The Dutch Village Where Everyone Has Dementia | Hacker News Reader

The Dutch Village Where Everyone Has Dementia

theatlantic.com

125 pointsprawn43 comments

I have never delved into the issue, but the model that Japan and other countries have adopted where the young take care of the old, has always seemed to me the most humane and stimulating solution for the elderly. I don't feel it corresponds well with how modern society works, and my impression is that that model is fading in popularity in Japan as well, but I certainly believe there are innumerable positives to extract from that kind of care-taking.

Along with other speculation such as a seafood-heavy diet, it seems to me to be the reason that Japanese people live the longest.

(Nope, not a single thread of evidence in my post, Sorry. A quick google search somewhat agrees though)

There's some side effects of the custom as well. For example, in Japan and Korea (and possibly parts of China), the custom is for the woman to move in with the husband's family where she'll spend most of her time providing household services and attending her parents-in-law every wish. Her mother-in-law, having done the same thing is now ready to relinquish her role as the home caretaker and well...mother-in-law/daughter-in-law friction (at truly dysfunctional levels) is a common theme in conversation, movies, tv shows, books, etc.

In Korea, being cursed with a difficult mother-in-law is a leading cause of divorce.

It more or less guarantees to take women out of the workforce as they now have a house to run, take care of the kids and the in-laws. And unless you don't have kids or your husband's parents are dead or otherwise able to care for themselves, there's nothing you can do about it.

Not surprisingly Japan and South Korea have among the lowest female workforce participation among OECD countries.

It also means that incentive for higher education among women is mostly as a social marker for marriage, but then any education is thrown away once she gets married (and especially once she has a child).

This also puts enormous pressure on the husband to be the sole provider for himself, his wife, any kids, and his parents.

What about the daughter-in-law's parents? Well, they better have had a son at some point who finds a wife who will take care of them.

The list of social issues that come from this arrangement are long and madness inducing to study (or live with).

(edit) I'd add, there's a culture-bound psychological syndrome that's related to this https://en.wikipedia.org/wiki/Hwabyeong

I get what you're saying.. but "thrown away", really? Education's only purpose is work? An educated majority within society is desirable regardless of unemployment rates, and an educated mother will tend to provide with more opportunity for her children and create a virtuous cycle of good base education. That of course ideally should be provided by just as much contact with an educated father as with a mother, and I agree with the rest of what you said.

No that's true. But I think it's important to recognize education as a tool for learning and improvement vs. education as a social status marker so you can ensure you marry at the right level.

I'm frequently disappointed when some of my friends, who are otherwise wildly educated and smart, with great careers, simply drop completely out of their field for no other reason than they finally met a man who can support her at the prestige level she's worked so hard to obtain.

> There's some side effects of the custom as well.

Is this truly a side effect of the idea itself, or is this peculiar to Asian culture?

I'm a man, but if we had to care for my in-laws, I wouldn't consider this a burden. If anything, the opposite is quite true... my in-laws have always helped my wife and I through rough spots when they could.

We could adopt the custom without all of the baggage you describe, if we were so inclined.

Well keep in mind that this has two effects

1) If you don't want to care for your in-laws, there's little social safety net for them to retire on. Society is structured around this form of retirement.

2) Many women are now choosing not to get married in order to avoid being their mother-in-law's personal servant.

Here's a good writeup on the role http://msleetobe.wordpress.com/2010/06/18/on-obstacles-to-wh...

One of my Korean friends who married a Canadian man told me that one of the greatest perks of having a Canadian husband was that she did not have a demanding mother-in-law. They are legendary in Korea. Whether or not all mother-in-laws are as evil as they are sometimes portrayed, in general it is safe to say that they are somewhat more demanding, and the cultural expectations of a daughter-in-law are greater than in the mainstream Canadian context. My friend loves that during family gatherings she is a guest in her mother-in-law’s house instead of a worker serving men who do nothing but socialize and drink. She loves that she is not responsible for cleaning her mother-in-law’s house and does not have to prepare the enormous amount of food necessary for ancestral memorial rituals (and then be excluded from the ceremony because she is a woman). For her, marriage to her husband is about her relationship with her husband and not duty toward her mother-in-law.

I agree that there's cultural aspects of this. But there are always side effects of some sort. So adopting a model like this might mean that some of the unintentional side effects might come along as well.

I think the overall point is that at least one of you or your wife has to stop working to take care of your extended family.

It is the most humane for the elder, I'll agree with that. But the sheer amount of stress and expectation it puts on the next generation?

Not to mention the total nullification of privacy. Not everything I do I want my parents to see, and I'm not even gay, transgender, of a different religion than my parents, or any other controversial topic your parents might disown you for.

And you thought having kids was bad? Try dealing, day to day, with your dementing parents that shit themselves and do not recognize you anymore.

Indeed! As i said in my original post, I find it extremely hard to reconcile the Japanese model with modern society.

As a community of problem-solvers I feel it's important to always describe possible causes, effects and solutions to present a clear image of a situation.

Children abuse their elderly parents. They do this by stealing their money; by neglectig them; by subjcting them to physical violence.

"Eldar abuse" is a significant cause of harm to older people.

Dementia is not a simple illness. Next time you visit a specialist dementia hospital ask why their crockery is red. http://www.bcf.nhs.uk/docs/14053_1922582528.doc

> Deliberate use of colour cues can also help significantly. For example, one study with people with advanced Alzheimer's disease showed that changing to highly visible red cups and plates led to a 25 per cent increase in food intake and an 84 per cent increase in liquid consumption. Brightly coloured toilet doors have also been used successfully in a variety of care settings to help people with dementia find the toilet independently, and more readily.

But these losses of visual ability are masked when someone is in their familiar home. People don't realise that the older person can't see the mug - they just assume the older person is not thirsty.

> Children abuse their elderly parents. They do this by stealing their money; by neglectig them; by subjcting them to physical violence.

I am taken back by your formulation here. Do you imply that children abusing their parents is the norm?

Your question prompted me to look again.

http://www.bbc.co.uk/news/uk-24399139

It seems I was wrong!

> Of these, 38% of the alleged abuse took place in the older person's home, while 45% took place in a care home.

> Physical abuse and neglect were the most common types of abuse reported.

> In 6% of cases the alleged abuser was the older person's partner, in 16% it was another family member and in 37% a social care worker.

There are many other reasons, many elder people are very active physically especially when compared to NA car/suburb lifestyle. This summer I hiked climbed quite a bit in Japanese alps and was struck by number of people in their 60s-70s with massive backpacks, hiking up scary trails at 2-3k elevation. Sometimes I felt scared for them(a couple that we passed on a really scary traverse in rain and lashing wind, both were probably late 60s early 70s?). That are has about 30 lethal accidents a year and since one has to die anyway, might as well fall to your death doing something awesome. This is absolutely different then when I hike climb in Rockies for example, there are always few really hardcore alpinist/climber old school guys in their 60s but almost no retirees doing anything past trailer camping.

On less extreme side, my inlaws play mallet golf religiously. Wake up every day at 6am then they spend most of the day walking around playing, they have a whole room dedicated to their trophies.

Parents usually live alone but close to their children. I think the biggest factor is that most of the elderly don't just sit at home on vacation once they retire. Most people participate in some kind of class to keep their minds sharp. My volunteer Japanese class is almost entirely made up of retirees.

I don't want to burden my kids like that. If that was the only option, I'd make sure to have an "accident" before I reach the point where I can't take care of myself any more.

Having watched the disease developed up close, the problem is that there is a very good chance you'll never be aware that you can't take care of yourself or even that you are approaching that point.

Or just tell it like it is. http://deadatnoon.com/ As I watch my mother go from 'mild cognitive impairment' to dementia and now Alzheimer's, I think this is the path I want to take when it's time.

Japan also has a strong social bond culture where elders will stay friend and meet often making their lives much more meaningful. Seen in a documentary.

Senior care is actually quite innovative. The Pebble Project (https://www.healthdesign.org/pebble) works on design of healthcare facilities to promote patient safety (among other things). I attended a lecture by one of the directors, he talked about things like lining dementia units with dark tile. Dementia patients like to walk and often will wander away. The contrast between dark and light tile creates a sense of water or a hazard, and patients tend not to cross it. So at the entrance and exit of nursing units, at doorways to medication rooms, they lay a row of dark tiles to prevent wandering.

Inconsistent spelling of names in the article: is it Hogeway or Hogewey? (It's Hogewey. Or De Hogeweyk, which is the name of the fake neighbourhood, whereas Hogewey is the name of the nursing home operating in it.) And the town it's in is called Weesp rather than Wheesp.

Other than that, cool article. It's not far from where I live, but I'd never heard of it. Hard to get in, apparently. I hope they open more places like this before my parents get to the point where they might need it.

After reading several articles on euthanasia in Dutch papers, I get the impression that quite some people seem to think going to a nursing home is worse than dying (and a substantial part of them thus see euthanasia as a good alternative).

Last year I had to return to Belgium, where I grew up for the most part, to say my goodbyes to my grandfather. He had been diagnosed with mesothelioma and decided at his age he had lived a good life and was opting for euthanasia. I'm pretty Americanized at this point, and being away from the openess of this option made it quite tough - even though I have been pro giving people this option. While not a direct correlation to a nursing home, he didn't want to spend the last of his life in a hospital bed, receiving treatment - instead he opted to use the good time he still had and spent it with the family, and even went on a cruise to Norway that he and my grandmother had wanted to go on since when they first got married but never had the opportunity to go.

I think part of the mentality is that he got to go out on his own terms, with a sound mind, and knowing he had taken care of everything he wanted to - and living in a home is a burden and not a pleasant way to spend the remainder of your days, wondering who will visit you and when.

I thought this was a fairly common attitude all over. After seeing my grandparents go through it, I'd definitely prefer to just die right away rather than live out the rest of my days in a nursing home. Maybe I'd change my mind once faced with it... but of course the big fear is that I'd no longer be capable of making the choice.

Would you mind elaborating a bit on what's bad about it? I've been to a few retirement homes and they seemed reasonably nice places, but I don't think I've visited a nursing home.

Imagine a day care where the children never get picked up, need to sleep there, and cost is the biggest factor except for in a very small percentage of facilities.

Now replace every child with an octogenarian who hasn't seen his family in six weeks, or maybe just saw his family yesterday for his birthday but doesn't remember at all. Replace the apples and letters on the walls with Cardiograms and notices about patient safety and how dedicated the employee who was on the shift when your grandmother's wedding band went missing is to her care.

It's a problem that a lot of people want to ignore because it really is hard to think about it.

It greatly depends on the nursing home and possibly how much money you had going in.

My grandmother was in one, in the 90's, and it was quite a nice place with an active social life (which she pretty much ignored, because she had lots of family around).

Very interesting article.

Nitpicking: Why do they give the cost for this solution "per month", and then for comparison the costs in the US "per day" and "per year"? Did they choose to make it harder to make a comparison??

Agreed.

Hogewey = $8,000/month or $96,000/year.

US Average = $90,500/year.

Perhaps their comparison was to point out that for roughly the same cost, you get much better care (outcomes) in the unique facility.

Yes, that was confusing. It's not hard to do the math, but the comparison would have made a lot more sense if they'd done it in the article.

Its CNN. They convert between rocks, limbs and miles, so this should be easy.

Here's some photos of the village: http://www.allgenerationscare.com/amazing-village-designed-j... it's in the small town of Weesp, in Holland. It's a really neat, self-contained world with restaurants, cafes, supermarket and more. Doors are kept unlocked and residents have the freedom to go out within the village whenever they please. Though it does look like an expensive facility, I'm sure there are ways to make it more affordable in other areas of the world to accommodate more of our aging population that suffers from dementia.

Did anyone else figure out this comment, or is it just author bias?

"But because cost is one of the greatest barriers to making self-contained villages the standard in dementia care, it would be extremely difficult to implement in a non-socialized healthcare system—meaning that in the U.S., a facility like Hogewey might be impossible for the forseeable future."

From other parts of the article:

"The cost of care [at Hogeway] is nearly $8,000 per month..."

"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" => $7541.67/month

So, the average cost in the US is the same, but "due to the high cost" the US (with its non-socialized medicine) could never build a comparable program?

FTA: 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.

I'm pretty confident that the healthcare system in the US would not be able to bring down the cost down to ~4k/family.

> But because cost is one of the greatest barriers to making self-contained villages

I think they're talking about up-front capital, not recurring/maintenance costs, but it's hard to tell since we don't know whether the $8,000 a month includes the amortized costs...

If you are interested in more images or detail, the village is called 'Hogeweyk'(meaning: higher area/borough), not Hogewey or Hogeway as the article states.

'Weyk' is old Dutch for 'wijk' (area/district) which is smaller than a borough.

In the town Sliedrecht there is also an area called 'Merwebolder' which is a small 'wijk' for mentally disabled people housing around 400 people.

It's just a name, you're reading too much into it. Katwijk also ends with "wijk" and is home to 60k people.

No "wijk" is the dutch word for a neighborhood of a few streets. Or a small block if you prefer. It just so happens a few towns used that suffix, a nimble expression.

Wow, this was a great read. I live in The Netherlands and was unaware of this project. Too bad it's one of a kind and only accomodates so little people; I'd love to be cared for in this way should I ever need it.

For the Dutchies, a report which aired on Dutch TV a few weeks ago: http://journalistiek.npo.nl/dossiers/ouderenzorg/290_84312-r...

I live in the Netherlands too, and I also never heard of it. But what I understand from it, it's not really a village, it's just a large complex in the city of Weesp (the article misspelled it as "Wheesp"). Despite having never heard of it, it saddens me we don't have more of these style of nursing homes. Last year my grandma passed away as a result of Ahlzheimer disease, she spent the last year of her life in a traditional nursing home, which was a really depsressing place, she would been far better of in a place like Hogewey.

Both my grandmothers spent about a decade each in nursing homes due to Alzheimers. Both of them had clearly been trying hard to conceal their dementia for several years prior to that, because they were terrified accepting that something was wrong, and terrified of ending in a nursing home.

Once things had gone so far that they could not take care of themselves, and could not manage with the help of their spouses, they just fell apart within months.

CNN World published their item on YouTube:

Untold Stories: Dementia Village

https://www.youtube.com/watch?v=LwiOBlyWpko

Reply on news.ycombinator.com