sils 2015 - de hogeweyk, the care concept

De Hogeweyk

Care Concept

Living life as usual with advanced

dementia.

Sherbrooke International Life

Sciences Summit September

2015

May I introduce myself?

Yvonne van Amerongen- Heijer

occupational therapist, social worker and founder of De

Hogeweyk

1992: Care manager- nursing home Hogewey

1993: Project leader innovational project „living as usual“ nursing home

Hogewey

1994: Project manager- quality & innovation nursing home Hogewey

2015: Senior managing consultant for “Be” ( part of nursing home

Hogewey)



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May I introduce myself?

Yvonne



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Live your life

“It is not about staying alive whatever it

takes, but what your life is about. “

From the diary of Etty Hillesum- murdered in Auschwitz in

1943



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Some figures (WHO, 2012)

People living with dementia : ( 40% late stage)

- 2012: 35 million

- 2030: 70 million

- 2050: 115 million



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In De Hogeweyk live only

people with severe,

advanced dementia.



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The vision on living, wellbeing and

care - Ageing in place: 85% of all people with dementia (in the

Netherlands).

- For those other 15% we offer and support living, care and

wellbeing (life’s pleasures).

- Living in a normal home within a normal household, together

with others who have the same lifestyle.

- Living his or her individual life in this home and outside

Living a life as usual Sherbrooke International Life


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The principles of

De Hogeweyk- care concept

- Normal living

- Living in a small group of people with

the same lifestyle

- Normal household

- Your own individual life

- Living a social life Sherbrooke International Life


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Favourable

surrounding

Life’s

pleasures

Employees

& volunteers Health Organization Lifestyle



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6 pillars

• A favorable surrounding

• Pleasure in life and meaning in life

• Health

• Lifestyle

• Organisation

• Employees and volunteers



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A favorable surrounding

Living life as usual ,in a normal house, with a normal

household.

- Where confusion is minimized

- Where life has a normal human scale, living together in a

small group with the same lifestyle

- Where the resident is supported by professionals to cope

in daily life as usual



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A favorable surrounding

- A house with a front door, a living room and a kitchen.

And a terrace or a garden to sit outside in the sun.

- A house with your own bedroom.

- A house that is furnished in the style of your own home.

- A house where the household is done according to your

own ideas: cleaning the house, washing and ironing

clothes, preparing meals.

- A house with a daily routine according to your own ideas.

- A small group : 6-7 in each house



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Pleasure in life

and a meaningful life - A social life: meeting others in the pub or as a member

of a club

- Enjoying a walk in the fresh air

- Daily shopping in the supermarket

- Concerts at the theater

- The freedom to wander around

- The church and the rituals



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Your own individual life

A social life …….

Cultural events, just a stroll on your own,

meeting others, following your own interests



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De Hogeweyk



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Pillar: employees and volunteers • Employees and volunteers know the vision and apply it

in their work. They work independently on the basis of

the vision.

• Volunteers are fully fledged and equivalent colleagues.

• A volunteer always works under the direction or the

indirect supervision of an employee who is responsible

for his or her work.



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De Hogeweyk

The team in the house

1 Team in every house (6/7 residents)

Each team consists of 6-8 employees

• Professional caregiver (level 3): 7.00 am – 10.30 pm

(2,9 fte netto)

• Assistant (level 1-2): 8.00 am – 1 pm (0,97 fte netto)



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©CEANconsulting / © Be The Hogeweyk Care Concept / © Vivium Zorggroep

De Hogeweyk

• ‘Quality of life’

QUALITY OF LIFE

of

people suffering

from dementia

Caring relationships

and social structure

Feeling at home

Having something to

do

Independence and

autonomy

Esthetics

Physical environment

En

viro

nm

en

tal fa

cto

rs

Happiness

Health

Medication

Self esteem

Ind

ivid

ua

l fa

cto

rs

Health is a state of complete physical, mental and social well-

being and not merely the absence of disease or infirmity. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946

by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

Culture & Tradition Family &

Community

Personal Freedom Surroundings

De Hogeweyk

Pillar: Health

- Experiencing health and the quality of life are leading

- Medics/ therapists to support quality of life

- Balance in life: wellbeing, living and health

- A social-relational system instead of a medical system

- Quality of life is our goal, as long as the extensive

program in search for the cure of dementia is going on



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De Hogeweyk

Pillar: Lifestyle

Lifestyle for people with dementia?

Yes! A person with dementia is the same individual as before

the dementia.

Lifestyle is: surroundings, environment, interior

design, social behaviour, daily routines,

preparation of meals, norms and values.



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How did we do it?

1993: experimental ward: study on lifestyles

1994: interviews with family of 169 residents

2002: Motivaction- validation of the lifestyles

- questionnaire for analysis lifestyle

new residents

2015: update of the lifestyles

Dutch lifestyles!



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Mentality

milieus in

Western

Europe

• Dementia occurs in all social milieus

• Therefore clients living in De Hogeweyk are a reflection of all

kinds of (elderly) people in Dutch society.

Motivaction’s segmentation model of the Western

European population based on social values



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38

Motivaction’s approach: beyond sociodemographics



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Modelling clients of De Hogeweyk

Methodology

• Grouping elderly people who share the same social values and

lifestyles

• Based on criteria and data in the Mentality-database of the Dutch

population

Outcome: 7 lifestyle profiles in ‘de Hogeweyk’

1. Urban (‘Stads’): open, outgoing, talkative

2. Traditional (‘Ambachtelijk’): traditional, handicraft, mashed potatoes

3. Homy (‘Huiselijk’): traditional, cosey, household work

4. Indonesian (‘Indisch’): tradition, nostalgia, indonesian food

5. Upper class/ well-to-do (‘Goois’) manners, classical music, high tea

6. Cultural (‘Cultureel’): the arts, wine, vegetarian meals

7. Christian (‘Christelijk’): sober, religious music, praying



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De Hogeweyk: Dutch Culture

7 Lifestyles

- Homely

- Urban

- Upper class

- Cultural

- Indonesian (Colonial)

- Handicrafts men

- Religious Sherbrooke International Life


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De Hogeweyk

Pillar : the organisation - The vision is leading for all policy and the organisation

structure.

- Finances and procedures are adapted to the vision.

- Nursing home care: back stage

- Living life as usual: front stage

- All professionals work together to integrate all aspects of

life for the resident

- The professional is in service of the resident to

experience a normal life and health

- Organization: wellbeing, living and health



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De Hogeweyk

Guiding principles

(1) Deinstitutionalize

(2) Transform

(3) Normalize

• Operationalizing rehumanization


De Hogeweyk

• 1) Guiding principles – deinstitutionalize


De Hogeweyk

• 2) Guiding principles – transform


De Hogeweyk

• 3) Guiding principles – normalize

And the budget !?!

• The Dutch social security system provides the budget

• The budget is + € 5800,- per resident per month

- All personal: caregivers, nurses, doctors, paramedics,

administration, cleaning, management and staff

- All housing costs: real estate, maintenance, energy costs,

etc.

- All food costs: food and drinks

- All care and cure products: medicines, incontinence

materials, syringes, etc.

- Activities for each resident, 30 minutes per week



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De Hogeweyk- concept

It is not only about the bricks!

An integral concept in which all aspects add

up to a quality of life for people living with

severe demenia.



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De Hogeweyk

Architecture

- 23 houses, 17 designs

- Total of 15.310 m²,

- 50% of the property is

outdoors, 50% is built

environment

Social life

- Supermarket, restaurant, café,

hairdresser, a theater

and clubrooms

- parks,

- gardens,

- squares,

- alleys, streets and lanes,

- a fountain, a pond,

- art-exhibitions

- Christmas fairs

- concerts



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Support and safety

- All employees and all

volunteers know how to

support a person with

dementia in experiencing daily

life.

- The exterior and the interior

design support the person to

understand where he is and

what is expected of him.

• De Hogeweyk is accessible for

everybody, the façades are the

safe guard to the “unsafe”

world outside.



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From nursing home Hogewey to

De Hogeweyk 1992: the idea

1993: experimental ward

1994: transform from nursing home to

Hogewey concept

2002: lifestyle analyses based on research

2008: move from old building to new

2010: official opening De Hogeweyk



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Scientific research?

• Positive effects of small scale living on dementia*

• Better cognitive and functional capacity

• Reduced agressive behavior

• Improved social involvement

• Improved work environment for caregivers:

• More autonomy

• Less stress

• Reduced physical strain * Verbeek, 2010; De Rooij et al, 2012.



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Scientific research?

Positive effects care for people with dementia in small

groups

- On the brain / agitation

- Exercise

- Fresh air and daylight (van Hoof et al., 2009)

- Social contacts (Lawton, 1997)

- Pleasant physical surroundings (Zeisel, 1999)

- On the appetite

- A pleasant atmosphere

- A set table

- On employee satisfaction (Verbeek et al, 2010)



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Results in De Hogeweyk

High satisfaction score among residents

and family (8.9 on a scale of 10)

High satisfaction among personal (7.6)

High satisfaction among volunteers (7.6)



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Results in De Hogeweyk

- No nursing home stigma, but a sense of normal life.

- Less anti-psychotics :

1993: 50%, 2013: 16%, 2014: 13%

- No bedridden residents since 1993

- Decrease in aggression by an increase in:

- Space to walk around

- Fresh air

- Exercise

- Daylight

- Freedom



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Thank you!

De Hogeweyk Living life as usual for people living with advanced dementia

Yvonne van Amerongen

E-Mail:

[email protected]

[email protected]



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mailto:[email protected]

mailto:[email protected]



2015

sils 2015 - de hogeweyk, the care concept

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