The Hogeweyk dementia village in the Netherlands is like The Truman Show. The community is designed to look identical to the outside world, complete with nurses, doctors and carers dressed in plain clothes. Specialist dementia villages are just one way this sector is evolving – The Fifth Estate has taken a closer look at alternatives that turn traditional senior living on its head.
The problem with dementia, according to Natascha Chadwick of NewDirection, is that it’s not well understood.
“If we don’t understand something, we tend to fear it.”
Chadwick, who has created a new “microtown” model for aged care, struggles with the institutional environment that’s common in the sector.
She says that when you think about institutional living, the main ones are hospitals – which are temporary – gaols, and nursing homes.
“I have never been able to understand that we are an inclusive community, but when we get to the end of our lives, we are suddenly excluded.”
It’s now accepted that people with dementia are better off in an environment that’s familiar because they are less likely to become confused and upset.
There are now villages specially designed for people living with dementia, such as The Hogeweyk village in the Netherlands. It’s reminiscent of The Truman Show because the community is designed to look identical to the outside world, complete with nurses, doctors and carers dressed in plain clothes.
Residents do their groceries in the supermarket and help manage the household with other residents and carers. Studies on the facility have shown that the residents are more active and require less medication compared to people in traditional nursing homes.
Tasmania is soon to be home to Australia’s first residential village designed for people living with dementia. Like the village in the Netherlands, the Korongee village will be based on a typical Tasmanian streetscape.
Another innovation showing promise is allowing the very young to mingle with the elderly, such as the Little Diggers Preschool that’s located in Sydney’s RSL ANZAC Village in Collaroy.
Allowing the young and the old to interact can potentially improve the health and wellbeing of the older people as well as boost learning outcomes for preschool aged children.
The ABC recently ran a social experiment (now an ongoing program) where a group of older retirement home residents and a group of pre-schoolers were brought together, which aired as a documentary called Old People’s Homes for 4 Year Olds narrated by Annabel Crabb.
Getting old, institution-free
Seniors at the NewDirection aged care facility Bellmere in Queensland live in a “microtown” that accommodates 120 people living in small “mini-care” homes.
Residents have access to shops, a cinema, café, beauty salon, a general practitioner, a dentist and a wellness centre, all of which are fully functional and are available to the external community.
The community isn’t gated: Instead, wearable sensors notify staff when a vulnerable resident is leaving the premises so that they can send someone out to escort them if necessary.
Natascha Chadwick says the privacy of residents is not jeopardised – “we aren’t following them around looking at them on the CCTV”. It’s a “hands off” approach that relies on smart watches to alert carers when someone is leaving the community or at risk of a bed sores or other health problem.
Seven per home is the sweet spot
She says the village looks like any suburban location and the houses “just like you and I live in”.
Every person has their own room and ensuite but share the lounge and dining areas, including an outdoor BBQ area and other features you see in the average Australian home.
There are seven people in each home, which is based on research that any number above eight is perceived as institutional.
There’s one to two specialist carers in each home who are in charge of the cooking, cleaning, administering medication and other household tasks.
“There’s no delineation of role… that’s been a big challenge for people to understand.”
Chadwick says this creates a more varied and interesting job for the employee, and a more familiar setting for residents. The carers are instructed to support residents rather than do everything for them. “They are there to put the milk in the tea if someone forgets”.
The facility attracted “a lot of interest” and is now fully occupied. She also says the company “found a lot of support from the general community”.
The same, but smaller
On the sustainability front, Chadwick says microtown communities can be located on smaller blocks of land.
“We believe we can actually achieve the same objectives and greenspace but on a much smaller piece of land.”
The company has licensed the model so it will be available to other aged care providers, lessening the risk for providers looking to make the transition.
Integrated care and vertical villages – other emerging trends in senior living
Ben Myers, the executive director of the Retirement Living Council at the Property Council of Australia, says that one noticeable trend is the integration between retirement living and aged care.
Different regulatory environments for the two streams of senior care has led to separate property ownership: aged care facilities funded and regulated by the government; retirement living typically with independent residences with care available if necessary. But Myers says the more innovative players are responding to customer needs and shifting towards an integrated model.
He says that the clear benefit is that a familiar environment is preferred by people as they transition to higher care needs. Couples also don’t become separated by vast distances as one half transitions into around the clock care.
Senior living is also “going up rather than out”, with vertical villages on the rise in some parts of the country due to rising land prices.
Myers hasn’t observed a significant reduction in size of retirement communities, nor aged care where the economics are a “delicate equation” and “scale is necessary to be able to deliver the kinds of support and services that are required”.
“I think as we see the increase in the numbers of vertical properties, there will need to be a scale that will make these viable, which will see the average sizes stay as they are.”
Some customers prefer smaller boutique properties, he says, but others are attracted to bigger communities, which usually come with more amenities such as pools and libraries.
The elderly tend to be less mobile, he says, so don’t always want to travel far to go for a swim or borrow a book.
Close to 100 per cent of new villages are offering what he defines as “extensive facilities”.
Higher end facilities such as swimming pools and theatres are on the rise, with art rooms and sheds for tinkering also common.
“People like the idea of moving into a retirement community that is, in some way, full service.”
The ambition is generally to “make it feel like home”, according to Myers.
Sustainability is also a growing interest
He says there’s growing interest in onsite solar and other sustainability measures that result in lower bills.
“Many seniors are on a fixed income so any saving that you can make to utilities is welcome, and they want to do the right thing.”