Continuing Urban Edge Architecture’s research into innovative solutions for senior living, Sonia Parol visits two care homes in the Netherlands that have placed the happiness and wellbeing of residents at the center of their design and operation. This article will cover the Hogeweyk care village, with a post to follow covering the Humanitas centre in Deventer. Both schemes are highly successful, yet differ greatly from models commonly found in the UK – is it time we started to challenge the accepted rules, regulations and concepts that have dominated the UK care home market for several decades?
As part of our ongoing research into senior living developments in urban settings, Urban Edge Architecture recently undertook a study tour of several innovative care homes and senior living accommodation schemes with students from the University of Lincoln. Our trip to the Netherlands follows a visit made to two care homes in Copenhagen last year where social connection is actively encouraged through the provision of shared and social spaces (see part 1 of Sonia’s blog).
That spirit of challenging the norms could clearly be seen at the Hogeweyk care village in Weesp. It was clear from the outset that this care home was very different from those we see in the UK. Whilst it is a nursing home for severe dementia, at no stage during our three-hour visit did it feel like a nursing home. For a start, there were plenty of people walking around independently and it was almost impossible to distinguish whether they were residents, workers or visitors. Usually, when you go to a dementia ward or care home in the UK, you have locked doors because the focus is on creating safe environments – but in Hogeweyk doors are left unlocked and sometimes wide open, minimising the frustration and irritation that is often symptomatic for people living with dementia. Incredibly, even the main door to access the care village remains unlocked! The focus at Hogeweyk is on normality – a simple concept perhaps, but a really huge challenge to maintain in a care or nursing home setting. Eloy van Hal, Project Manager for the realisation of Hogeweyk and Senior consultant at Be (part of the Vivium Care Group), told us that keeping the doors open, having fresh air and encouraging people to leave their rooms and participate in daily life keeps residents in better physical and mental condition.
Eloy told us that 24 years ago, there was a nursing home on the site but it wasn’t a great place for people to continue their lives because they had too many people living together and it was too institutional, more focused on care rather than wellbeing. He said that people want to continue their lives in recognisable environments with a normal daily life. So they decided to challenge the norms by introducing some changes, for instance creating smaller groups of people living together and matching those people who lived together according to their lifestyle, ideas, history, hobbies and values. After 10 years they noticed how beneficial this was and so decided to demolish the existing building and create something new.
The result is the Hogeweyk village we see today – 23 homes (growing to 27 by the end of this year) with small groups of six or seven like-minded people living together, the matched lifestyles and preferences ensuring a regular rhythm to residents’ lives, creating less stress, irritation and aggression. Residents, even with severe dementia, can leave their homes and walk inside the village neighbourhood, accessing amenities such as shops, restaurants and pubs.
Whilst Hogeweyk provides a really high level of nursing care, the priority is on creating wellbeing and as normal a day-to-day lifestyle as possible. In each house they cook their own meals, with residents buying ingredients and other household essentials from the village shop. Whilst the shop is part of the scheme, it can be accessed from the local neighbourhood and is also used by the wider community. Much like the Bomi-Parken development we visited in Copenhagen, spaces within Hogeweyk are also rented out, not only to provide additional revenue streams but also to provide more activity and opportunities for residents to interact with a variety of different people. Indeed, the scheme has been designed to make it very easy for visitors and is a much more pleasant place to visit than a standard nursing home.
Eloy explained that it was very important to bring people of different ages into the village – whether they are volunteers or visitors to the shop and restaurant – to create a liveable, vibrant society with lots of activities going on. This is important because it starts to question our understanding of ‘activity’. In the UK, we tend to have activity managers in care homes who run classes, whereas the Hogeweyk model focuses on natural and organic activity. Having a ‘normal’ lifestyle – whether walking around the village, going shopping, sitting in the café or cooking your own meals – generates natural and real activities.
Of course, many people reading this may be thinking, ‘Well, this is the Netherlands, they’re traditionally relaxed and probably don’t have the same volume of regulations as the UK.’ But, actually, there are lots of rules and regulations in the Netherlands that the care sector must follow – however, the rules and regulations often follow innovation, they do not stifle it. It concerns me that in the UK we no longer challenge the rules and considered norms. We have focused on creating safe and attractive environments, but still within the same standard concept of a nursing home. In other words, we are just wrapping the same concept in nicer material.
We still have a cluster of bedrooms with one lounge, a quiet lounge and a dining room. We might add a shop or a hairdresser, but they are only available to the residents and only accessible via an internal lift – residents don’t have to put a coat on, they don’t have to walk far, they don’t see anyone other than carers at the hairdresser or the shop. We are still worried about their interaction with other people, we want to keep them safe and in a completely risk-free environment. When you stop to consider it, this is about as far from a ‘normal’ environment as possible. I think we have to do better and we have to look for innovation.
Pointedly, Eloy also said that instead of following the rules, we should make our own. This may seem a like flippant statement, but in witnessing these different approaches to senior living in other parts of Europe it struck a chord and made me consider whether we have become too reticent to challenge the accepted norms in the UK. The majority of care homes in the UK may look architecturally different, but they are very similar in their concept, with operators and developers adhering to the concepts they have delivered for the last 20 years or so. However, the mindset of “if it ain’t broke, don’t fix it” will no longer wash because the people who will be moving into retirement or care homes in the future will have completely different lifestyles and expectations. In many care homes – as well as children’s developments, it has to be said – our focus has been on reducing risk rather than creating an environment for happy people. Perhaps it is time to challenge our risk-averse mindset?