1
00:00:00,659 --> 00:00:02,610
This is the Hogeweyk.

2
00:00:02,984 --> 00:00:07,365
It's a neighborhood in a small town
very near Amsterdam, in the Netherlands.

3
00:00:07,881 --> 00:00:11,350
There are 27 houses
for six, seven people each.

4
00:00:11,821 --> 00:00:16,341
There's a small mall with a restaurant,
a pub, a supermarket, a club room.

5
00:00:16,900 --> 00:00:21,225
There are streets, alleys,
there's a theater.

6
00:00:22,434 --> 00:00:24,434
It actually is a nursing home.

7
00:00:25,093 --> 00:00:30,727
A nursing home for people
that live with an advanced dementia

8
00:00:30,751 --> 00:00:34,210
and that need 24-7 care and support.

9
00:00:35,234 --> 00:00:38,497
Dementia is a terrible disease,

10
00:00:38,521 --> 00:00:41,739
and we still don't have any cure for it.

11
00:00:42,211 --> 00:00:45,838
It's getting to be
a major problem in the world,

12
00:00:45,862 --> 00:00:47,710
for the people, for the politicians,

13
00:00:47,734 --> 00:00:50,705
for the world -- it's getting
to be a big problem.

14
00:00:51,228 --> 00:00:54,473
We see that we have waiting lists
in the nursing homes.

15
00:00:55,093 --> 00:00:58,893
Most people that come to the nursing homes
with dementia are women.

16
00:00:59,855 --> 00:01:04,815
And that's also because women
are used to taking care of people,

17
00:01:04,839 --> 00:01:08,692
so they can manage to take care
of their husband with dementia,

18
00:01:08,716 --> 00:01:13,124
but the other way around
is not so easy for the gentlemen.

19
00:01:14,629 --> 00:01:18,962
Dementia is a disease
that affects the brain.

20
00:01:18,986 --> 00:01:21,128
The brain is confused.

21
00:01:21,923 --> 00:01:24,684
People don't know anymore
what the time is,

22
00:01:24,708 --> 00:01:27,446
what's going on, who people are.

23
00:01:27,470 --> 00:01:28,942
They're very confused.

24
00:01:28,966 --> 00:01:31,180
And because of that confusion,

25
00:01:31,204 --> 00:01:37,249
they get to be anxious,
depressed, aggressive.

26
00:01:38,728 --> 00:01:41,109
This is a traditional nursing home.

27
00:01:41,133 --> 00:01:43,188
I worked there in 1992.

28
00:01:43,641 --> 00:01:45,148
I was a care manager.

29
00:01:45,687 --> 00:01:48,703
And we often spoke together about the fact

30
00:01:48,727 --> 00:01:53,728
that what we were doing there
was not what we wanted for our parents,

31
00:01:53,752 --> 00:01:57,060
for our friends, for ourselves.

32
00:01:57,815 --> 00:01:59,600
And one day, we said,

33
00:01:59,624 --> 00:02:02,378
"When we keep on saying this,
nothing is going to change.

34
00:02:02,402 --> 00:02:03,775
We are in charge here.

35
00:02:03,799 --> 00:02:06,295
We should do something about this,

36
00:02:06,319 --> 00:02:09,683
so that we do want
to have our parents here."

37
00:02:10,773 --> 00:02:13,781
We talked about that,
and what we saw every day

38
00:02:13,805 --> 00:02:17,498
was that the people
that lived in our nursing home

39
00:02:17,522 --> 00:02:19,887
were confused about their environment,

40
00:02:19,911 --> 00:02:23,458
because what they saw
was a hospital-like environment,

41
00:02:23,482 --> 00:02:27,593
with doctors and nurses
and paramedics in uniform,

42
00:02:27,617 --> 00:02:29,284
and they lived on a ward.

43
00:02:30,069 --> 00:02:32,903
And they didn't understand
why they lived there.

44
00:02:32,927 --> 00:02:36,236
And they looked for the place to get away.

45
00:02:36,617 --> 00:02:41,554
They looked and hoped to find
the door to go home again.

46
00:02:42,022 --> 00:02:45,847
And we said what we are doing
in this situation

47
00:02:45,871 --> 00:02:50,910
is offering these people
that already have a confused brain

48
00:02:50,934 --> 00:02:52,220
some more confusion.

49
00:02:52,244 --> 00:02:55,778
We were adding confusion to confusion.

50
00:02:56,180 --> 00:02:58,631
And that was not what these people needed.

51
00:02:59,084 --> 00:03:01,846
These people wanted to have a life,

52
00:03:01,870 --> 00:03:05,434
and the help, our help,
to deal with that dementia.

53
00:03:05,957 --> 00:03:10,689
These people wanted to live
in a normal house,

54
00:03:10,713 --> 00:03:11,863
not in a ward.

55
00:03:12,482 --> 00:03:15,307
They wanted to have a normal household,

56
00:03:15,331 --> 00:03:20,029
where they would smell their dinner
on the stove in the kitchen.

57
00:03:20,966 --> 00:03:25,228
Or be free to go to the kitchen
and grab something to eat or drink.

58
00:03:25,611 --> 00:03:27,841
That's what these people needed.

59
00:03:27,865 --> 00:03:30,364
And that's what we should
organize for them.

60
00:03:31,269 --> 00:03:35,990
And we said we should
organize this like at home,

61
00:03:36,014 --> 00:03:40,966
so they wouldn't live with a group
of 15 or 20 or 30, like in a ward.

62
00:03:41,434 --> 00:03:45,648
No, a small group of people,
six or seven, family-like.

63
00:03:47,069 --> 00:03:48,942
Like living with friends.

64
00:03:50,709 --> 00:03:53,788
And we should find a way to select people

65
00:03:53,812 --> 00:03:56,566
based on their ideas about life

66
00:03:56,590 --> 00:03:59,690
so that they did have
a good chance to become friends,

67
00:03:59,714 --> 00:04:01,282
when they lived together.

68
00:04:02,225 --> 00:04:06,385
And we interviewed
all the families of the residents

69
00:04:06,409 --> 00:04:10,102
about "what is important for your father,"
"what's important for your mother,"

70
00:04:10,126 --> 00:04:12,875
"what is their life like,"
"what do they want."

71
00:04:12,899 --> 00:04:17,144
And we found seven groups,
and we call them lifestyle groups.

72
00:04:17,709 --> 00:04:21,370
And for instance,
we found this formal lifestyle.

73
00:04:21,851 --> 00:04:23,077
In this lifestyle,

74
00:04:23,101 --> 00:04:26,522
people have a more formal way
of interacting with each other,

75
00:04:26,546 --> 00:04:27,839
a distant way.

76
00:04:27,863 --> 00:04:30,109
Their daily rhythm
starts later in the day,

77
00:04:30,133 --> 00:04:31,855
ends later in the day.

78
00:04:31,879 --> 00:04:34,905
Classical music is more heard
in this lifestyle group

79
00:04:34,929 --> 00:04:36,632
than in other lifestyle groups.

80
00:04:36,656 --> 00:04:38,140
And their menu,

81
00:04:38,164 --> 00:04:41,943
well, is more French cuisine
than traditional Dutch.

82
00:04:41,967 --> 00:04:43,559
(Laughter)

83
00:04:43,583 --> 00:04:47,194
In contrary to the craftsman lifestyle.

84
00:04:47,218 --> 00:04:49,361
That's a very traditional lifestyle,

85
00:04:49,385 --> 00:04:51,955
and they get up early
in the morning, go to bed early,

86
00:04:51,979 --> 00:04:55,981
because they have worked hard
their whole life, mostly with their hands,

87
00:04:56,005 --> 00:05:00,608
very often had a very small
family business, a small farm, a shop,

88
00:05:00,632 --> 00:05:04,767
or like Mr. B, he was a farmhand.

89
00:05:05,466 --> 00:05:08,966
And he told me that he would go
to his work every morning

90
00:05:08,990 --> 00:05:11,194
with a paper bag with his lunch

91
00:05:12,014 --> 00:05:13,504
and one cigar.

92
00:05:14,824 --> 00:05:18,887
That one cigar was the only luxury
he could afford for himself.

93
00:05:19,420 --> 00:05:22,553
And after lunch,
he would have that one cigar.

94
00:05:23,460 --> 00:05:26,788
And until the day he died in the Hogeweyk,

95
00:05:26,812 --> 00:05:32,724
he was in this little shed, every day,
after lunch, to smoke his cigar.

96
00:05:35,201 --> 00:05:36,387
This is my mother.

97
00:05:36,411 --> 00:05:38,022
She's of the cultural lifestyle,

98
00:05:38,046 --> 00:05:40,512
she's been living
in the Hogeweyk six weeks now.

99
00:05:41,236 --> 00:05:46,476
And that lifestyle is about traveling,
meeting other people, other cultures,

100
00:05:46,500 --> 00:05:49,501
interest in arts and music.

101
00:05:50,072 --> 00:05:51,805
There are more lifestyles.

102
00:05:52,818 --> 00:05:56,551
But that's what we talked about
and that's what we did.

103
00:05:57,766 --> 00:06:02,617
But that's not life in a house
with a group of people,

104
00:06:02,641 --> 00:06:06,019
like-minded people, your own life,
your own household.

105
00:06:06,434 --> 00:06:07,763
There's more in life,

106
00:06:07,787 --> 00:06:11,091
everybody wants fun in life,
and a meaningful life.

107
00:06:11,688 --> 00:06:13,109
We are social animals --

108
00:06:13,133 --> 00:06:15,402
we need a social life.

109
00:06:15,817 --> 00:06:17,617
And that's what we started.

110
00:06:18,817 --> 00:06:22,293
We want to go out of our house
and do some shopping,

111
00:06:22,317 --> 00:06:23,784
and meet other people.

112
00:06:24,698 --> 00:06:28,438
Or go to the pub,
have a beer with friends.

113
00:06:28,462 --> 00:06:33,444
Or like Mr. W -- he likes
to go out every day,

114
00:06:33,468 --> 00:06:36,084
see if there are nice ladies around.

115
00:06:36,108 --> 00:06:38,096
(Laughter)

116
00:06:38,465 --> 00:06:40,020
And he's very courteous to them

117
00:06:40,044 --> 00:06:42,545
and he hopes for smiles and he gets them.

118
00:06:42,863 --> 00:06:45,196
And he dances with them in the pub.

119
00:06:46,014 --> 00:06:47,530
It's a feast, every day.

120
00:06:47,554 --> 00:06:50,768
There are people that would
rather go to the restaurant,

121
00:06:50,792 --> 00:06:52,466
have a wine with friends,

122
00:06:52,490 --> 00:06:56,156
or lunch or dinner with friends
and celebrate life.

123
00:06:56,180 --> 00:06:58,966
And my mother,
she takes a walk in the park,

124
00:06:58,990 --> 00:07:00,673
and sits on a bench in the sun,

125
00:07:00,697 --> 00:07:03,823
hoping that a passerby will come
and sit next to her,

126
00:07:03,847 --> 00:07:06,410
and have a conversation about life

127
00:07:06,434 --> 00:07:09,669
or about the ducks in the pond.

128
00:07:10,355 --> 00:07:12,616
That social life is important.

129
00:07:12,998 --> 00:07:17,574
It means that you're part
of society, that you belong.

130
00:07:17,974 --> 00:07:20,041
And that's what we people need.

131
00:07:21,013 --> 00:07:24,561
Even if you're living
with advanced dementia.

132
00:07:25,482 --> 00:07:28,347
This is what I see from my office window.

133
00:07:28,371 --> 00:07:32,580
And one day, I saw a lady
coming from one side,

134
00:07:32,604 --> 00:07:36,223
and the other lady from the other side,
and they met at the corner.

135
00:07:36,247 --> 00:07:38,595
And I knew both ladies very well.

136
00:07:38,929 --> 00:07:42,281
I often saw them walking around outside.

137
00:07:42,618 --> 00:07:46,999
And now and then, I tried
to have a conversation with them,

138
00:07:47,023 --> 00:07:49,776
but their conversation was ...

139
00:07:50,586 --> 00:07:53,072
rather hard to understand.

140
00:07:53,839 --> 00:07:57,498
But I saw them meeting,
and I saw them talking,

141
00:07:57,522 --> 00:07:59,402
and I saw them gesturing.

142
00:07:59,426 --> 00:08:01,159
And they had fun together.

143
00:08:01,554 --> 00:08:04,632
And then they said goodbye,
and each went their own way.

144
00:08:05,331 --> 00:08:08,569
And that's what you want in life,
meeting other people

145
00:08:08,593 --> 00:08:10,640
and being part of society.

146
00:08:11,093 --> 00:08:13,227
And that's what I saw happening.

147
00:08:14,148 --> 00:08:16,155
The Hogeweyk has become a place

148
00:08:16,179 --> 00:08:19,861
where people with very advanced
dementia can live,

149
00:08:19,885 --> 00:08:21,821
have freedom and safety,

150
00:08:21,845 --> 00:08:26,329
because the professionals working there
and the volunteers working there

151
00:08:26,353 --> 00:08:28,575
know how to deal with dementia.

152
00:08:29,093 --> 00:08:32,426
And the professionals know
how to do their professional work

153
00:08:32,450 --> 00:08:37,482
in a way that it fits in a natural way
in the life of our residents.

154
00:08:38,826 --> 00:08:43,506
And that means that the management
has to provide everything

155
00:08:43,530 --> 00:08:45,864
those people need to do their work.

156
00:08:46,866 --> 00:08:50,710
It needs a management
that dares to do this.

157
00:08:50,734 --> 00:08:53,871
To do things differently
than we always have done

158
00:08:53,895 --> 00:08:56,028
in a traditional nursing home.

159
00:08:58,989 --> 00:09:00,893
We see that it works.

160
00:09:02,006 --> 00:09:05,172
We think this can be done everywhere,

161
00:09:05,196 --> 00:09:07,396
because this is not for the rich.

162
00:09:07,863 --> 00:09:12,212
We've been doing this with the same budget

163
00:09:12,236 --> 00:09:16,315
as any traditional nursing home
has in our country.

164
00:09:16,339 --> 00:09:19,116
We work only with the state budget.

165
00:09:20,220 --> 00:09:27,092
(Applause)

166
00:09:28,226 --> 00:09:31,798
Because it has to do
with thinking different,

167
00:09:31,822 --> 00:09:34,552
and looking at the person in front of you

168
00:09:34,576 --> 00:09:38,257
and looking at what
does this person need now.

169
00:09:39,352 --> 00:09:42,592
And it's about a smile,
it's about thinking different,

170
00:09:42,616 --> 00:09:46,663
it's about how you act,
and that costs nothing.

171
00:09:47,823 --> 00:09:51,490
And there's something else:
it's about making choices.

172
00:09:51,903 --> 00:09:55,636
It's about making choices
what you spend your money on.

173
00:09:56,855 --> 00:09:58,131
I always say,

174
00:09:59,323 --> 00:10:04,069
"Red curtains are
as expensive as gray ones."

175
00:10:04,093 --> 00:10:05,470
(Laughter)

176
00:10:05,494 --> 00:10:08,017
It's possible, everywhere.

177
00:10:09,263 --> 00:10:10,422
Thank you.

178
00:10:10,446 --> 00:10:15,077
(Applause)