TEDWomen 2018
Yvonne van Amerongen: The "dementia village" that's redefining elder care
伊馮娜 · 凡阿莫隆根: 重新定義老人照護的「失智村」
Filmed:
Readability: 2.7
1,767,650 views
你希望怎麼過人生中最後的日子：在一個枯燥乏味、像醫院的機構中？或在一個村子裡，那裡有超級市場、酒吧、公園，都可以輕鬆步行到達？此刻答案似乎很明顯，但當 25 年前伊馮娜 · 凡阿莫隆根協助在阿姆斯特丹開發出開創性的霍格威失智照護中心，打破傳統似乎是個很冒險的決定。凡阿莫隆根要帶大家到霍格威，看看一個根據自由、意義、以及社交生活所重新打造的療養院是什麼樣子。
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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這是霍格威。
00:14
It's a neighborhood in a small town
very near Amsterdam, in the Netherlands.
very near Amsterdam, in the Netherlands.
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它是荷蘭一個小鎮上的鄰里，
非常靠近阿姆斯特丹。
非常靠近阿姆斯特丹。
00:19
There are 27 houses
for six, seven people each.
for six, seven people each.
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那裡有 27 間房子，
每間有 6~7 人。
每間有 6~7 人。
00:23
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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有一個小型購物中心，內有餐廳、
酒吧、超級市場、俱樂部房間。
酒吧、超級市場、俱樂部房間。
00:28
There are streets, alleys,
there's a theater.
there's a theater.
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那裡有街道、巷弄，
也有一間戲院。
也有一間戲院。
00:34
It actually is a nursing home.
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它其實是一間療養院。
00:37
A nursing home for people
that live with an advanced dementia
that live with an advanced dementia
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這間療養院所住的是
重度失智症患者，
重度失智症患者，
00:42
and that need 24-7 care and support.
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他們一天 24 小時，一週七天
都需要照護和支持。
都需要照護和支持。
00:47
Dementia is a terrible disease,
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失智是一種很糟的疾病，
00:50
and we still don't have any cure for it.
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我們仍然沒有方法治療它。
00:54
It's getting to be
a major problem in the world,
a major problem in the world,
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它漸漸成為世界上的
一個重大問題，
一個重大問題，
00:57
for the people, for the politicians,
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對人民、對政治人物、
00:59
for the world -- it's getting
to be a big problem.
to be a big problem.
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對世界來說——
它漸漸成為一個大問題。
它漸漸成為一個大問題。
01:03
We see that we have waiting lists
in the nursing homes.
in the nursing homes.
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我們知道，在療養院有等候名單。
01:07
Most people that come to the nursing homes
with dementia are women.
with dementia are women.
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大部分到療養院的
失智症患者是女性。
失智症患者是女性。
01:11
And that's also because women
are used to taking care of people,
are used to taking care of people,
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那也是因為女性很習慣照料人，
01:16
so they can manage to take care
of their husband with dementia,
of their husband with dementia,
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所以她們的先生若得了失智症，
她們也能負責照顧，
她們也能負責照顧，
01:20
but the other way around
is not so easy for the gentlemen.
is not so easy for the gentlemen.
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但在相反的情況中，
對男性而言就沒這麼容易了。
對男性而言就沒這麼容易了。
01:26
Dementia is a disease
that affects the brain.
that affects the brain.
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失智是一種會影響大腦的疾病。
01:30
The brain is confused.
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大腦很困惑。
01:33
People don't know anymore
what the time is,
what the time is,
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患者不再知道現在是什麼時間、
01:36
what's going on, who people are.
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有什麼事有發生，也認不得人了。
01:39
They're very confused.
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他們非常困惑。
01:40
And because of that confusion,
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因為那種困惑，
01:43
they get to be anxious,
depressed, aggressive.
depressed, aggressive.
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他們會變得很焦慮、
憂鬱、有侵略性。
01:50
This is a traditional nursing home.
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這是一間傳統的療養院。
01:53
I worked there in 1992.
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1992 年時我在那裡工作。
01:55
I was a care manager.
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我是照護經理。
01:57
And we often spoke together about the fact
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我們常常聚在一起談，
02:00
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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說我們在那裡所做的事，
並不是我們希望我們的父母、
並不是我們希望我們的父母、
02:05
for our friends, for ourselves.
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我們的朋友、我們自己
若失智時會得到的照護。
若失智時會得到的照護。
02:09
And one day, we said,
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有一天，我們說：
02:11
"When we keep on saying this,
nothing is going to change.
nothing is going to change.
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「我們一直說這些，
什麼都改變不了。
什麼都改變不了。
02:14
We are in charge here.
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這裡是我們主導的。
02:15
We should do something about this,
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我們應該要來採取行動，
02:18
so that we do want
to have our parents here."
to have our parents here."
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做到讓我們也希望
我們的父母住到這裡。」
我們的父母住到這裡。」
02:22
We talked about that,
and what we saw every day
and what we saw every day
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我們談了這件事，
以及我們每天所看到的
以及我們每天所看到的
02:25
was that the people
that lived in our nursing home
that lived in our nursing home
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都是住在我們療養院的病人
02:29
were confused about their environment,
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對於他們的環境感到非常困惑，
02:31
because what they saw
was a hospital-like environment,
was a hospital-like environment,
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因為他們看到的是
一個像醫院的環境，
一個像醫院的環境，
02:35
with doctors and nurses
and paramedics in uniform,
and paramedics in uniform,
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都是穿著制服的醫生、
護士、急救護理人員，
護士、急救護理人員，
02:39
and they lived on a ward.
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且他們住在病房中。
02:42
And they didn't understand
why they lived there.
why they lived there.
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他們不了解為什麼他們住在那裡。
02:44
And they looked for the place to get away.
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他們會想要想辦法逃離。
02:48
They looked and hoped to find
the door to go home again.
the door to go home again.
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他們會尋找並希望
能找到回家的那扇門。
能找到回家的那扇門。
02:54
And we said what we are doing
in this situation
in this situation
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我們說，在這個
情況下我們所做的事
情況下我們所做的事
02:57
is offering these people
that already have a confused brain
that already have a confused brain
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是帶給這些頭腦已經
非常困惑的病人
非常困惑的病人
更多的困惑。
03:02
some more confusion.
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03:04
We were adding confusion to confusion.
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我們在困惑上再加上困惑。
03:08
And that was not what these people needed.
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那並不是這些人所需要的。
03:11
These people wanted to have a life,
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這些人想要有個人生，
03:13
and the help, our help,
to deal with that dementia.
to deal with that dementia.
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想要得到協助，我們的協助，
來處理失智的問題。
來處理失智的問題。
03:17
These people wanted to live
in a normal house,
in a normal house,
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這些人想要住在一般的房子裡，
03:22
not in a ward.
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而不是病房。
03:24
They wanted to have a normal household,
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他們想要有個正常的家庭，
03:27
where they would smell their dinner
on the stove in the kitchen.
on the stove in the kitchen.
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在這個家庭裡，能聞到
廚房的爐子傳來晚餐的香味。
廚房的爐子傳來晚餐的香味。
03:32
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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或者他們能夠自由進入廚房，
隨手抓些東西來吃或喝。
隨手抓些東西來吃或喝。
03:37
That's what these people needed.
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那才是這些人需要的。
03:39
And that's what we should
organize for them.
organize for them.
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那才是我們應該為他們安排的。
03:43
And we said we should
organize this like at home,
organize this like at home,
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我們說，我們應該
把環境安排成像家一樣，
把環境安排成像家一樣，
03:48
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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讓他們不用和 15、20，或 30 個人
住在一起，像住病房一樣。
住在一起，像住病房一樣。
03:53
No, a small group of people,
six or seven, family-like.
six or seven, family-like.
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不要，應該一小群人就好，
6 或 7 個人，就像個家庭。
6 或 7 個人，就像個家庭。
03:59
Like living with friends.
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就像和朋友同住。
04:02
And we should find a way to select people
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我們得要想出一種方式來挑選人，
04:05
based on their ideas about life
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依據他們對於人生的想法來挑選，
04:08
so that they did have
a good chance to become friends,
a good chance to become friends,
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這麼一來，當他們住在一起時，
才會更有機會成為朋友。
04:11
when they lived together.
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04:14
And we interviewed
all the families of the residents
all the families of the residents
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我們和所有居民的家人進行面談，
04:18
about "what is important for your father,"
"what's important for your mother,"
"what's important for your mother,"
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談「你父親重視什麼」、
「你母親重視什麼」、
「你母親重視什麼」、
04:22
"what is their life like,"
"what do they want."
"what do they want."
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「他們的人生是什麼樣子的」、
「他們想要什麼」。
「他們想要什麼」。
04:24
And we found seven groups,
and we call them lifestyle groups.
and we call them lifestyle groups.
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我們分出了七種族群，
被我們命名為生活方式分組。
被我們命名為生活方式分組。
04:29
And for instance,
we found this formal lifestyle.
we found this formal lifestyle.
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比如，我們發現了
一種正式生活方式，
一種正式生活方式，
04:33
In this lifestyle,
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在這種生活方式中，
04:35
people have a more formal way
of interacting with each other,
of interacting with each other,
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人們和彼此互動的方式比較正式，
04:38
a distant way.
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比較有距離。
04:39
Their daily rhythm
starts later in the day,
starts later in the day,
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他們每天的日常節奏
開始得比較晚，
開始得比較晚，
04:42
ends later in the day.
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結束得也比較晚。
04:43
Classical music is more heard
in this lifestyle group
in this lifestyle group
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比起其他生活方式分組，
在這種生活方式分組中
在這種生活方式分組中
04:46
than in other lifestyle groups.
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更常聽到古典音樂。
04:48
And their menu,
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他們的菜單，
04:50
well, is more French cuisine
than traditional Dutch.
than traditional Dutch.
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比較多是法國菜
而不是傳統荷蘭菜。
而不是傳統荷蘭菜。
04:53
(Laughter)
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（笑聲）
04:55
In contrary to the craftsman lifestyle.
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相對的分組則是工匠生活方式。
04:59
That's a very traditional lifestyle,
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那是種非常傳統的生活方式，
05:01
and they get up early
in the morning, go to bed early,
in the morning, go to bed early,
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他們早上很早起床，
很早上床睡覺，
很早上床睡覺，
05:03
because they have worked hard
their whole life, mostly with their hands,
their whole life, mostly with their hands,
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因為他們一生中都辛勤工作，
大部分都是要動手去做，
大部分都是要動手去做，
05:08
very often had a very small
family business, a small farm, a shop,
family business, a small farm, a shop,
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很常見的是經營小型
家族事業、小農場、小店，
家族事業、小農場、小店，
05:12
or like Mr. B, he was a farmhand.
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或像 B 先生，他是農場工人。
05:17
And he told me that he would go
to his work every morning
to his work every morning
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他告訴我，他每天早上去工作時，
05:20
with a paper bag with his lunch
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會用紙袋裝著午餐一起帶去，
05:24
and one cigar.
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裡面還有一根雪茄。
05:26
That one cigar was the only luxury
he could afford for himself.
he could afford for himself.
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那根雪茄是他唯一能
負擔得起的奢侈品。
負擔得起的奢侈品。
05:31
And after lunch,
he would have that one cigar.
he would have that one cigar.
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午餐之後，他就會抽那根雪茄。
05:35
And until the day he died in the Hogeweyk,
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到他在霍格威過世的那一天之前，
05:38
he was in this little shed, every day,
after lunch, to smoke his cigar.
after lunch, to smoke his cigar.
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每天午餐後他都在這間小屋抽雪茄。
05:47
This is my mother.
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這是我母親。
05:48
She's of the cultural lifestyle,
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她的分組是文化生活方式，
05:50
she's been living
in the Hogeweyk six weeks now.
in the Hogeweyk six weeks now.
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現在她已經在霍格威住了六週了。
05:53
And that lifestyle is about traveling,
meeting other people, other cultures,
meeting other people, other cultures,
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那種生活方式的特點是旅行、
認識其他人、其他文化、
認識其他人、其他文化、
05:58
interest in arts and music.
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對藝術和音樂感興趣。
06:02
There are more lifestyles.
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還有更多其他生活方式。
06:04
But that's what we talked about,
and that's what we did.
and that's what we did.
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但，那就是我們在談的，
也是我們所做的。
也是我們所做的。
06:09
But that's not life in a house
with a group of people,
with a group of people,
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但，那並不只是和一群人
住在一間房子裡的生活，
住在一間房子裡的生活，
06:14
like-minded people, your own life,
your own household.
your own household.
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和想法相似的人，
你自己的人生，你自己的家庭。
你自己的人生，你自己的家庭。
06:18
There's more in life,
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人生不只如此，
06:19
everybody wants fun in life
and a meaningful life.
and a meaningful life.
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大家都希望人生有樂趣且有意義。
06:23
We are social animals --
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我們是社交的動物——
06:25
we need a social life.
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我們需要社交生活。
06:27
And that's what we started.
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那就是我們開始做的事。
06:30
We want to go out of our house
and do some shopping,
and do some shopping,
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我們想要走出
我們的房子，去購物，
我們的房子，去購物，
06:34
and meet other people.
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去見見其他人。
06:36
Or go to the pub,
have a beer with friends.
have a beer with friends.
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或是去酒吧，和朋友喝杯啤酒。
06:40
Or like Mr. W -- he likes
to go out every day,
to go out every day,
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或像是 W 先生——
他喜歡每天都出門，
他喜歡每天都出門，
06:45
see if there are nice ladies around.
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看看附近有沒有美女。
06:48
(Laughter)
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（笑聲）
06:50
And he's very courteous to them,
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他對她們非常有禮，
06:52
and he hopes for smiles and he gets them.
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他希望能得到微笑，
也確實得到了。
也確實得到了。
06:54
And he dances with them in the pub.
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他和她們在酒吧跳舞。
06:58
It's a feast every day.
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每天都是盛宴。
06:59
There are people that would
rather go to the restaurant,
rather go to the restaurant,
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有些人寧願去餐廳，
07:02
have a wine with friends,
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和朋友喝葡萄酒，
07:04
or lunch or dinner with friends
and celebrate life.
and celebrate life.
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或和朋友吃午餐
或晚餐，頌揚生命。
或晚餐，頌揚生命。
07:08
And my mother,
she takes a walk in the park,
she takes a walk in the park,
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而我母親，她會在公園散步，
07:10
and sits on a bench in the sun,
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在太陽下坐在長凳上，
07:12
hoping that a passerby will come
and sit next to her
and sit next to her
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希望有人路過，坐在她旁邊，
07:15
and have a conversation about life
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和她聊聊人生，
07:18
or about the ducks in the pond.
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或是池塘裡的鴨子。
07:22
That social life is important.
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那種社交生活很重要。
07:24
It means that you're part
of society, that you belong.
of society, that you belong.
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那意味著你是社會的
一部分，你有歸屬。
一部分，你有歸屬。
07:29
And that's what we people need.
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那是我們人類的需求。
07:33
Even if you're living
with advanced dementia.
with advanced dementia.
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即使你得到重度的失智症也一樣。
07:37
This is what I see from my office window.
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這是我從我辦公室的
窗戶所看見的景象。
窗戶所看見的景象。
07:40
And one day, I saw a lady
coming from one side,
coming from one side,
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有一天，我看見
一位女士從一邊過來，
一位女士從一邊過來，
07:44
and the other lady from the other side,
and they met at the corner.
and they met at the corner.
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另一位女士從另一邊過來，
她們在街角相遇。
她們在街角相遇。
07:48
And I knew both ladies very well.
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我很熟識這兩位女士。
07:50
I often saw them walking around outside.
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我常常看到她們在外面行走。
07:54
And now and then, I tried
to have a conversation with them,
to have a conversation with them,
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偶爾，我會試著和她們交談，
07:59
but their conversation was ...
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但她們的對話……
08:02
rather hard to understand.
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蠻難理解的。
08:05
But I saw them meeting,
and I saw them talking,
and I saw them talking,
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但我看見她們相遇，
看見她們說話，
看見她們說話，
08:09
and I saw them gesturing.
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看見她們比手劃腳。
08:11
And they had fun together.
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她們在一起很開心。
08:13
And then they said goodbye,
and each went their own way.
and each went their own way.
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接著，她們道別，各自上路離開。
08:17
And that's what you want in life,
meeting other people
meeting other people
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這就是你在人生中想要的，
和其他人會面，
和其他人會面，
08:20
and being part of society.
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成為社會的一部分。
08:23
And that's what I saw happening.
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而我就看到了這樣的狀況發生。
08:26
The Hogeweyk has become a place
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霍格威變成了一個不同的地方，
08:28
where people with very advanced
dementia can live,
dementia can live,
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在這裡，重度失智症病人可以
08:31
have freedom and safety,
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自由且安全地生活，
08:33
because the professionals working there
and the volunteers working there
and the volunteers working there
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因為在那裡工作的
專業人士以及志工
專業人士以及志工
08:38
know how to deal with dementia.
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知道如何處理失智。
08:41
And the professionals know
how to do their professional work
how to do their professional work
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專業人士知道如何
做他們的專業工作，
做他們的專業工作，
08:44
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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且採用的方式能很自然地
融入到我們居民的生活中。
融入到我們居民的生活中。
08:50
And that means that the management
has to provide everything
has to provide everything
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那就表示，管理階層得要提供他們
工作所需要的一切。
08:55
those people need to do their work.
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08:58
It needs a management
that dares to do this.
that dares to do this.
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管理階層需要有膽識這麼做。
09:02
To do things differently
than we always have done
than we always have done
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採不同的方式來做事，
不同於傳統療養院慣用的方式。
09:05
in a traditional nursing home.
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09:10
We see that it works.
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我們知道這是行得通的。
09:14
We think this can be done everywhere,
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我們認為這種方式
可以用在任何地方，
可以用在任何地方，
09:17
because this is not for the rich.
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因為它不是給富人專用的。
09:19
We've been doing this with the same budget
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我們這麼做所使用的預算
09:24
as any traditional nursing home
has in our country.
has in our country.
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和我們國內任何傳統
療養院的預算都一樣。
療養院的預算都一樣。
09:28
We work only with the state budget.
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我們只用州提供的預算。
09:32
(Applause)
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（掌聲）
09:40
Because it has to do
with thinking different,
with thinking different,
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因為它的重點在於
不同的思考方式，
不同的思考方式，
09:43
and looking at the person in front of you
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以及看看你面前的人，
09:46
and looking at what
does this person need now.
does this person need now.
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看看他現在需要的是什麼。
09:51
And it's about a smile,
it's about thinking different,
it's about thinking different,
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重點是一個微笑，
重點是不同的思考方式，
重點是不同的思考方式，
09:54
it's about how you act,
and that costs nothing.
and that costs nothing.
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重點是你怎麼做，
那些是不用花錢的。
那些是不用花錢的。
09:59
And there's something else:
it's about making choices.
it's about making choices.
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還不只如此：重點是要做選擇。
10:03
It's about making choices
what you spend your money on.
what you spend your money on.
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重點是要選擇你把
你的錢花在什麼地方。
你的錢花在什麼地方。
10:08
I always say,
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我總是說：
10:11
"Red curtains are
as expensive as gray ones."
as expensive as gray ones."
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「紅色窗簾和灰色窗簾一樣貴。」
10:16
(Laughter)
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（笑聲）
10:17
It's possible, everywhere.
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在任何地方，這都是有可能的。
10:21
Thank you.
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謝謝。
10:22
(Applause)
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（掌聲）
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