The Dutch have led the way on practical, human-centred ways to deal with people diagnosed with dementia – first with the groundbreaking Hogeweyk Dementia Village, which has inspired a range of similar villages elsewhere, and now with the ‘care farm’ known as Boerderij Op Aarde — “Farm On Earth”.
“Four days a week, Kees Oranje’s 81-year-old mother Paula gets up and goes off to work on a farm in the neighboring village of Brielle, just west of Rotterdam,” begins the Reasons to be Cheerful story about the care farm, which raises pigs for meat and grows pumpkins, beans, kale and other vegetables. It has been self-sufficient in energy since 2016.
It is a trend that began in the Netherlands three decades ago, when two trends intersected. Farmers were facing higher costs but getting lower prices for their crops, while there was an increasing trend in social services to move people out of institutions and into the community as much as possible. The Netherlands were ahead of the curve – the World Health Organization declared dementia to be a public health priority in 2012.
The Dutch farmers earn income by providing health and social services as well as from agriculture. Holland’s healthcare and social services system provides adult day-care services to people with dementia, and government reimburses the farmers for the visits.
“Most people with dementia who visit care farms live at home and go to the farms two to three days a week, arriving about 10 a.m. and leaving about 4 p.m.,” says Simone de Bruin, who works for the Dutch National Institute for Public Health and the Environment. Some reside on the few farms that offer 24-hour nursing home care.
There are about 1,400 care farms now, up from about 70 in the late 1990s, and about a fourth of them cater to people with dementia.
“Not only are people with dementia more active at care farms, but the farms stimulate social interaction and meaning in life,” says de Bruin. “Compared with traditional long-term care institutions, we see people at care farms participating more often in both domestic and outdoor activities, and spending less time on passive or purposeless activities. They tell us the farms make them feel like they’re still contributing to society.” Men prefer gardening, feeding animals, and sweeping the farmyard, she says of the 40 care farms she’s visited, while women like picking fresh vegetables for cooking, preparing lunch, and tidying up — like washing dishes.
Caroline and IJsbrand Snoeij run Paradise care farm, which cares for people with Alzheimer’s and other types of dementia, children with autism, and young and middle-aged adults with mental health or other conditions. The farm serves people with dementia on weekdays, then shifts to children with autism, who stay overnight on Friday and Saturday and return home on Sunday. About 90 children arrive in a typical month. The weekenders help feed pigs and cows, help collect the 8,000 eggs a day our hens lay, and help with vegetables and fruit in the summer and fall.
“We started 14 years ago, with only our children helping us,” Caroline said. “Now we have 24 employees, including 13 full time. Three-fourths are educated in care and one-fourth in agriculture.” The staff includes teachers for students whose conditions make it challenging for them to attend regular schools; volunteers perform such tasks as driving people with dementia to and from the farm.
Two countries with aging populations — Japan and South Korea — have sent delegations to check out their Paradise operation.
Similarly, there has been widespread interest in the dementia village concept, since it officially opened in 2007, and now there are a number of such villages in Canada and it is being studied in Germany, Switzerland and Norway.
“Started by 2 nurses who feared having to put their own parents in a traditional nursing home, ‘Dementia Village’ is a place where residents live a seemingly normal life, but are actually being watched by caregivers at all times. There are almost twice as many caregivers as residents in the village and they staff everything from the grocery store to the hair salon.”
Hogeweyk sits on 4 acres of land and construction costs were €19.3 million (about $27 million Canadian). The project was funded primarily by the Dutch government, which provided approximately $25 million for the village
It is a paradigm shift in nursing home care. “The traditional nursing home has been deinstitutionalized, transformed and normalized. The Hogeweyk is just like any other neighborhood. A neighborhood that is part of the broader society in the town of Weesp.
In The Hogeweyk you will find houses where people live together based on similar lifestyles. They can visit the pub, restaurant, theater, the supermarket or one of the many offered clubs. The concept supports unique needs, lifestyles and personal preferences. Living in The Hogeweyk puts boredom, loneliness and hopelessness in another perspective. It focusses on possibilities, not on disabilities. And it goes without say that this is all supported by trained professionals.”
While it looks like any other village, many of its 152 residents don’t realize that their orderly community is actually a nursing home for people with severe dementia. “We protect our residents from the unsafe world. They do not understand the world outside this because the outside world doesn’t understand them,” says co-founder Yvonne van Amerongen.
Canada’s first dementia village opened in 2019. The Village, located in Langley, BC, has independent, cottage-style living, in five acres of grounds, with accessible walking paths, a vegetable garden, farm animals and water garden. Four years earlier, the Georgian Bay Retirement home in Penetanguishene, Ont., opened a ‘memory care’ section designed to recreate the look and feel of the 1950s and ’60s, with a vintage kitchen, a garage with a 1947 Dodge and a nursery with dolls designed to feel like actual babies.
Sources
People with Dementia Find Fresh ‘Meaning in Life’ at Dutch Care Farms. Alzheimer’s News Today, Jan. 15, 2020
Care farms provide nursing home care in the Netherlands. AGE Platform Europe.
Canada’s version of Hogewey dementia village recreates ‘normal’ life. CBC News, May 3, 2015
Exploring Dementia Villages and Other Care Models in Canada. BC Care, Oct, 23, 2015
Canada’s first ‘dementia village’ is set to open its doors in Langley, B.C. next year. National Post, Feb. 28, 2018