A Dutch Village Where Everyone Has Dementia (2014) | Hacker News Reader

A Dutch Village Where Everyone Has Dementia (2014)

theatlantic.com

98 pointsElFitz79 comments

I found this excerpt mildly annoying:

  The cost of care is nearly $8,000 per month, but the Dutch government subsidizes the residents—all of whom receive private rooms—to varying degrees; the amount each family pays is based on income, but never exceeds $3,600.

  To put it into perspective, a private room at a U.S. nursing home cost an average of $248 per day in 2012, or more than $90,500 annually—a figure that’s even more staggering when applied to the rapid increase in dementia patients globally.

Making me do the math in my head only to find out that the private room in the US is actually cheaper than the Dutch one (at $96,000/year) feels pretty misleading. Sure, I bet the quality of care is much much better than what you'd find in the average US nursing home, but that's exactly why you don't need to be sneaky with the numbers!

It’s cheaper but the government isn’t paying for more than half of it, I guess that’s the comparison. Poorly written though, for sure.

Sure, but subsidizing elderly care is a different discussion than how the elderly care is carried out. I'm sure the Dutch government would also be capping family expenses at $3600 even if this was just a run-of-the-mill nursing home we were talking about.

How much of that figure is paid by the government/insurance? I think it's more about comparing the costs that are actually paid by patients.

The family of the patient never pays more then €43,200, and probably more close to half of that for most the families.

I agree that was purposely chosen to hide the comparison

It's also off by a factor of 10 on the residents side. Not sure where that figure came from, and the residents do not have much privacy, they live with 6 people to a home, which has a fixed team of caretakers.

The amount of money that the families pay is considerably lower, though ($43,200/year). Though honestly, that's still a lot of money.

Especially if you adjust for Dutch salaries which are on average lower than American salaries.

Isn't that driven up by more extreme outliers in the US? From my expertience "on the street" the people of the Netherlands generally seem better off.

The people are better off in the median because there's more social services, but that means higher taxes and lower net income. Which makes paying x amount even harder.

From my quick searches it looks like people in the Netherlands have about double the bank balance, again on average, than people in the US.

I'm not sure why being better off makes it harder to make purchases? The social services actually help people, they're not just a money vacuum.

The social services help people, but having to spend an amount for additional services on top of what you already pay more than Americans is extra hard, no?

No? I disagree. If people are safe, healthy and comfortable then they're in a better position to cover their costs.

Reaction: Lovely - but the article notes that it has 152 residents, vs. 250 full- and part-time staff. If more than a very small percentage of a country's older folks develop dementia, and the country's population is not growing exponentially...then such well-staffed solutions are physically impossible to implement at scale, for lack of working-age care staff.

I don't think that's clear at all.

Working age adults work from their early 20s to their 60s and end of life care does not typically last that long.

EOL with dementia can linger for well over a decade, and it only gets more expensive as it goes on.

Most people don’t experience dementia, and most of those who have it don’t need such extreme care. Taken to an extreme, this radio suggests under 5% of a steady state population would either have significant dementia or need to treat it. But again most such people are cared for by family members.

The point of this Village is to minimize the cost of treating significant outliers while maximizing their quality of life.

So it would need to scale out to 10s of thousands, no?

If everyone with dementia went to such a facility then we would need ~30,000 of them in the US. However, most people with dementia either don’t need such extreme care or have more severe medical issues, so the real number is probably a several hundred such facilities.

To compare, there are about 4,000 Walmarts in the USA. Each employs about 300 people.

>Most people don’t experience dementia

>In the first nationally representative study of cognitive impairment prevalence in more than 20 years, Columbia University researchers have found almost 10% of U.S. adults ages 65 and older have dementia, while another 22% have mild cognitive impairment.

https://www.cuimc.columbia.edu/news/one-10-older-americans-h...

https://jamanetwork.com/journals/jamaneurology/article-abstr...

Sure, though don’t forget 1/4th of American men don’t live past 65, and less than half make it to 79. Dying young isn’t necessarily preferable, but it does impact these statistics.

Dementia is the between the 3rd and the 5th largest cause of death in first world countries, depending on the country, and how you count. Most people aren't currently experiencing dementia, but there's a very significant chance that you're going to end up with it eventually.

The actual question should not be what percentage of the population has it; the question should be what percentage of people will be suffering from dementia to the point that they need assisted living care when they die.

My father has dementia. I have some hope that robotics together with AI will make good caretakers for people with dementia. Interacting with him is not very complex. It’s basically just a repeat of the same conversations. Very labor intensive for humans but an AI would have way more patience.

Rather more like infinite patience.

Interesting to hear someone articulate this dynamic. I do not believe my father has dementia but there are similarities in regards to “repeat of the same conversations”.

Wish you and your family well.

My mother has dementia. At present, conversations repeat on about 3 minute intervals. There is significant value to catching early signs of dementia.

What is the value in catching early signs of dementia given that we have no useful treatments for it?

Getting prepared for what is to come for everyone involved?

You might want to read Drop Acid by Perlmutter, stuff about sugar by Robert Lustig and maybe Fiber Fueled by Bulsiewicz. They give pointers to why Alzheimer might happen in the first place and how to avoid it. Those are life-long advices.

There are no cures; but there are treatments that can delay onset, slow progression, and improve quality of life to varying extents depending on which disease.

There was a great post here recently about automating some of this work.

https://news.ycombinator.com/item?id=35749579

Wow, yeah, I've never thought about this use case for AI. Honestly seems pretty ideal. A relative of mine afflicted with dementia recently passed, and while they still needed physical care, an AI "person" to bounce questions off of and talk to would have done wonders for them, and saved their carer a lot of stress and effort in a difficult time.

Someone here built an amazing tool for this. They should commercialize it https://news.ycombinator.com/item?id=35749579

I can understand the impulse, but boy do I hope my family won’t turn me over to a computer in my dotage. I’d rather be loved than managed.

I would hope the solution would be both... humans augmented by computers so that the humans aren't overloaded and overly burdened.

Love is a burden no way around it. Some burdens are worth carrying however.

We'll just need to create an AI that'll emulate love semi-perfectly.

Let us reimplement love in Rust from first principles to solve this inconvenience. Nothing can go wrong, it’ll be so disruptive and innovative.

Don't engage in negative sum transactions. The burden on families by a dementia patient is often higher than the benefit the dementia patient gets.

Caring for a dementia patient properly is all consuming for the caretakers. You don’t want to do this to your family. Getting help from a robot would be a win win for all.

Seriously. My grandpa had dementia for 10 years. Pretty much everyone in my family doesn't want to inflict that on anyone else.

Senile people are going to love the AIs of 10 years from now, I guarantee you. Once it has perfect audio control and responses, it's going to be like the perfect friend for an old person.

I always thought healthcare for people is not well suited for humans to do. Doctors, yes. Everything else, no. It’s such a demanding job for nurses and hospice care workers to deal with such terrible human situations. Sadly, it will probably be decades before robots could take over for nurses

What's a problem now that won't be around in 2070? Elderly and the disabled...

What's the patient to staff ratio at typical elder-care facilities?

Covid "solves" long-term care sadly.

One worker insists on going to work anyway knowing they are sick because they need the paycheck and no health insurance or days off, and wipes the place out a few weeks later. Top that off with states that insist on allowing workers to not mask and it's almost on purpose.

Ironically covid may also cause a surge in dementia years from now so it's an ouroboros.

Dementia is often horrible and I shouldn't joke about it... but I read this headline and immediately thought it sounded like my kind of town. :-)

More seriously, this town is a beautiful, compassionate idea and I'm glad it's there.

Here in the United States, the final years of a person's life are usually overwhelmingly expensive. Either paying many thousands of dollars per month in an assisted living facility, or paying almost nothing to a family member who sacrifices their own life for a time to provide care at home.

I've seen great results in mixed-generational care, where childcare and elder care have close interaction at least a couple of days per week. Amazing improvement in the elders living in relatively modest assisted living homes, and possible to provide at scale, more commonplace... But a global pandemic shut that down hard.

The costs quoted in the article are not at all in line with the costs that the facility quotes:

https://www.vivium.nl/zorgeloos-wonen-concept

More about this particular facility:

https://www.vivium.nl/verpleeghuis-dementie-hogewey-de-hogew...

Also, pretty sloppy to quote the name wrong in the article, it's not 'Hogeway' but 'Hogewey', the difference in dutch is between 'road' and 'meadow' (the latter in a weird spelling). On the facility website they also use 'weyk' which has yet another connotation (borough).

I've seen and am seeing some family members and close friends at very advanced age go through this. They are utterly unaware that they are dementing, to them everything is fine and their memories of the things that go wrong fade so fast that you can't really have a meaningful conversation on the subject. Some 80+ year olds are sharp as can be, but they are the exception around me, the default is a body that is still there coupled with a mind that is slowly leaving, too slow for the mind itself to notice.

Good genes may help keep your body alive but without a mind to go with it I'm not sure whether that's worth it. Personally I live in fear of ending up like that, depending on others for even the most basic needs.

They also wrote Wheesp but it should be Weesp.

Indeed, I've never before seen 'Wheesp'. Makes you wonder how that happened.

I just had auto-correct change Philippines change to Philistines, so maybe it was something like that.

Some funny math there saying it only costs $8k a month and then saying US costs an astonishing 90k a year. Do they realize 8*12 is 96k a year?

More than half that cost is subsidized. The maximum cost to residents is $43k, and it is on a sliding scale based on family income.

I think the comparison is between a lovely Dutch village in which the residents live comfortable fulfilling lives and whatever the hell it is that’s happening in US elder care facilities. Like an awful lot of things, it seems like the Dutch are getting a heck of a lot more for their money than we are.

Do HN users just generally prefer to talk about whatever interests them, while totally ignoring the article they are allegedly "commenting" on?

There was nothing in the article about robots or AI, OK? Maybe that's what you like, but this article isn't about that.

Current estimates are that ~6M people in the US have dementia today, out of a population of ~340M. Let's call that about 2%. Immediately obvious conclusion: There is not shortage of population to serve as caregivers.

What there is a shortage of is anyone who would actually want to work in a US dementia care facility. It's one of the lowest paid, least appreciated and most grueling occupations. Emotionally grueling as well as physically. How many 80 year old's butts did you wipe on Zoom today?

In spite of this, most staff I encountered were dedicated to the residents.

Maybe you're ready to lock your senile parents in a room with a robot dog, but I'm here to tell you that the human interaction is one of the only decent things in US assisted living. This is 100% from the people n the trenches. Healthcare ownership are bloodsucking jackals. Once you remove that person to person contact, the only thing left is ownership exploiting the defenseless.

> Do HN users just generally prefer to talk about whatever interests them, while totally ignoring the article they are allegedly "commenting" on?

Yep. Users frequently treat the link title as a writing prompt rather than clicking through to read the article. This can generate pretty jarring results if there are several different ways to interpret the title.

Now ask yourself: how do you know you are not already a resident of a village like that?

I don't know anything about dementia but I gotta wonder how many people with it would even contemplate such a question.

Signs to look for:

1. romantic opportunity stolen by a beachfront kidnapping by your love interest's father, who she claims not to know.

2. your father's untimely demise in a sailing accident.

3. falling lighting equipment, e.g. like a light to represent the dogstar.

4. radio station peculiarly addressing your specific concerns.

5. your wife and friends always enthusiastically endorsing particular brands.

6. no near future departures for Fiji at your local travel agent.

Alternatively:

1. Only local maps being available.

2. Being addressed as 'number six'.

3. Being followed around by eerie white ball things.

4. Everything looks like the 1960s.

Why would I care?

Remember, this is going to be "it" instead of full-on science-driven "war on Alzheimer's".

It is not that we cannot do more; it looks like the US public & private investment arms decided to avoid maximizing the research bandwidth available, with many life sciences grads not being able to find a research job.

A shame, really, given the inflation happens anyway - except that without spending the other side of this equation on medical R&D you stall the pipeline and rob yourself of your future.

Why is there not enough job openings for life scientists, given the urgency? Real tough question.

It has already been posted here before [1], but given how little nursing homes seem to have changed, I find it still relevant, and perhaps of interest to others who like me hadn’t read about it until today.

[1]: https://news.ycombinator.com/item?id=8616383

There are a lot of activities organised on a city/town level by the Dutch Alzheimer Foundation chapters, such as Alzheimer Cafe, Creatieve Werkplaats, Bijzonder ontmoeten, Cooking Together, Choir, hiking/walking, etc

I just visited a place called "Alzheimer's Cafe," but I can't remember the name of the place.

That's not all, besides Alzheimer Cafe, Creatieve Werkplaats and Bijzonder ontmoeten, there are also Gezellige Kletsen, Gronkelstoot Spelletjes and Zorgzame Knoetelbijeenkomsten.

That’s great. Yeah, I am aware it’s not complete. Listed a few I am aware off because my mom helped organising them. Haven’t kept up-to-date with since she passed away

Did you run that through a GPT? What the hell is a Gronkelstoot, what is a Knoetel, and don't you need to drop the -e in "Gezellige Kletsen"?!

Something fishy going on here ;)

And of course the AAA: allemachtig, achtentachtig al?

Yes. Chat GPT 4!

On a side note, getting the shingles vaccine may lower the risk of dementia by 20% in women: https://web.archive.org/web/20230613022921/https://www.natur...

Shingles is an awful affliction, so if you or a loved one is eligible for the vaccine, then you may also be helping to prevent dementia by getting it.

I continues to concern me that we spend enormous resources on people who cannot appreciate them (the old, the severely disabled) but nothing on normal people...

Maybe they cannot appreciate them but I kinda appreciate the society won't just let me die if I become disabled or old.

This is true even though I am 100% intent of getting euthanasia one day.

I think we absolutely will just let most people die when they get sick and disabled unless you fall into one of these special groups. If you need 2k a month for insulin and cannot afford it, you will absolutely be allowed to slowly die because you are not old/disabled enough to be saved. But 10k a month for a special village because you checked-out with dementia? Sure!

Sorry to be the kill joy...

Some people with dementia get violent. I bet it isn't a pretty sight when a bunch of 80 year olds start fighting over who stole Theodore's false teeth!

Or tabs versus spaces. It's best just to hide the keyboards after 78.

After 78 characters on a line... right?

My grandma has Alzheimer’s disease.

I want to be euthanized if I ever get that. So do my siblings and my parents. Euthanasia is illegal in my country and my grandma never agreed how to proceed once she gets severe dementia but what she has is simply a hell not a life anymore. Not only for her but also for my mom. Terrible disease.

I had forgotten about this story.

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