

The Dutch Village Where Everyone Has Dementia - prawn
http://www.theatlantic.com/health/archive/2014/11/the-dutch-village-where-everyone-has-dementia/382195/?single_page=true

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MrJagil
I have never delved into the issue, but the model that Japan and other
countries have adopted where the young take care of the old, has always seemed
to me the most humane and stimulating solution for the elderly. I don't feel
it corresponds well with how modern society works, and my impression is that
that model is fading in popularity in Japan as well, but I certainly believe
there are innumerable positives to extract from that kind of care-taking.

Along with other speculation such as a seafood-heavy diet, it seems to me to
be the reason that Japanese people live the longest.

(Nope, not a single thread of evidence in my post, Sorry. A quick google
search somewhat agrees though)

~~~
bane
There's some side effects of the custom as well. For example, in Japan and
Korea (and possibly parts of China), the custom is for the woman to move in
with the husband's family where she'll spend most of her time providing
household services and attending her parents-in-law every wish. Her mother-in-
law, having done the same thing is now ready to relinquish her role as the
home caretaker and well...mother-in-law/daughter-in-law friction (at truly
dysfunctional levels) is a common theme in conversation, movies, tv shows,
books, etc.

In Korea, being cursed with a difficult mother-in-law is a leading cause of
divorce.

It more or less guarantees to take women out of the workforce as they now have
a house to run, take care of the kids _and_ the in-laws. And unless you don't
have kids or your husband's parents are dead or otherwise able to care for
themselves, there's nothing you can do about it.

Not surprisingly Japan and South Korea have among the lowest female workforce
participation among OECD countries.

It also means that incentive for higher education among women is mostly as a
social marker for marriage, but then any education is thrown away once she
gets married (and especially once she has a child).

This also puts enormous pressure on the husband to be the sole provider for
himself, his wife, any kids, _and_ his parents.

What about the daughter-in-law's parents? Well, they better have had a son at
some point who finds a wife who will take care of them.

The list of social issues that come from this arrangement are long and madness
inducing to study (or live with).

(edit) I'd add, there's a culture-bound psychological syndrome that's related
to this
[https://en.wikipedia.org/wiki/Hwabyeong](https://en.wikipedia.org/wiki/Hwabyeong)

~~~
NoMoreNicksLeft
> There's some side effects of the custom as well.

Is this truly a side effect of the idea itself, or is this peculiar to Asian
culture?

I'm a man, but if we had to care for my in-laws, I wouldn't consider this a
burden. If anything, the opposite is quite true... my in-laws have always
helped my wife and I through rough spots when they could.

We could adopt the custom without all of the baggage you describe, if we were
so inclined.

~~~
bane
Well keep in mind that this has two effects

1) If you _don 't_ want to care for your in-laws, there's little social safety
net for them to retire on. Society is structured around this form of
retirement.

2) Many women are now choosing not to get married in order to avoid being
their mother-in-law's personal servant.

Here's a good writeup on the role
[http://msleetobe.wordpress.com/2010/06/18/on-obstacles-to-
wh...](http://msleetobe.wordpress.com/2010/06/18/on-obstacles-to-white-
western-female-korean-male-long-term-relationships-part-2/)

 _One of my Korean friends who married a Canadian man told me that one of the
greatest perks of having a Canadian husband was that she did not have a
demanding mother-in-law. They are legendary in Korea. Whether or not all
mother-in-laws are as evil as they are sometimes portrayed, in general it is
safe to say that they are somewhat more demanding, and the cultural
expectations of a daughter-in-law are greater than in the mainstream Canadian
context. My friend loves that during family gatherings she is a guest in her
mother-in-law’s house instead of a worker serving men who do nothing but
socialize and drink. She loves that she is not responsible for cleaning her
mother-in-law’s house and does not have to prepare the enormous amount of food
necessary for ancestral memorial rituals (and then be excluded from the
ceremony because she is a woman). For her, marriage to her husband is about
her relationship with her husband and not duty toward her mother-in-law._

I agree that there's cultural aspects of this. But there are always side
effects of some sort. So adopting a model like this might mean that some of
the unintentional side effects might come along as well.

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giarc
Senior care is actually quite innovative. The Pebble Project
([https://www.healthdesign.org/pebble](https://www.healthdesign.org/pebble))
works on design of healthcare facilities to promote patient safety (among
other things). I attended a lecture by one of the directors, he talked about
things like lining dementia units with dark tile. Dementia patients like to
walk and often will wander away. The contrast between dark and light tile
creates a sense of water or a hazard, and patients tend not to cross it. So at
the entrance and exit of nursing units, at doorways to medication rooms, they
lay a row of dark tiles to prevent wandering.

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mcv
Inconsistent spelling of names in the article: is it Hogeway or Hogewey? (It's
Hogewey. Or De Hogeweyk, which is the name of the fake neighbourhood, whereas
Hogewey is the name of the nursing home operating in it.) And the town it's in
is called Weesp rather than Wheesp.

Other than that, cool article. It's not far from where I live, but I'd never
heard of it. Hard to get in, apparently. I hope they open more places like
this before my parents get to the point where they might need it.

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danmaz74
Very interesting article.

Nitpicking: Why do they give the cost for this solution "per month", and then
for comparison the costs in the US "per day" and "per year"? Did they choose
to make it harder to make a comparison??

~~~
giarc
Agreed.

Hogewey = $8,000/month or $96,000/year.

US Average = $90,500/year.

Perhaps their comparison was to point out that for roughly the same cost, you
get much better care (outcomes) in the unique facility.

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thisjepisje
After reading several articles on euthanasia in Dutch papers, I get the
impression that quite some people seem to think going to a nursing home is
worse than dying (and a substantial part of them thus see euthanasia as a good
alternative).

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mikeash
I thought this was a fairly common attitude all over. After seeing my
grandparents go through it, I'd definitely prefer to just die right away
rather than live out the rest of my days in a nursing home. Maybe I'd change
my mind once faced with it... but of course the big fear is that I'd no longer
be capable of making the choice.

~~~
thisjepisje
Would you mind elaborating a bit on what's bad about it? I've been to a few
retirement homes and they seemed reasonably nice places, but I don't think
I've visited a nursing home.

~~~
debacle
Imagine a day care where the children never get picked up, need to sleep
there, and cost is the biggest factor except for in a very small percentage of
facilities.

Now replace every child with an octogenarian who hasn't seen his family in six
weeks, or maybe just saw his family yesterday for his birthday but doesn't
remember at all. Replace the apples and letters on the walls with Cardiograms
and notices about patient safety and how dedicated the employee who was on the
shift when your grandmother's wedding band went missing is to her care.

It's a problem that a lot of people want to ignore because it really is hard
to think about it.

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chris_va
Did anyone else figure out this comment, or is it just author bias?

"But because cost is one of the greatest barriers to making self-contained
villages the standard in dementia care, it would be extremely difficult to
implement in a non-socialized healthcare system—meaning that in the U.S., a
facility like Hogewey might be impossible for the forseeable future."

\--

From other parts of the article:

"The cost of care [at Hogeway] is nearly $8,000 per month..."

"To put it into perspective, a private room at a U.S. nursing home cost an
average of $248 per day in 2012, or more than $90,500 annually" =>
$7541.67/month

\--

So, the average cost in the US is the same, but "due to the high cost" the US
(with its non-socialized medicine) could never build a comparable program?

~~~
misterbwong
FTA: The cost of care is nearly $8,000 per month, but the Dutch government
subsidizes the residents—all of whom receive private rooms—to varying degrees;
the amount each family pays is based on income, but never exceeds $3,600.

I'm pretty confident that the healthcare system in the US would not be able to
bring down the cost down to ~4k/family.

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elleferrer
Here's some photos of the village: [http://www.allgenerationscare.com/amazing-
village-designed-j...](http://www.allgenerationscare.com/amazing-village-
designed-just-people-dementia-de-hogeweyk-aka-dementia-village/) it's in the
small town of Weesp, in Holland. It's a really neat, self-contained world with
restaurants, cafes, supermarket and more. Doors are kept unlocked and
residents have the freedom to go out within the village whenever they please.
Though it does look like an expensive facility, I'm sure there are ways to
make it more affordable in other areas of the world to accommodate more of our
aging population that suffers from dementia.

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aapje
If you are interested in more images or detail, the village is called
'Hogeweyk'(meaning: higher area/borough), not Hogewey or Hogeway as the
article states.

~~~
huuu
'Weyk' is old Dutch for 'wijk' (area/district) which is smaller than a
borough.

In the town Sliedrecht there is also an area called 'Merwebolder' which is a
small 'wijk' for mentally disabled people housing around 400 people.

~~~
skrebbel
It's just a name, you're reading too much into it. Katwijk also ends with
"wijk" and is home to 60k people.

~~~
barrystaes
No "wijk" is the dutch word for a neighborhood of a few streets. Or a small
block if you prefer. It just so happens a few towns used that suffix, a nimble
expression.

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NKCSS
Wow, this was a great read. I live in The Netherlands and was unaware of this
project. Too bad it's one of a kind and only accomodates so little people; I'd
love to be cared for in this way should I ever need it.

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LeonM
I live in the Netherlands too, and I also never heard of it. But what I
understand from it, it's not really a village, it's just a large complex in
the city of Weesp (the article misspelled it as "Wheesp"). Despite having
never heard of it, it saddens me we don't have more of these style of nursing
homes. Last year my grandma passed away as a result of Ahlzheimer disease, she
spent the last year of her life in a traditional nursing home, which was a
really depsressing place, she would been far better of in a place like
Hogewey.

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vidarh
Both my grandmothers spent about a decade each in nursing homes due to
Alzheimers. Both of them had clearly been trying hard to conceal their
dementia for several years prior to that, because they were terrified
accepting that something was wrong, and terrified of ending in a nursing home.

Once things had gone so far that they could not take care of themselves, and
could not manage with the help of their spouses, they just fell apart within
months.

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edwinjm
CNN World published their item on YouTube:

Untold Stories: Dementia Village

[https://www.youtube.com/watch?v=LwiOBlyWpko](https://www.youtube.com/watch?v=LwiOBlyWpko)

