Quality of life: A ‘dementia village’ in the Netherlands is changing the way we think about care and aging
Published in the Vancouver Sun, December 7th, 2014
Weesp is an idyllic Dutch town with narrow cobblestone streets, canals, windmills, stores selling wooden shoes, and cheese shops. But what has put Weesp on the map are not the tourist attractions, but a neighbourhood designed and built exclusively for people with advanced stages of dementia who can no longer live independently.
De Hogeweyk Dementia Village is designed around the concept of quality of life and has six to eight people living in a home each with their own bedroom and shared living room, dining room and bathing rooms.
In the morning, residents wake up at their own time and gather around the dining room table, choosing what they would like for breakfast. A popular choice is pancakes. During breakfast, the conversation often focuses on what activities the residents want to do for the rest of the day. Following breakfast, a resident goes shopping in the local supermarket for groceries to be used for lunch and dinner.
A freezer at the entrance of the grocery store has frozen ice cream treats to satisfy a sweet tooth. In the same store, personal items such as incontinence products, medical supplies and cleaning supplies are purchased for the homes.
Once the resident has purchased her items, she walks back to her residence with the aid of her shopping cart. The supermarket is located in The Passage, a two-storey marketplace complete with a café, restaurant and art studio.
The Rembrandt Art Studio welcomes residents who arrive at their own pace and schedule. In the art studio, seniors paint like the Dutch masters Van Gogh and Vermeer. The art studio offers its residents a warm beverage to help keep their attention. When the drink is finished and the art is complete, the residents make their way to another attraction allowing space for other residents to paint.
The marketplace is large enough to feel like a town square and is used for group activities on rainy days. A market stand sells fresh-cut flowers, a newsstand has the daily papers, and large canvases featuring abstract art decorate the empty spaces on the walls.
Leaving the Marketplace, Main Street has the look and feel of its namesake. The pedestrian walkway with cobblestones has a café, hardware store for repairing bikes, walkers and other mobility aids to independence.
A physiotherapist provides both individual restorative therapy and group fitness exercises classes. A doctor’s office is located on the main drag, as is a modern beauty salon. One store front is called Mozart Hall and is decorated in Louis XIV style with classy dining tables and chairs and chandeliers. The hall is used for music therapy where residents create their own musical entertainment, much like they would have before moving to the dementia village.
A theatre hosts performances by local musicians and entertainers who champ at the bit to add this venue to their resumé. Another storefront is an activities booking travel agent who arranges trips to Amsterdam, De Hague, Haarlem, Delft and other regional cities and cultural attractions.
The main restaurant is decorated like a hip spot with perfectly poured espresso coffees and delicious biscotti. The lunchtime buffet menu is available to residents and guests from the local town and is a popular local eatery. The food quality is the same or better than the finest local restaurants and is part of the vibrant local food scene. It is a cool place to go out for a meal, not just a place to have a meal with grandma.
The buildings have the look and feel like the neighbouring buildings of both apartments and industrial park. The sounds of children playing can be heard in the distance as a school is located across the street with a soccer pitch visible for the residents to watch.
The homes are designed around people from similar backgrounds to encourage new friendships, to decrease aggressive behaviours, and to increase the chance of people getting along based on speaking the same language from their similar life experience. Separate houses are designed for Indonesian residents, while others are from urban areas and another for people who spent their lives farming.
Each home has distinctive features that help residents identify their home. One doorfront has a pair of wooden shoes, a bird feeder, and a small planter box with tulips and a mailbox with a large number 5 indicating the address.
The homes have their own patio with sturdy tables and chairs, covered shelter and a garden, which have been beautifully maintained. Park benches line outdoor space that is interconnected to other gardens sharing a common pathway for outdoor activities like Bochi, gravel field, life-size chess set, and lots of places to sit and take a break to watch what others are doing and to enjoy the independence of the outdoors.
An elevator without buttons automatically transports residents to and from their residences equipped with a motion sensor and electronic door closure sensors.
Gone are all the characteristics of an institutional living environment. Long corridors have been replaced with pedestrian boulevards and wandering paths; there are no sterile looking shiny floors reflecting the fluorescent tube lighting above. Care aides dressed in hospital scrubs do not rush residents to a main dining room to make it to a meal on time.
As demographic trends advance, homes for the aged will transform the aging experience with new models of care, and innovative living environments dignifying the lives of people with severe memory impairments. Theses communities are based on the need for a global response to the looming Alzheimer’s disease crisis that will triple in the next 40 years. New ways of caring for seniors in purpose-built environments as well as new options for living at home longer will perhaps mean that tomorrow’s seniors may never need a traditional nursing home.
This is not just a business model. It is a different way of thinking about the way people with advanced dementia experience the aging journey.
The Dementia Village is operated by Vivium, which operates other sites in the area and previously tested many of the design elements and philosophies to living and approaches to caring that have given the site an international reputation as a leading place for how innovative dementia care changes perceptions of what is important to residents, staff and families.
The village is modelled after the open-minded societal values of The Netherlands. If you walk down streets of any village, past the tourist attractions, you will find all of the same elements of living a meaningful life that you find in the Dementia Village. What is unique is the avant garde philosophy that freedom equals happiness. The seniors in the village can come and go as they please. Everywhere is safe within De Hogeeweyk. No one can leave the community unnoticed. As most seniors with advanced dementia cannot independently enter society, why not invite society into their purpose built communities?
Dan Levitt is executive director of Tabor Village in Abbotsford and an adjunct professor in the Gerontology Department at Simon Fraser University.
Grateful Community Volunteer Celebrates 100th Birthday
/in 100 Years!, Family and Friends, NewsOn January 6, 2015, Siegfried Bartel smiled with content surrounded by his family and friends who celebrated his 100th Birthday.
Born in a time when the US House of Representatives was denying women the vote, neon tubes were patented and the first coast-to-coast long distance call was made, Siegfried has lived through the incredible and rapid changes of the 20th and 21st centuries. World War 1 had just begun to rage across Europe when Siegfried’s mother prayed a prayer of blessing upon her unborn child.
Growing up in Prussia (Poland) in a Mennonite community, Siegfried enjoyed a privileged life earned by the hard labour of his farming family. As a young boy, he watched his father extend grace to a man whose drunken negligence caused a train accident that took the lives of his mother and oldest brother.
It was natural for a man of German descent to enlist in the German Army and Siegfried did so in 1937 before the second world war. When the war erupted in September of 1939, he found himself in an army that eventually brought horrors to others and convinced Siegfried that pacifism was the only sane response to killing and war.
During the war, Siegfried married Erna and started a family. Seven boys were born into his family as Siegfried went back to farming to earn a living. In 1951, he received refugee help through Mennonite Central Committee (http://www.mcccanada.ca) to re-establish his life in Canada becoming a dairy farmer in Agassiz, BC. Siegfried became an active participant in the community as well as serving in leadership with MCC from 1972 – 1987, grateful for how he had received refugee help in his time of need.
Siegfried’s birthday celebration was a vibrant afternoon party with friends and residents from Menno Home joining in the festivities. Five sons, six daughter-in-laws, one grandson and one great-granddaughter and the staff of Menno Place celebrated as well. Siegfried’s older brother, Hans, age 103 came over from Primrose Gardens Apartments with his wife to celebrate his brother’s life and enjoy a delicious piece of home-made cake and some German music. Ingrid Schultz, Chaplain, shared highlights of Siegfried’s life of faith and a prayer of blessing upon his life and the lives of those who love him.
Siegfried is the author of two books, Living with Conviction and Journey to Pacifism. In these books, he shares his life’s story and resulting convictions about pacifism and dedication to others in need. Happy 100th Birthday, Siegfried from your friends at Menno Place, Abbotsford Retirement Home.
Families & Friends – You’re Invited! Concert in Care – January 6th, 2015
/in Events, Family and FriendsJanelle Nadeau, Harp
You’re invited to join a resident or tenant at Menno Place for this Concert in Care!
Tuesday, January 6th, 2015 at 10:30am
Menno Hospital Chapel (enter through the main entrance of Menno Hospital – 32945 Marshall Road)
Harpist Janelle Nadeau’s performances showcase a range of musical genres from Celtic, Spanish, classical and popular songs. She is a graduate of the University of British Columbia with a major in Harp Performance. She is a member of the ensemble Winter Harp, a guest performer in various orchestras, and enjoys a career of performing around the lower mainland. Janelle was a member of the National Youth Orchestra of Canada, Celebrity Cruises, has performed numerous solo tours and has won various awards. Her classical training, combined with her personal contemporary repertoire, provides a refreshing approach to the harp. Janelle’s small town farming roots are reflected in her warm engagement with each audience as she introduces each selection.
Seamstress Shares Gifts
/in NewsPublished by Matthew’s House
It looks like Christmas in Freda Teichroeb’s little apartment. She’s decorated her home with all the joy and flair of a true Christmas-lover: a festive wreath hangs on the door, another in the living room. Her table is covered in a pretty red and green tablecloth. At her window, a little decorated tree stands atop a table surrounded by more ornaments, a beautiful nativity set, and lit-up village houses. Christmas carols play softly in the background.
But Freda’s love of Christmas goes much deeper than surface decorations. At the heart of this season is the message of giving, and Freda lives this out all year round. It is a value that is borne out of her deep faith in God and a desire to share her gifts with others.
“All my life I’ve been a faithful giver, tithing and supporting missions,” she says. “Then when my health began to fail, I really talked to the Lord and asked how I could continue to serve and give.”
The answer came through her sewing machine. Freda has sewn all her life. She and her husband Henry, a school teacher, raised their three children in Saskatchewan and she sewed all their clothes including coats and snow suits.
“My daughter always said that she had the nicest Christmas dresses,” Freda recalls.
They moved to B.C. 30 years ago to be closer to Henry’s aging parents. Freda managed a gift shop in Sevenoaks Mall called The Panhandler and Henry managed Alliance Manor, a rental apartment for seniors. They attended the Alliance church and then Clearbrook M.B. Church where they are still members. Over the years, the Lord has blessed them with seven grandchildren and one great-grandchild. Now in their late 80s, health challenges have necessitated a change in lifestyle. Henry lives in an extended care home while Freda’s assisted living arrangement gives her both the support and the independence she needs. Throughout her life’s journeys, her little sewing machine has traveled with her, so it was only natural that the answer to her prayer was to use her sewing skills to bless others. It was also natural that her skills and her love of Christmas would come together.
Freda began to sew Christmas stockings. She began by sewing them for her children, filling them with crayons, socks and books. She’d wrap everything carefully so that they had something to unwrap. She enjoyed it so much, she decided to sew stockings for sick children in Vancouver. She sewed 50 stockings that were so enthusiastically received that she decided to sew more – 250 more.
Then this summer, while attending a Lady’s Tea, a woman who was familiar with her abilities asked if Freda would consider sewing stockings for the children at Matthew’s House in Abbotsford. Matthew’s House is a ‘home away from home’ that provides respite care for children with complex health care issues, giving parents a chance to rest and rejuvenate.
“I thought it was a wonderful idea, so I did!” she says.
It takes a commitment from the community to keep Matthew’s House running, costing $860,000 annually, all of which comes from generous donations. When Alan Cavin, resource development coordinator for Matthew’s House, first received a call from Freda about her idea, he was moved by her desire to share her gifts with the children at Matthew’s House.
“We really value Freda’s generosity and her creativity,” he says. “Each child connected to Matthew’s House will receive a stocking and she has made dozens more for us to use to raise funds for Matthew’s House.”
Each stocking is made from high quality fabric that has been pre-shrunk so that they can be washed. They are fully lined and come with a strong loop so they can be filled and hung from a mantle. In the two years since she began this project, she has sewn more than 1000 stockings and continues to sew more. When asked why she keeps on doing it, a smile lights her face.
“I really feel that the Lord guided me to know that children would get smiles and joy from these stockings,” she says. ‘In my heart, I am doing this for the Lord and I feel so good doing it for Matthew’s House.”
Freda’s Christmas stockings will be available at several Matthew’s House community events this season: December 5th and 6th at the Lepp Farm Market Christmas events and December 6 & 13 at Sevenoaks Mall. The cost of a stocking is a donation to Matthew’s House.
Is this the future for nursing homes?
/in seniors-interestQuality of life: A ‘dementia village’ in the Netherlands is changing the way we think about care and aging
Published in the Vancouver Sun, December 7th, 2014
Weesp is an idyllic Dutch town with narrow cobblestone streets, canals, windmills, stores selling wooden shoes, and cheese shops. But what has put Weesp on the map are not the tourist attractions, but a neighbourhood designed and built exclusively for people with advanced stages of dementia who can no longer live independently.
De Hogeweyk Dementia Village is designed around the concept of quality of life and has six to eight people living in a home each with their own bedroom and shared living room, dining room and bathing rooms.
In the morning, residents wake up at their own time and gather around the dining room table, choosing what they would like for breakfast. A popular choice is pancakes. During breakfast, the conversation often focuses on what activities the residents want to do for the rest of the day. Following breakfast, a resident goes shopping in the local supermarket for groceries to be used for lunch and dinner.
A freezer at the entrance of the grocery store has frozen ice cream treats to satisfy a sweet tooth. In the same store, personal items such as incontinence products, medical supplies and cleaning supplies are purchased for the homes.
Once the resident has purchased her items, she walks back to her residence with the aid of her shopping cart. The supermarket is located in The Passage, a two-storey marketplace complete with a café, restaurant and art studio.
The Rembrandt Art Studio welcomes residents who arrive at their own pace and schedule. In the art studio, seniors paint like the Dutch masters Van Gogh and Vermeer. The art studio offers its residents a warm beverage to help keep their attention. When the drink is finished and the art is complete, the residents make their way to another attraction allowing space for other residents to paint.
The marketplace is large enough to feel like a town square and is used for group activities on rainy days. A market stand sells fresh-cut flowers, a newsstand has the daily papers, and large canvases featuring abstract art decorate the empty spaces on the walls.
Leaving the Marketplace, Main Street has the look and feel of its namesake. The pedestrian walkway with cobblestones has a café, hardware store for repairing bikes, walkers and other mobility aids to independence.
A physiotherapist provides both individual restorative therapy and group fitness exercises classes. A doctor’s office is located on the main drag, as is a modern beauty salon. One store front is called Mozart Hall and is decorated in Louis XIV style with classy dining tables and chairs and chandeliers. The hall is used for music therapy where residents create their own musical entertainment, much like they would have before moving to the dementia village.
A theatre hosts performances by local musicians and entertainers who champ at the bit to add this venue to their resumé. Another storefront is an activities booking travel agent who arranges trips to Amsterdam, De Hague, Haarlem, Delft and other regional cities and cultural attractions.
The main restaurant is decorated like a hip spot with perfectly poured espresso coffees and delicious biscotti. The lunchtime buffet menu is available to residents and guests from the local town and is a popular local eatery. The food quality is the same or better than the finest local restaurants and is part of the vibrant local food scene. It is a cool place to go out for a meal, not just a place to have a meal with grandma.
The buildings have the look and feel like the neighbouring buildings of both apartments and industrial park. The sounds of children playing can be heard in the distance as a school is located across the street with a soccer pitch visible for the residents to watch.
The homes are designed around people from similar backgrounds to encourage new friendships, to decrease aggressive behaviours, and to increase the chance of people getting along based on speaking the same language from their similar life experience. Separate houses are designed for Indonesian residents, while others are from urban areas and another for people who spent their lives farming.
Each home has distinctive features that help residents identify their home. One doorfront has a pair of wooden shoes, a bird feeder, and a small planter box with tulips and a mailbox with a large number 5 indicating the address.
The homes have their own patio with sturdy tables and chairs, covered shelter and a garden, which have been beautifully maintained. Park benches line outdoor space that is interconnected to other gardens sharing a common pathway for outdoor activities like Bochi, gravel field, life-size chess set, and lots of places to sit and take a break to watch what others are doing and to enjoy the independence of the outdoors.
An elevator without buttons automatically transports residents to and from their residences equipped with a motion sensor and electronic door closure sensors.
Gone are all the characteristics of an institutional living environment. Long corridors have been replaced with pedestrian boulevards and wandering paths; there are no sterile looking shiny floors reflecting the fluorescent tube lighting above. Care aides dressed in hospital scrubs do not rush residents to a main dining room to make it to a meal on time.
As demographic trends advance, homes for the aged will transform the aging experience with new models of care, and innovative living environments dignifying the lives of people with severe memory impairments. Theses communities are based on the need for a global response to the looming Alzheimer’s disease crisis that will triple in the next 40 years. New ways of caring for seniors in purpose-built environments as well as new options for living at home longer will perhaps mean that tomorrow’s seniors may never need a traditional nursing home.
This is not just a business model. It is a different way of thinking about the way people with advanced dementia experience the aging journey.
The Dementia Village is operated by Vivium, which operates other sites in the area and previously tested many of the design elements and philosophies to living and approaches to caring that have given the site an international reputation as a leading place for how innovative dementia care changes perceptions of what is important to residents, staff and families.
The village is modelled after the open-minded societal values of The Netherlands. If you walk down streets of any village, past the tourist attractions, you will find all of the same elements of living a meaningful life that you find in the Dementia Village. What is unique is the avant garde philosophy that freedom equals happiness. The seniors in the village can come and go as they please. Everywhere is safe within De Hogeeweyk. No one can leave the community unnoticed. As most seniors with advanced dementia cannot independently enter society, why not invite society into their purpose built communities?
Dan Levitt is executive director of Tabor Village in Abbotsford and an adjunct professor in the Gerontology Department at Simon Fraser University.
Ballet Therapy for Seniors at Menno Place
/in Family and FriendsWhat an incredible opportunity for our residents at Menno Place to participate in the ballet therapy program that was featured on the Intergenerational Dance Project. This project was from the Centre for Education and Research on Aging at the University of the Fraser Valley. Lee Kwidzinski, Mission-based dance instructor is leading the children and our residents in a weekly dance class.
Christmas at Menno Place
/in Family and FriendsChristmas is a magical time at Menno Place with all the lights, decorations and Christmas spirit! Thank you to another set of elves who donated their time and talents to decorate and make everything so beautiful at the Fireside Cafe.
Do away with ‘do not resuscitate’ – a doctor’s thoughts
/in seniors-interestPublished in the National Post – December 1, 2014
National Post article – by Dr. Brett Belchetz, an emergency room physician
The 83-year-old man lay in front of me. Weak and pale, his blood pressure dropping, he was barely strong enough to lift his head off of his stretcher to speak to me. The patient — let’s call him Paul — had been brought to my emergency room by his family after several days of heavy gastrointestinal bleeding.
Paul had suffered from a heart attack two years prior, and I worried greatly about the strain his ongoing blood loss was causing his system. Talking to him and his family, I urgently outlined his treatment plan, finally asking the question I pose to every elderly or chronically ill patient: “Should your heart stop beating while under my care, would you like us to attempt CPR (cardiopulmonary resuscitation)?”
It is a question most physicians dread asking, as no matter how the issue is raised, patients and family members react at first with shock, aghast that this is even a question at all. Swayed by Hollywood’s depiction of cardiac arrests, where 75% of fictional resuscitation attempts are successful and uncomplicated, the initial answer for most patients as to whether to attempt CPR if their heart stops beating in a hospital is an automatic “yes.”
Unfortunately, in the real world, the statistics are far more grim, and the decision far more difficult. CPR performed on patients who are already in hospital carries a survival rate of approximately 15%, while CPR performed in nursing homes achieves only a 2% survival rate. Survival rates among those with serious illnesses such as cancer (6.7%) and dialysis (2%) are dismal.
Even worse, one study found that among CPR survivors, only 51% were able to be discharged, while the rest required permanent nursing home or hospice care. At the same time, over 50% of CPR survivors exhibit at least some degree of brain damage.
Unlike what is depicted in movies, the truth is that CPR is a brutal event. In my experience, chest compressions often break ribs, sometimes puncture lungs and occasionally even rupture abdominal organs. Those who survive CPR frequently spend lengthy periods of time in intensive care units (ICUs).
Due to these stark outcomes, physicians are obligated, when treating patients whose CPR outcomes are the most bleak, to clarify whether resuscitation in hospital is indeed what these patient and their loved ones want. I make it clear in these discussions that CPR is likely to fail, likely to be painful while it is being performed and, if successful, will carry a 50% chance of lifelong institutionalization and/or brain damage.
I ask patients what their goals and fears are for end of life: Do they wish for more days above all else, or do they fear pain and suffering and the risk of a prolonged loss of independence the most? When it is explained this way, a significant number of patients who initially prefer CPR, change their minds. For Paul, this was definitely the case.
Regrettably, however, the standard in health care throughout the world is to require patients or decision makers to sign what is called a “do not resuscitate” or DNR form, once this decision has been made. It is at this point that end-of-life discussions often become confused, complicated by feelings of remorse and guilt.
Family members acting as powers of attorney often ask me, “how will I live with myself if I tell you to do nothing?” Similarly, patients struggle with the negativity inherent in the DNR statement. One cancer patient I treated recently stated, “I don’t want to end up in an ICU, but I feel like I’m giving up when you use a term like DNR.”
To avoid such uncomfortable discussions, some physicians skip DNR consultations altogether. A 2012 study found that only 20% of elderly patients had actually created a document with their physician to record their CPR wishes.
In order to deal with the fact that most elderly and severely ill patients opt out of receiving CPR once the risks are explained to them, but are leery about signing DNR forms, we need to change our vocabulary. Instead of asking patients who say no to CPR to sign a form telling us not to care for them, physicians should be asking them to affirm their preference for a natural, dignified passing. Simply put, I believe the term DNR needs to go away, to be replaced with the term AND – Allow Natural Death.
Thus, I recently stopped using the words “do not resuscitate” in all such discussions. For legal purposes, I retain the term on forms, but underneath, I write AND, and ask patients to focus instead on those three letters when they consider what they are requesting.
In my admittedly unscientific sample with AND, my discussions with these patients have transformed from what was a morose part of my job, into something inspiring. I no longer witness the terrible guilt among family members that I so frequently saw when the choice to avoid CPR was defined solely by the term DNR.
Thankfully, Paul never did suffer a cardiac arrest that day. He responded well to treatment, and later he told me that the term AND optimistically captured his wish for dignity in death, while DNR made him feel like we saw him as unworthy of care. It is a sentiment that I can only hope the rest of my profession will hear and respond to, and that one day soon, all of us in the medical profession will collectively choose to do away with the words “do not resuscitate.”
Seniors Advocate – The Journey Begins
/in seniors-interestIn March 2014, the BC government appointed Isobel Mackenzie as the Seniors Advocate. Ms. Mackenzie has a broad mandate to monitor and review system-wide issues affecting the well-being of seniors and raise awareness about resources available to them. The Advocate will also make recommendations to government and those who deliver seniors’ services related to health care, personal care, housing, transportation and income support.
We had the privilege of meeting Isobel Mackenzie at the BC Chapter of the Canadian College of Health Leaders. We were thrilled to hear that her background is administration in both home health and higher levels of care. She understands the issues from the inside.
In October, Isobel Mackenzie stated that “We Can Do Better” and released her first report, Together We Can Do Better. Click for PDF.
The Seniors Advocate is seeking seniors to participate in Seniors Councils throughout the province. Application deadline is December 4, 2014. Seniors Advocate Council of Advisers Website.
Christmas Elves visit Menno Place
/in Family and Friends85 high school students from Abbotsford Christian High School joined us this week to “bring Christmas to Menno Place”. They worked tirelessly throughout the campus to decorate Christmas trees, fireplaces, activity centers, dining rooms, the courtyard and the Fireside Cafe.
In addition to Christmas decorations, they worked in our gardens. Ben, a gardner at Menno Place said, “They did an entire week’s worth of work in 3 hours. Thank you!”
Thank you to each and every one of you for participating as Santa’s Little Helpers here at Menno Place this week!
Help! I need to buy grandma or grandpa a gift!
/in Articles, Sharon SimpsonMost elderly seniors will say that they don’t need anything for Christmas – and yet, we want to get something for our elders that will remind them that they are loved and cherished…