• Sunday , 24 September 2017

The Terra Incognita of Dementia in An (in)Authentic World

Hogeweyk Super. Supermarket at Hogeweyk, the Netherlands. Source: author's own. Hogeweyk Super. Supermarket at De Hogeweyk, the Netherlands. Source: author’s own.

Until now, architects have designed buildings that attempt to ‘house’ people with dementia. Being taken from your home and admitted to an unfamiliar nursing home environment, is a potentially frightening experience that can cause confusion, disorientation and aggression in any patient. As the disease progresses, it is difficult to relate oneself to the world surrounding and often a person can feel lost and alone. This causes a very particular way of experiencing and negotiating space.

Music Room, De Hogeweyk, the Netherlands. De Hogeweyk employs strategies which optimise the functioning and quality of everyday life. There are 35-40 clubs including arts and crafts, flower arranging, music, baking, and reading. This helps to sustain a healthy and active lifestyle as well as offering residents the opportunity to continue doing the things that they did before their arrival. Music Room, De Hogeweyk, the Netherlands. De Hogeweyk employs strategies which optimise the functioning and quality of everyday life. There are 35-40 clubs including arts and crafts, flower arranging, music, baking, and reading. This helps to sustain a healthy and active lifestyle as well as offering residents the opportunity to continue doing the things that they did before their arrival. Source: author’s own.

De Hogeweyk is a model village situated on the outskirts of Weesp in Holland which offers an alternative lifestyle to those suffering with dementia. Verging on the experimental, residents live in categorised lifestyle home choices, unaware that their orderly community is actually a nursing home for people with severe dementia. Founded almost twenty years ago, the village was designed by architects Molenaar & Bol & Van Dillen. It occupies a four-acre site and is a complex consisting of several green parks with ponds, a long boulevard, cozy side streets, an indoor theatre, a supermarket, hairdressers and a number of small cafes and restaurants, all staffed by non-uniformed carers. De Hogeweyk is praised for providing the quintessential antithesis to the frighteningly institutional atmosphere of a standard care home. Avoiding any resemblance to a hospital or care home, the architectural design of De Hogeweyk is methodically thought out. For good long-term care – design is key. It promotes activity, social interaction, independence and outdoor engagement. There are a total of twenty-three small homes in De Hogeweyk, accommodating up to 152 senior citizens, accepting only those who have been diagnosed with severe dementia. Everything about the community, from its layout and its shops to its antique décor and style, is geared toward creating an environment that is as close to home as possible for all inhabitants.

Typical Floor Plan, De Hogeweyk, the Netherlands. The plan of each household in De Hogeweyk varies, although each one has either six or seven bedrooms, two bathrooms, a kitchen and living area, and one shared occupancy room for those who prefer company. Source: author's own.

Typical Floor Plan, De Hogeweyk, the Netherlands. The plan of each household in De Hogeweyk varies, although each one has either six or seven bedrooms, two bathrooms, a kitchen and living area, and one shared occupancy room for those who prefer company. Source: author’s own.

Dining Room, De Hogeweyk, the Netherlands. Each household decides on its own meals; there are no menus. Residents eat dinner at a table with normal plates and enjoy the smells of food cooking in the kitchens of their own homes. Source: author's own. Dining Room, De Hogeweyk, the Netherlands. Each household decides on its own meals; there are no menus. Residents eat dinner at a table with normal plates and enjoy the smells of food cooking in the kitchens of their own homes. Source: author’s own.

Architecture is a profession that encounters ethical dilemmas almost continuously in the course of designing and constructing buildings. Designed to lead residents to believe that they are living in a version of the past, De Hogeweyk raises the question of deception in architecture and how we design for those with cognitive impairment. A land of make-believe, the design of De Hogeweyk approaches the menacing hyper reality probed by philosophers like Jean Baudrillard and compared to a real life adaptation of the movie The Truman Show. The Truman Show is a fake world - a kind of suburban utopia - where Truman Burbank lives, tricked by loops of spaces and stuck in routines. The film’s lead character, Truman Burbank, is in a similar position to the residents at De Hogeweyk, where every aspect of his life is controlled and influenced without knowledge. Critics have described De Hogeweyk as a place where carers take on the role of actors, with the goal of manipulating and monitoring the behaviour of residents. From the perspective of urban planning and architecture, the film makes you wonder: to what extent should we have control over our built environments. It also approaches the ethical question; to what extent are architects willing to go to ‘deceive’ people? Is De Hogeweyk the construction of an illusory, artificial world or the physical embodiment of a therapeutic lie? Can the power of architecture heal the sick? And can designs such as De Hogeweyk’s have a seemingly significant positive impact on the user or are we as a culture drifting towards a distancing of relation to reality?

Residents Bar. De Hogeweyk, the Netherlands. Source: author's own. Residents Bar. De Hogeweyk, the Netherlands. Source: author’s own.

In order to truly understand the concept of De Hogeweyk and to attain a grasp of what makes this place so special, on 21st March 2016, I travelled to The Netherlands to visit De Hogeweyk, taking part in an ‘inspirational’ tour conducted by Yvonne Van Amerongen, one of the key founders of the village. In 1990, Yvonne along with six others developed a new model which revolutionised care for people developing dementia in the vicinity of this nursing home. Before the new care model was introduced, every resident was on anti-psychotic medication. Now only 8% of residents take the medication and by next year they aim to reduce that figure to 0%. From my initial research and study of De Hogeweyk, I had a certain vision of what to expect. At first glance, De Hogeweyk looks like any other village – albeit, a securely enclosed one where residents are free to roam. The village is designed in every way to give clues to help residents understand where they are, what is expected of them in that space and which way they need to go. I could not imagine feeling lost or confused in this outdoor environment and with a carer always nearby, families know that their loved ones are safe and secure. From my brief time there, I was impressed at this alternative village which bared no resemblance to that of a traditional nursing home setting. The range of activities, interaction and care I observed, which was afforded to the residents, was nothing short of inspiring.

Boulevard, De Hogeweyk, the Netherlands. This external 'street' consists of an outdoor theatre square, a supermarket, hairdressers and a number of small cafes and restaurants. Source: author's own. Boulevard, De Hogeweyk, the Netherlands. This external ‘street’ consists of an outdoor theatre square, a supermarket, hairdressers and a number of small cafes and restaurants. Source: author’s own.

As our population increases, so does the proportion of elderly people and therefore the need for more long term care solutions. Looking ahead to the future, we have to think about new living solutions for those with dementia. We should seek to transform the type of institutional care that we currently provide. As a result of my visit to Holland, I believe that the quality of life for those with dementia can be improved in facilities like De Hogeweyk. My visit brought about a whole new way of thinking for me as to how we, as architects, can provide a therapeutic environment. Places like De Hogeweyk can be instrumental in turning something so sad into something hopeful, where one can feel safe and protected in his/her surroundings. More often than not, traditional nursing homes don’t quite live up to modern day society’s expectations for our loved ones, becoming the terra incognita (or unknown land of dementia), a frightening place leading to the irreversible decreation of oneself.

Exterior Plan, De Hogeweyk, the Netherlands. The exterior landscape provides a route for residents, making it navigable and legible. There are landmarks such as ponds and fountains, occupied by ducks in springtime, giving residents familiarity with their surroundings. Source: author's own. Exterior Plan, De Hogeweyk, the Netherlands. The exterior landscape provides a route for residents, making it navigable and legible. There are landmarks such as ponds and fountains, occupied by ducks in springtime, giving residents familiarity with their surroundings. Source: author’s own.

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