Netherlands are behind New Zealand in terms of the integration of care between primary, secondary and tertiary care, with Dutch hospitals appearing isolated from what is happening in the community. She was also grateful for
New Zealand’s simpler health workforce structure – particularly the clearly delineated three scopes of nursing: enrolled, registered and nurse practitioner.

De Hogeweyk the highlight

“De Hogeweyk was absolutely out of this world,” says Carryer.

She says of the other residential aged care facilities visited, some were “exactly as expected”, and some of the more recently built provided “refreshingly different” environments. But it was the person-centred care that made the 23-year-old De Hogeweyk village stand apart, not only from dementia care facilities in the Netherlands, but also from those worldwide.

“The fascinating part is that they don’t receive any different funding from the other facilities, but it is like another planet.”

It is part of the village’s philosophy that residents – most still physically able but severely demented – contribute by continuing to do normal household tasks (with the help of two daytime caregivers), including cooking, laundry and cleaning.

“So these people instead of pacing around with nothing to do are actually pottering around chopping up vegetables, weeding the garden and hanging out the sheets.” This also contributes to keeping running costs down. Carryer says that while this may create issues of hygiene and safety, the philosophy of the village asserts that these people are living their lives, not institutionalised, and therefore so-called risk assessment (or compliance issues) take second place to living
a normal life.

De Hogeweyk village has a secure perimeter – but it is created by the outer walls of the houses so Carryer says visitors and residents are not conscious of it and internally it looks like a small village linked by paths and courtyard gardens with trees and fountains through which residents can roam freely. It even has a shop for residents to get their daily groceries, plus a theatre and a restaurant and bar (where the resident joined the New Zealand team for a drink).

De Hogeweyk, like other facilities visited, has little input from registered nurses, says Carryer. Residents can be cared for at De Hogeweyk in their village house until they die, with the village having permanent, trained caregiver staff in each house during the day and a skeleton caregiver staff at night, who use sensitive noise and motion sensors to detect when they need to visit a house to check on a resident.

Carryer also visited the University Medical Centre (UMC) in Utrecht, where the Chief Nurse of Netherlands is a nursing professor. The UMC Utrecht is a ‘senior-friendly hospital’ that uses gerontological nurse practitioners (probably closer to our clinical nurse specialists) to assess every person admitted over the age of 70 for frailty, delirium and falls. People with delirium are taken to a special intensive care unit for delirium, where the emphasis is on providing a quiet and non-busy space for people to recover and where families are encouraged to stay 24/7. :

The study trip that Professor Jenny Carryer joined was organised by Dutch-trained nurse researcher Dr Jan Weststrate (an honorary research fellow at Massey).

Nursing Review’s sister publication INsite last year published an interview with Thérèse Jeffs, who is behind New Zealand’s first dementia village, modelled on De Hogeweyk, which is due to open in Rotorua in December this year.
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