This article was published on Matters Journal on March 21, 2019, and in the printed matters journal, issue 2, in 2018.
A new residential dementia village is set to open in Tasmania in 2019. Inspired by the Hogeweyk dementia village concept pioneered in the Netherlands, it offers a potential shift away from traditional models of dementia care in Australia.
Every day, around 244 people in Australia are diagnosed with dementia. Without any medical advancement, it’s a figure that’s expected to rise to over 650 Australians a day by 2056. According to ‘Economic Cost of Dementia in Australia 2016– 2056’, a report prepared by the National Centre for Social and Economic Modelling, this increase will see the number of people living with the disease soar from today’s figure of 413,106 to over 1.1 million by 2058 at a total cost of $37 billion.
In the report, Professor Graeme Samuel AC, chair of the Dementia Australia Research\ Foundation, warns, “The impact of dementia is tremendous and will only endure should we choose to ignore what the staggering numbers in this report are telling us. Serious and urgent collective action is needed now, to combat or mitigate the impacts of dementia not only within Australia, but globally.”
Dementia is the collective term used to describe symptoms caused by neurological disorders that progressively diminish the brain’s function. There are over 100 disorders that may cause dementia, the most common of which is Alzheimer’s disease. Dementia affects an individual’s cognitive function (such as memory, concentration, thinking, reasoning and language skills), behaviour and mood. Over time, it impacts their ability to undertake everyday tasks and how they live day-to-day, and while it’s most common in people aged 65 and over it can occur earlier in what’s known as ‘younger onset dementia’.
Learning from the Hogeweyk concept
People with dementia account for over half (52 per cent) of those currently living in residential aged care facilities in Australia. Korongee, which is being built in Tasmania by care provider Glenview Community Services, references and is inspired by the Hogeweyk concept in the Netherlands.
Around 160 residents with advanced dementia reside at the Hogeweyk. There are 23 houses, each with six to seven residents, in what appears at first glance to be a typical Dutch village. It has its own central square, parks, supermarket, pub, theatre, restaurant and various social and outdoor spaces. Residents move around freely (or with assistance, if needed), constructing their day and spending their time as they choose in a familiar and monitored community.
“It’s a living environment for people with dementia,” says Eloy van Hal, founder of Hogeweyk. “The concept is a cultural shift in care for the elderly. A shift from the medical system to a social relational system with a focus on experiencing health and enjoying a normal life despite dementia. This cultural shift demands creativity and a person-centred focus from all professionals within the organisation.” The Hogeweyk concept is a step away from the institutional model towards one that resembles normal, everyday life, but supported by professional care. Residents are involved in all their daily activities and the staff — dressed in normal street clothes and not uniforms — help residents with everything from shopping to meal preparation, laundry and the scheduling of daily activities.
Korongee: A Tasmanian take on the model
In a similar vein, Korongee aims to trial a different kind of residential care experience for people with dementia in Australia. “If you have a cognitive impairment, or you have dementia, this space is designed specifically for you,” says Glenview Community Service CEO, Lucy O’Flaherty, about Korongee.
The new facility is currently under construction in Glenorchy in Hobart’s northern suburbs and is a partnership between Glenview, industry super fund HESTA, social purpose organisation Social Ventures Australia and the Commonwealth Government. Designed by international architecture firm ThomsonAdsett, it will feature 12 eight-bedroom houses, each of which has a ‘lifestyle’ attributed to it (a concept also present in Hogeweyk), which will be reflected through elements such as the interiors, furnishings and gardens.
The lifestyle concept helps to ensure commonality between residents in each house, in that they have similar values and ideas in how they live. For example, shared interests and hobbies, life experiences, culture, religion and approaches to living. The lifestyles were developed by Glenview in conjunction with the University of Tasmania, a partnership strengthened by Glenview board member Professor James Vickers, who is deputy dean of the Faculty of Health at the University of Tasmania and co-director/co-founder of the University’s Wicking Dementia Research and Education Centre.
Korongee will be constructed as a self-contained village, which will be based on a typical Tasmanian streetscape. From their homes, residents will be able to walk to the village cafe, supermarket, shops and boulevard safely and freely in an environment overseen and cared for by staff (who don’t present as such). Family and friends can visit and partake in activities around the village complex with residents.
O’Flaherty says much research — both on a national and international level — has been undertaken in developing the Korongee model, which integrates successful evidence-based outcomes. During a recent Studying and Advancing Global Eldercare (SAGE) tour for educational study, O’Flaherty was introduced to successful alternative models around the world and visited aged care and retirement village facilities in the US, Canada and Europe, including Hogeweyk.
Glenview has also been collaborating with the Museum of Old and New Art (MONA) in Hobart over the last 12 months. “I am really curious about the opportunity to introduce art and music, the more cultural side of our normal world, into the village,” says O’Flaherty.
Engaging in creative arts has been found to improve the quality of life and wellbeing of people living with dementia. A 2015 study, commissioned by the Art Gallery of New South Wales on its own art and dementia access program, found that interacting with art creates a heightened sense of joy in people living with dementia, alongside feelings of being valued, acknowledged and stimulated. The National Gallery of Australia, the National Portrait Gallery and the Museum of Contemporary Art Australia also host similar art and dementia programs.
“We’ve been working with them [MONA] to talk about how we might work together.” While this is still being explored, O’Flaherty says the partnership could take the form of artists-in-residence, small-scale exhibitions or craft markets tailored to the residents.
“We know from experience internationally that if you live in more of a real-life environment, you are likely to be more engaged — emotionally, cognitively, spiritually, physically, which is more likely to slow down your trajectory,” says O’Flaherty. “So, we’re hoping to see people effectively live longer — or at least live a better quality of life.”