TEDWomen 2018
Yvonne van Amerongen: The "dementia village" that's redefining elder care
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How would you prefer to spend the last years of your life: in a sterile, hospital-like institution or in a village with a supermarket, pub, theater and park within easy walking distance? The answer seems obvious now, but when Yvonne van Amerongen helped develop the groundbreaking Hogeweyk dementia care center in Amsterdam 25 years ago, it was seen as a risky break from tradition. Journey with van Amerongen to Hogeweyk and get a glimpse at what a reimagined nursing home based on freedom, meaning and social life could look like.
Yvonne van Amerongen - Dementia-care visionary
Yvonne van Amerongen is an occupational therapist and a social worker. Full bio
Yvonne van Amerongen is an occupational therapist and a social worker. Full bio
Double-click the English transcript below to play the video.
00:12
This is the Hogeweyk.
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It's a neighborhood in a small town
very near Amsterdam, in the Netherlands.
very near Amsterdam, in the Netherlands.
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There are 27 houses
for six, seven people each.
for six, seven people each.
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There's a small mall with a restaurant,
a pub, a supermarket, a club room.
a pub, a supermarket, a club room.
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There are streets, alleys,
there's a theater.
there's a theater.
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It actually is a nursing home.
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A nursing home for people
that live with an advanced dementia
that live with an advanced dementia
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and that need 24-7 care and support.
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Dementia is a terrible disease,
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and we still don't have any cure for it.
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It's getting to be
a major problem in the world,
a major problem in the world,
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for the people, for the politicians,
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for the world -- it's getting
to be a big problem.
to be a big problem.
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We see that we have waiting lists
in the nursing homes.
in the nursing homes.
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Most people that come to the nursing homes
with dementia are women.
with dementia are women.
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And that's also because women
are used to taking care of people,
are used to taking care of people,
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so they can manage to take care
of their husband with dementia,
of their husband with dementia,
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but the other way around
is not so easy for the gentlemen.
is not so easy for the gentlemen.
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Dementia is a disease
that affects the brain.
that affects the brain.
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The brain is confused.
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People don't know anymore
what the time is,
what the time is,
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what's going on, who people are.
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They're very confused.
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And because of that confusion,
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they get to be anxious,
depressed, aggressive.
depressed, aggressive.
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This is a traditional nursing home.
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I worked there in 1992.
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I was a care manager.
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And we often spoke together about the fact
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that what we were doing there
was not what we wanted for our parents,
was not what we wanted for our parents,
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for our friends, for ourselves.
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And one day, we said,
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"When we keep on saying this,
nothing is going to change.
nothing is going to change.
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We are in charge here.
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We should do something about this,
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so that we do want
to have our parents here."
to have our parents here."
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We talked about that,
and what we saw every day
and what we saw every day
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was that the people
that lived in our nursing home
that lived in our nursing home
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were confused about their environment,
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because what they saw
was a hospital-like environment,
was a hospital-like environment,
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with doctors and nurses
and paramedics in uniform,
and paramedics in uniform,
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and they lived on a ward.
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And they didn't understand
why they lived there.
why they lived there.
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And they looked for the place to get away.
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They looked and hoped to find
the door to go home again.
the door to go home again.
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And we said what we are doing
in this situation
in this situation
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is offering these people
that already have a confused brain
that already have a confused brain
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some more confusion.
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We were adding confusion to confusion.
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And that was not what these people needed.
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These people wanted to have a life,
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and the help, our help,
to deal with that dementia.
to deal with that dementia.
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These people wanted to live
in a normal house,
in a normal house,
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not in a ward.
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They wanted to have a normal household,
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where they would smell their dinner
on the stove in the kitchen.
on the stove in the kitchen.
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Or be free to go to the kitchen
and grab something to eat or drink.
and grab something to eat or drink.
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That's what these people needed.
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And that's what we should
organize for them.
organize for them.
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And we said we should
organize this like at home,
organize this like at home,
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so they wouldn't live with a group
of 15 or 20 or 30, like in a ward.
of 15 or 20 or 30, like in a ward.
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No, a small group of people,
six or seven, family-like.
six or seven, family-like.
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Like living with friends.
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And we should find a way to select people
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based on their ideas about life
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so that they did have
a good chance to become friends,
a good chance to become friends,
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when they lived together.
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And we interviewed
all the families of the residents
all the families of the residents
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about "what is important for your father,"
"what's important for your mother,"
"what's important for your mother,"
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"what is their life like,"
"what do they want."
"what do they want."
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And we found seven groups,
and we call them lifestyle groups.
and we call them lifestyle groups.
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And for instance,
we found this formal lifestyle.
we found this formal lifestyle.
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In this lifestyle,
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people have a more formal way
of interacting with each other,
of interacting with each other,
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a distant way.
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Their daily rhythm
starts later in the day,
starts later in the day,
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ends later in the day.
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Classical music is more heard
in this lifestyle group
in this lifestyle group
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than in other lifestyle groups.
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And their menu,
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well, is more French cuisine
than traditional Dutch.
than traditional Dutch.
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(Laughter)
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In contrary to the craftsman lifestyle.
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That's a very traditional lifestyle,
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and they get up early
in the morning, go to bed early,
in the morning, go to bed early,
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because they have worked hard
their whole life, mostly with their hands,
their whole life, mostly with their hands,
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very often had a very small
family business, a small farm, a shop,
family business, a small farm, a shop,
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or like Mr. B, he was a farmhand.
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And he told me that he would go
to his work every morning
to his work every morning
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with a paper bag with his lunch
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and one cigar.
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That one cigar was the only luxury
he could afford for himself.
he could afford for himself.
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And after lunch,
he would have that one cigar.
he would have that one cigar.
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And until the day he died in the Hogeweyk,
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he was in this little shed, every day,
after lunch, to smoke his cigar.
after lunch, to smoke his cigar.
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This is my mother.
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She's of the cultural lifestyle,
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she's been living
in the Hogeweyk six weeks now.
in the Hogeweyk six weeks now.
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And that lifestyle is about traveling,
meeting other people, other cultures,
meeting other people, other cultures,
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interest in arts and music.
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There are more lifestyles.
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But that's what we talked about,
and that's what we did.
and that's what we did.
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But that's not life in a house
with a group of people,
with a group of people,
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like-minded people, your own life,
your own household.
your own household.
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There's more in life,
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everybody wants fun in life
and a meaningful life.
and a meaningful life.
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We are social animals --
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we need a social life.
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And that's what we started.
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We want to go out of our house
and do some shopping,
and do some shopping,
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and meet other people.
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Or go to the pub,
have a beer with friends.
have a beer with friends.
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Or like Mr. W -- he likes
to go out every day,
to go out every day,
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see if there are nice ladies around.
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(Laughter)
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And he's very courteous to them,
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and he hopes for smiles and he gets them.
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And he dances with them in the pub.
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It's a feast every day.
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There are people that would
rather go to the restaurant,
rather go to the restaurant,
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have a wine with friends,
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or lunch or dinner with friends
and celebrate life.
and celebrate life.
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And my mother,
she takes a walk in the park,
she takes a walk in the park,
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and sits on a bench in the sun,
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hoping that a passerby will come
and sit next to her
and sit next to her
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and have a conversation about life
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or about the ducks in the pond.
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That social life is important.
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It means that you're part
of society, that you belong.
of society, that you belong.
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And that's what we people need.
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Even if you're living
with advanced dementia.
with advanced dementia.
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This is what I see from my office window.
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And one day, I saw a lady
coming from one side,
coming from one side,
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and the other lady from the other side,
and they met at the corner.
and they met at the corner.
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And I knew both ladies very well.
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I often saw them walking around outside.
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And now and then, I tried
to have a conversation with them,
to have a conversation with them,
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but their conversation was ...
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rather hard to understand.
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But I saw them meeting,
and I saw them talking,
and I saw them talking,
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and I saw them gesturing.
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And they had fun together.
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And then they said goodbye,
and each went their own way.
and each went their own way.
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And that's what you want in life,
meeting other people
meeting other people
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and being part of society.
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And that's what I saw happening.
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The Hogeweyk has become a place
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where people with very advanced
dementia can live,
dementia can live,
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have freedom and safety,
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because the professionals working there
and the volunteers working there
and the volunteers working there
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know how to deal with dementia.
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And the professionals know
how to do their professional work
how to do their professional work
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in a way that it fits in a natural way
in the life of our residents.
in the life of our residents.
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And that means that the management
has to provide everything
has to provide everything
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those people need to do their work.
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It needs a management
that dares to do this.
that dares to do this.
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To do things differently
than we always have done
than we always have done
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in a traditional nursing home.
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We see that it works.
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We think this can be done everywhere,
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because this is not for the rich.
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We've been doing this with the same budget
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as any traditional nursing home
has in our country.
has in our country.
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We work only with the state budget.
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(Applause)
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Because it has to do
with thinking different,
with thinking different,
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and looking at the person in front of you
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and looking at what
does this person need now.
does this person need now.
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And it's about a smile,
it's about thinking different,
it's about thinking different,
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it's about how you act,
and that costs nothing.
and that costs nothing.
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And there's something else:
it's about making choices.
it's about making choices.
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It's about making choices
what you spend your money on.
what you spend your money on.
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I always say,
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"Red curtains are
as expensive as gray ones."
as expensive as gray ones."
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(Laughter)
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It's possible, everywhere.
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Thank you.
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(Applause)
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ABOUT THE SPEAKER
Yvonne van Amerongen - Dementia-care visionaryYvonne van Amerongen is an occupational therapist and a social worker.
Why you should listen
Before 1983, when Yvonne van Amerongen started working for the nursing home Hogewey, she worked in a hospital for psychiatric diseases and in a rehabilitation center. In 1992 she was the care manager of the traditional nursing home Hogewey when the management team started thinking about the vision of care for people living with severe dementia. In 1993, this vision was the basis for the development of what now is the neighborhood The Hogeweyk, with 27 houses for more than 170 seniors with severe dementia. Van Amerongen was the project leader and one of the founders of the vision for excellent care, living and well-being for people with severe dementia and of neighborhood The Hogeweyk.
Van Amerongen now works as a consultant for Be, supporting and advising healthcare organizations, governments, architects and project starters around the world to improve the quality of life of people living with dementia. Be is part of the Vivium Care group (non-profit), also the owner of The Hogeweyk.
Yvonne van Amerongen | Speaker | TED.com