In a Dutch town about 20 kilometres outside of Amsterdam, a small community lives in what at first glance seems like a real-life version of The Truman Show.
Hogewey has a grocery store, a theatre and a barber shop. The only twist is that many of its 152 residents live unaware that their orderly community is actually a nursing home for people with severe dementia.
- Listen to the Current's special feature: diagnosis dementia
- Robot helpers may one day be assisting dementia patients
"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 Yvonne van Amerongen, an employee at Hogewey who also helped develop the concept.
Hogewey was officially opened in 2007, but the idea has now caught the attention of health-care professionals in Ontario and Alberta.
"We protect our residents from the unsafe world. They do not understand the world outside this because the outside world doesn't understand them." - Yvonne van Amerongen, Hogewey employee
Rhonda Desroches, who helped create a smaller-scale Hogewey in Penetanguishene, Ont., says relatives of the residents are pleased with how happy their family members seem to be in the new facility.
Dementia is a growing problem. According to the Alzheimer Society Canada, one out of 20 Canadians over 65 has Alzheimer's Disease, and that figure jumps to one in four for Canadians over 85. In 2012, the World Health Organization declared dementia a public health priority.
Many dementia patients move into nursing homes, where they are monitored in a safe setting. But some medical professionals want to shift patients away from unfamiliar, clinical settings and into spaces that resemble more typical surroundings.
Places like Hogewey.
Restaurant, theatre and other amenities
Hogewey creates a familiar, "normal" environment that dementia patients understand, says van Amerongen.
The citizens of Hogewey share a house with about six others, and are classified according to one of seven lifestyles.
For example, former tradespeople often live together in homey accommodations and eat a lot of Dutch comfort food. Those used to an upper-class lifestyle may join the Gooi group, named after a posh Netherlands region, and are more likely to feast on French cuisine in a stylishly decorated abode.
Each household has at least one health-care worker present who helps with housework and other tasks.
Residents are free to stroll all through town.
"You will see [residents] sitting in a restaurant with a glass of wine or buying a box of chocolates from the supermarket," says van Amerongen of those who still understand the concept of money. A worker and a resident from each house walk to the market daily to buy groceries.
Employees organize day trips to nearby shopping centres or towns. Special bikes allow two people to sit side by side so residents and health-care workers, volunteers or family members can cycle in pairs.
Nearby townspeople frequent Hogewey's amenities, and often go to concerts or the annual Christmas fair. On Sint Maarten, a Dutch holiday similar to Halloween, children knock on residents' doors to sing songs in exchange for candy.
Like all Dutch nursing homes, Hogewey is partially funded through taxes. Residents pay a portion of the cost based on their income.
'Wonderful innovation' inspires copycat homes
Van Amerongen says she regularly consults with organizations outside the Netherlands that want to create similar facilities. Plans to transform four existing nursing homes and build two new ones in Oslo, for example, have progressed "quite far," she says.
One of her colleagues frequently travels to Canada where there's increased interest in developing the concept. Researchers from the University of Alberta recently visited Hogewey to study it.
- 5 things to ask before moving into a retirement home
- Radical rest homes: Old people should live everywhere
Last August, Georgian Bay Retirement home in Penetanguishene, Ont., opened a section designed to recreate the look and feel of the 1950s and '60s.
Theme rooms include a vintage kitchen, a garage with a 1947 Dodge and a nursery with dolls designed to feel like actual babies, says Rhonda Desroches, who helped create the space. The idea is to try and transport patients to a time they may recall that is associated with positive feelings.
All the doors in the theme rooms look like bookshelves, so residents won't recognize them and stray.
In Florida, a company called Miami Jewish Health Systems wants to create a program that reflects Hogewey's philosophy "to really make living as normal as possible within the scope of the disease," says Marc E. Agronin, the company's vice-president of behavioural health and clinical research.
Miami Jewish Health Systems is planning a transformation of its 28-acre campus to give dementia patients more freedom by creating a safe space where they're not confined to their rooms.
Total honesty can cause 'significant problems'
While certain health-care professionals see Hogewey as the future of dementia care, others criticize it for being dishonest.
Some aspects of Hogewey seem "fantastic," says Julian Hughes, the deputy chair of the Nuffield Council on Bioethics in London, England, which studies ethical issues in biology and medicine and advises policy makers.
It's worrisome when a village or aspects of it are deliberately deceitful, says Hughes, who was part of a working group for Nuffield's 2009 report on ethical issues in dementia, including truth-telling.
Some nursing homes have built fake bus stops outside their facilities, Hughes says. When patients want to leave the facility and go home, health-care workers take them to the bus stop. After a while, caregivers can distract the person, presumably taking advantage of the fact that they have forgotten where they were going, and bring them back inside.
There are those that believe deceiving dementia patients breaches their trust. As the council's report states, some say it "serves to undermine the remaining grip the person with dementia may have on the everyday world."
Patients who realize something is amiss could become upset and slightly paranoid, Hughes says.
Van Amerongen insists that kind of criticism comes from people who misunderstand how Hogewey operates. The people who work at Hogewey aren't merely actors trying to create the illusion of a normal neighbourhood, she says.
There are nurses on staff, but the amenities are operated by real cooks, waiters and other employees who aren't health-care professionals. They're just trained to deal with dementia patients.
"There's no trick here," says van Amerongen.
She says that while some Hogewey residents recognize the caregivers as nurses, others simply think of them as "a nice friend."
Some deception is morally OK
Hughes says it's morally acceptable not to ruthlessly tell dementia patients the truth about certain situations.
"There's a difference between a Potemkin village where everything is just a facade [and] a place like Hogewey." - Marc E. Agronin, of Miami Jewish Health Systems
In its 2009 report, the Nuffield Council determined it's important to consider a person's best interests, like whether the information would needlessly distress them. The council said sometimes it may be best to evade or give partial answers.
When you tell someone suffering from dementia that a loved one has died, they may not remember, says Agronin from Miami Jewish Health Systems. It often makes little sense to repeatedly deliver the news, traumatizing them each time.
Agronin says that for him, it's about making people feel comfortable and oriented. That can be achieved by some of the things Hogewey does, like furnishing a patient's room and common spaces to be reminiscent of their previous home.
"There's a difference between a Potemkin village where everything is just a facade [and] a place like Hogewey."