SILS 2015 - De Hogeweyk, the Care Concept

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De Hogeweyk, the Care Concept – Living life as usual with an advanced dementia
By: Yvonne van Amerongen, De Hogeweyk and Oversingel, part of the Vivium Care Group
At Sherbrooke International Life Sciences Summit - 2nd edition | September 28/29/30 2015
www.sils-sherbrooke.com

Publié dans : Santé
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SILS 2015 - De Hogeweyk, the Care Concept

  1. 1. De Hogeweyk Care Concept Living life as usual with advanced dementia. Sherbrooke International Life Sciences Summit September 2015
  2. 2. May I introduce myself? Yvonne van Amerongen- Heijer occupational therapist, social worker and founder of De Hogeweyk 1992: Care manager- nursing home Hogewey 1993: Project leader innovational project „living as usual“ nursing home Hogewey 1994: Project manager- quality & innovation nursing home Hogewey 2015: Senior managing consultant for “Be” ( part of nursing home Hogewey) Sherbrooke International Life Sciences Summit September 2015
  3. 3. May I introduce myself? Yvonne Sherbrooke International Life Sciences Summit September 2015
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  9. 9. Live your life “It is not about staying alive whatever it takes, but what your life is about. “ From the diary of Etty Hillesum- murdered in Auschwitz in 1943 Sherbrooke International Life Sciences Summit September 2015
  10. 10. Some figures(WHO, 2012) People living with dementia : ( 40% late stage) - 2012: 35 million - 2030: 70 million - 2050: 115 million Sherbrooke International Life Sciences Summit September 2015
  11. 11. In De Hogeweyk live only people with severe, advanced dementia. Sherbrooke International Life Sciences Summit September 2015
  12. 12. The vision on living, wellbeing and care - Ageing in place: 85% of all people with dementia (in the Netherlands). - For those other 15% we offer and support living, care and wellbeing (life’s pleasures). - Living in a normal home within a normal household, together with others who have the same lifestyle. - Living his or her individual life in this home and outside Living a life as usual Sherbrooke International Life Sciences Summit September 2015
  13. 13. The principles of De Hogeweyk- care concept - Normal living - Living in a small group of people with the same lifestyle - Normal household - Your own individual life - Living a social life Sherbrooke International Life Sciences Summit September 2015
  14. 14. Favourable surrounding Life’s pleasures Employees & volunteers Health Organization Lifestyle Sherbrooke International Life Sciences Summit September 2015
  15. 15. 6 pillars • A favorable surrounding • Pleasure in life and meaning in life • Health • Lifestyle • Organisation • Employees and volunteers Sherbrooke International Life Sciences Summit September 2015
  16. 16. A favorable surrounding Living life as usual ,in a normal house, with a normal household. - Where confusion is minimized - Where life has a normal human scale, living together in a small group with the same lifestyle - Where the resident is supported by professionals to cope in daily life as usual Sherbrooke International Life Sciences Summit September 2015
  17. 17. A favorable surrounding - A house with a front door, a living room and a kitchen. And a terrace or a garden to sit outside in the sun. - A house with your own bedroom. - A house that is furnished in the style of your own home. - A house where the household is done according to your own ideas: cleaning the house, washing and ironing clothes, preparing meals. - A house with a daily routine according to your own ideas. - A small group : 6-7 in each house Sherbrooke International Life Sciences Summit September 2015
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  22. 22. Pleasure in life and a meaningful life - A social life: meeting others in the pub or as a member of a club - Enjoying a walk in the fresh air - Daily shopping in the supermarket - Concerts at the theater - The freedom to wander around - The church and the rituals Sherbrooke International Life Sciences Summit September 2015
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  25. 25. Your own individual life A social life ……. Cultural events, just a stroll on your own, meeting others, following your own interests Sherbrooke International Life Sciences Summit September 2015
  26. 26. De Hogeweyk Sherbrooke International Life Sciences Summit September 2015
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  29. 29. Pillar: employees and volunteers • Employees and volunteers know the vision and apply it in their work. They work independently on the basis of the vision. • Volunteers are fully fledged and equivalent colleagues. • A volunteer always works under the direction or the indirect supervision of an employee who is responsible for his or her work. Sherbrooke International Life Sciences Summit September 2015
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  32. 32. De Hogeweyk The team in the house 1 Team in every house (6/7 residents) Each team consists of 6-8 employees • Professional caregiver (level 3): 7.00 am – 10.30 pm (2,9 fte netto) • Assistant (level 1-2): 8.00 am – 1 pm (0,97 fte netto) Sherbrooke International Life Sciences Summit September 2015
  33. 33. ©CEANconsulting / © Be The Hogeweyk Care Concept / © Vivium Zorggroep De Hogeweyk • ‘Quality of life’ QUALITY OF LIFE of people suffering from dementia Caring relationships and social structure Feeling at home Having something to do Independence and autonomy Esthetics Physical environment Environmentalfactors Happiness Health Medication Self esteem Individualfactors Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. Culture & Tradition Family & Community Personal Freedom Surroundings
  34. 34. De Hogeweyk Pillar: Health - Experiencing health and the quality of life are leading - Medics/ therapists to support quality of life - Balance in life: wellbeing, living and health - A social-relational system instead of a medical system - Quality of life is our goal, as long as the extensive program in search for the cure of dementia is going on Sherbrooke International Life Sciences Summit September 2015
  35. 35. De Hogeweyk Pillar: Lifestyle Lifestyle for people with dementia? Yes! A person with dementia is the same individual as before the dementia. Lifestyle is: surroundings, environment, interior design, social behaviour, daily routines, preparation of meals, norms and values. Sherbrooke International Life Sciences Summit September 2015
  36. 36. How did we do it? 1993: experimental ward: study on lifestyles 1994: interviews with family of 169 residents 2002: Motivaction- validation of the lifestyles - questionnaire for analysis lifestyle new residents 2015: update of the lifestyles Dutch lifestyles! Sherbrooke International Life Sciences Summit September 2015
  37. 37. Mentality milieus in Western Europe • Dementia occurs in all social milieus • Therefore clients living in De Hogeweyk are a reflection of all kinds of (elderly) people in Dutch society. Motivaction’s segmentation model of the Western European population based on social values Sherbrooke International Life Sciences Summit September 2015
  38. 38. 38 Motivaction’s approach: beyond sociodemographics Sherbrooke International Life Sciences Summit September 2015
  39. 39. Modelling clients of De Hogeweyk Methodology • Grouping elderly people who share the same social values and lifestyles • Based on criteria and data in the Mentality-database of the Dutch population Outcome: 7 lifestyle profiles in ‘de Hogeweyk’ 1. Urban (‘Stads’): open, outgoing, talkative 2. Traditional (‘Ambachtelijk’): traditional, handicraft, mashed potatoes 3. Homy (‘Huiselijk’): traditional, cosey, household work 4. Indonesian (‘Indisch’): tradition, nostalgia, indonesian food 5. Upper class/ well-to-do (‘Goois’) manners, classical music, high tea 6. Cultural (‘Cultureel’): the arts, wine, vegetarian meals 7. Christian (‘Christelijk’): sober, religious music, praying Sherbrooke International Life Sciences Summit September 2015
  40. 40. De Hogeweyk: Dutch Culture 7 Lifestyles - Homely - Urban - Upper class - Cultural - Indonesian (Colonial) - Handicrafts men - Religious Sherbrooke International Life Sciences Summit September 2015
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  51. 51. De Hogeweyk Pillar : the organisation - The vision is leading for all policy and the organisation structure. - Finances and procedures are adapted to the vision. - Nursing home care: back stage - Living life as usual: front stage - All professionals work together to integrate all aspects of life for the resident - The professional is in service of the resident to experience a normal life and health - Organization: wellbeing, living and health Sherbrooke International Life Sciences Summit September 2015
  52. 52. ©CEANconsulting / © Be The Hogeweyk Care Concept / © Vivium Zorggroep De Hogeweyk Guiding principles (1) Deinstitutionalize (2) Transform (3) Normalize • Operationalizing rehumanization
  53. 53. ©CEANconsulting / © Be The Hogeweyk Care Concept / © Vivium Zorggroep De Hogeweyk • 1) Guiding principles – deinstitutionalize
  54. 54. ©CEANconsulting / © Be The Hogeweyk Care Concept / © Vivium Zorggroep De Hogeweyk • 2) Guiding principles – transform
  55. 55. ©CEANconsulting / © Be The Hogeweyk Care Concept / © Vivium Zorggroep De Hogeweyk • 3) Guiding principles – normalize
  56. 56. And the budget !?! • The Dutch social security system provides the budget • The budget is + € 5800,- per resident per month - All personal: caregivers, nurses, doctors, paramedics, administration, cleaning, management and staff - All housing costs: real estate, maintenance, energy costs, etc. - All food costs: food and drinks - All care and cure products: medicines, incontinence materials, syringes, etc. - Activities for each resident, 30 minutes per week Sherbrooke International Life Sciences Summit September 2015
  57. 57. De Hogeweyk- concept It is not only about the bricks! An integral concept in which all aspects add up to a quality of life for people living with severe demenia. Sherbrooke International Life Sciences Summit September 2015
  58. 58. De Hogeweyk Architecture - 23 houses, 17 designs - Total of 15.310 m², - 50% of the property is outdoors, 50% is built environment Social life - Supermarket, restaurant, café, hairdresser, a theater and clubrooms - parks, - gardens, - squares, - alleys, streets and lanes, - a fountain, a pond, - art-exhibitions - Christmas fairs - concerts Sherbrooke International Life Sciences Summit September 2015
  59. 59. Support and safety - All employees and all volunteers know how to support a person with dementia in experiencing daily life. - The exterior and the interior design support the person to understand where he is and what is expected of him. • De Hogeweyk is accessible for everybody, the façades are the safe guard to the “unsafe” world outside. Sherbrooke International Life Sciences Summit September 2015
  60. 60. From nursing home Hogewey to De Hogeweyk 1992: the idea 1993: experimental ward 1994: transform from nursing home to Hogewey concept 2002: lifestyle analyses based on research 2008: move from old building to new 2010: official opening De Hogeweyk Sherbrooke International Life Sciences Summit September 2015
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  69. 69. Scientific research? • Positive effects of small scale living on dementia* • Better cognitive and functional capacity • Reduced agressive behavior • Improved social involvement • Improved work environment for caregivers: • More autonomy • Less stress • Reduced physical strain * Verbeek, 2010; De Rooij et al, 2012. Sherbrooke International Life Sciences Summit September 2015
  70. 70. Scientific research? Positive effects care for people with dementia in small groups - On the brain / agitation - Exercise - Fresh air and daylight (van Hoof et al., 2009) - Social contacts (Lawton, 1997) - Pleasant physical surroundings (Zeisel, 1999) - On the appetite - A pleasant atmosphere - A set table - On employee satisfaction (Verbeek et al, 2010) Sherbrooke International Life Sciences Summit September 2015
  71. 71. Results in De Hogeweyk High satisfaction score among residents and family (8.9 on a scale of 10) High satisfaction among personal (7.6) High satisfaction among volunteers (7.6) Sherbrooke International Life Sciences Summit September 2015
  72. 72. Results in De Hogeweyk - No nursing home stigma, but a sense of normal life. - Less anti-psychotics : 1993: 50%, 2013: 16%, 2014: 13% - No bedridden residents since 1993 - Decrease in aggression by an increase in: - Space to walk around - Fresh air - Exercise - Daylight - Freedom Sherbrooke International Life Sciences Summit September 2015
  73. 73. Thank you! De Hogeweyk Living life as usual for people living with advanced dementia Yvonne van Amerongen E-Mail: yvonne@bethecareconcept.com y.vanamerongen@vivium.nl Sherbrooke International Life Sciences Summit September 2015
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