August 8, 2025 • 24 mins
What if we completely reimagined dementia care? In this eye-opening episode, Bob Mannor and Amy Persails take you inside their extraordinary visit to Hogeweyk, the revolutionary dementia village in Amsterdam that's transforming traditional memory care. This unique approach to elder care champions dignity, freedom, and quality of life for people with severe dementia, offering a new perspective on the challenges caregivers face.
Within the cobblestone streets of Hogeweyk, you'll find real grocery stores, restaurants, and pubs—not just window dressing but symbols of a fundamental shift in philosophy compared to typical American facilities. Here, residents are encouraged to wander freely, make choices, and embrace normalcy, significantly reducing the stress and agitation that often accompany traditional dementia care.
Remarkably, Hogeweyk experiences virtually no sundowning or agitation, achieving this not through medication or restraints, but by fulfilling fundamental human needs for autonomy and respect. One resident follows the tour group for hours, happily engaged and content, challenging our conventional practices that often misinterpret such behaviors.
The living arrangements further illustrate this revolutionary concept. Residents share homes based on their cultural backgrounds and prior lifestyles, fostering a sense of community. With just one caregiver per household during the day, and no overnight interruptions, residents enjoy restful nights, contrasting sharply with many nursing facilities.
Join us as we explore this transformative model of dementia care that may reshape your understanding of elder care. For caregivers, families, and professionals alike, this conversation prompts us to reconsider our most basic assumptions about memory care: what if freedom, rather than control, is the key to improving lives?
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Host: Attorney Bob Mannor
Guest: Amy Persails, CECC
Executive Producer: Savannah Meksto
Assistant Producer: Shalene Gaul
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ABOUT US:
Mannor Law Group helps clients in all matters of estate planning and elder law including special needs planning, veterans’ benefits, Medicaid planning, estate administration, and more. We offer guidance through all stages of life.
We also help families dealing with dementia, Alzheimer’s disease, Parkinson’s disease, and other illnesses that cause memory loss. We take a comprehensive, holistic approach, called Life Care Planning. LEARN MORE...
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
You're listening to Advice from your Advocates, a
show where we provide elder lawadvice to professionals who work
with the elderly and theirfamilies.
Speaker 2 (00:10):
Welcome back to Advice from your Advocates.
I'm Bob Manor.
I'm a board-certified elder lawattorney in Michigan, and
today's topic is something thatI know a lot of.
You've been talking about thisfor a little bit and mentioned
this to a number of guests onour podcast that we had an
opportunity to go to Amsterdamand visit the dementia village
(00:31):
which is called Hokevik in theNetherlands, and it was a really
great opportunity to see adifferent way to plan for and to
care for dementia plan for andto care for dementia.
And so fortunately we were veryfortunate that it wasn't just
me, amy Persales, who is ourplanning services director, and
(00:53):
Kelly King Penner, the otherpartner in the law firm.
All three of us got to go with agroup of lawyers and social
workers who were able to look atand observe this dementia
village in Amsterdam.
It is the first dementiavillage and there are a few
places in America that aretrying to repeat this and
(01:13):
there's other places throughoutthe world that have you know,
are trying to repeat the successof Hogevik, and a lot of you
have heard of this.
You've read articles, you'reexcited about it.
Some of you put it on yourbucket list to go visit.
We experienced because it was sotransformational as far as our
(01:47):
thought process, and so I haveAmy here, who also did the tour,
and it was a multi-dayexperience where we were able to
really immerse ourselves intothe Dementia Village.
I thought it would be useful,instead of just me talking about
it, to have Amy here and kindof explain what we experienced
(02:07):
there, because it's a wholedifferent way of thinking about
caring for dementia.
So, amy, the first question Ihave for you is what are your
initial impressions of when westarted out at that, the first
day at Hokevick?
What were your initialimpressions?
Speaker 1 (02:26):
It was overwhelming.
I would say first the villageitself, the first interaction
that we had, and we saw a fewresidents walking around, but we
were taken into this theaterarea where they gave us more of
a background, some rules, nopictures.
(02:47):
Right, no pictures, just a lotof things that were very
enlightening.
Speaker 2 (02:51):
It was not a tourist opportunity to take selfies and
promote yourself.
That was not what this villageis about.
It's really about the residentsand it really is about the
residents.
Everything we saw was about theresidents.
So I want to expand on what yousaid about going into the
theater in the first day, thatwe kind of started there and you
know I'm a person that has lotsof questions, always right, I
(03:15):
can't help myself if they starttelling us about what's going on
and I just have questions.
And so I started asking allthese questions and they were
kind of like well, just wait andsee, wait and see, you know.
So I had questions like well,what happens when family visits?
Ok, but what happens ifsomebody falls?
But what happens if you knowwhat happens at night, you know?
(03:36):
And they were just OK, yep,we're going to answer all those
questions, but wait and see.
And I wasn't satisfied with that, but I was once I waited and it
was very interesting becauseall the questions I had
particularly as a lawyer,because lawyers tend to be very
skeptical about things and theywere all answered by observing
it.
So I want to start off with astory about our experience,
(04:02):
because I think they broke us upinto a couple different groups
and we had, you know, a guide.
One of our guide was one of thefounders, and then there was
another very talented andwell-spoken guide, so we had the
second one and she was great.
So we were just going to walkaround the village and they made
a point of you know, this isnot a tourist attraction.
(04:23):
We're not going to be takingselfies, we're not going to go
out, we're going to talk andpeople are going to interact
with us.
Tell us a little bit about ourexperience when we, you know,
kind of started our what wewould have said is a tour, but
really was just walking aroundthe village about the folks that
came up and kind of joined ourtour.
Speaker 1 (04:41):
They did tell us that some people may walk up and
join our tour, but until youexperience it, you just don't
understand what they'reexperiencing.
And we had a nice lady thatwalked up and this was our tour
guide and she explained.
You know, we were from Americaand In Dutch.
Speaker 2 (05:03):
Yes, because the person didn't speak English.
Speaker 1 (05:04):
She didn't speak English.
She didn't speak English.
She explained to her in Dutchand she told us after what she
talked to her about and invitedher along if she wanted to tour
with us.
And she did.
She stayed with us almost thewhole time.
She walked around with us.
She was very engaged and Iriswas speaking to us in English
(05:26):
the whole time.
She would stop and have aconversation here and there, but
the woman was very engaged.
She walked around with us.
She was just a part of her day.
She was enjoying herself andthey liked to have visitors.
All of the residents werefriendly.
Everyone just enjoyed havingpeople there.
Speaker 2 (05:49):
So and I know this is challenging so don't, if you're
a caregiver, if you work in thelong-term care industry, just
stop imagining how we might doit here first and just accept
how they do it there.
Let's just look at it that wayfirst, and then we can talk
(06:12):
about how some of it might beadapted here.
Because I know, as people inthe caregiving industry would be
like, okay, you allow them towander aimlessly?
And the answer there was yes,we do allow them to wander, and
it was built like a traditionalDutch village allow them to
wander.
And it was built like atraditional Dutch village,
meaning it was cobblestone,right, so not the safest
environment to be walking on.
We're going to talk a littlebit about that as far as safety
(06:32):
and all of that, in a minutehere, but I want to talk a
little bit about our visitor.
Amy and I have both visited alot of memory cares, a lot of
great places, and they're doinga fantastic job.
But the typical answer when apatient or resident you know
starts, you know, being curiousabout what we're doing is they
try to distract right.
(06:52):
Distract is a word that we usea lot.
I've used it so many times totry to help families understand
how okay somebody's gettingagitated, let's try to distract
them.
Distract is not a word they useat Hokebeck.
I was amazed by this.
She would stop our tour andanswer her question.
(07:13):
Now she later shared with ussome of the times that she was
talking in Dutch and this was anative Dutch speaker.
Right, iris is a native Dutchspeaker.
She said she was not speakingin ways that I could understand.
It was and this might be notthe best way to say it, but what
I would call gibberish.
She was not speaking in a waythat she could respond to, but
(07:33):
she was very patient, listenedcarefully, spoke to her and then
would stop our tour to talk toher.
There was such a respect forthe residents there and patients
there and never dismissing them, never distracting them to the
point that I had a question.
So before I tell you about thequestion that I asked that got
(07:55):
shot down pretty good, I wantyou to tell a little bit more
about the village with regard tothe grocery store and the bar
and the pub and the music centerand all the rest of the stuff.
Speaker 1 (08:07):
It was amazing.
So research online?
Right, we do research online,we check things out and I
thought, okay, a grocery store.
The questions were how doesthat work?
Speaker 2 (08:18):
Is it?
Speaker 1 (08:19):
fake.
Is it fake?
Do they just bring the stuffback after they take it?
No, they buy their groceriesfor that day, the meals for that
day, they plan out.
They have a caregiver in thehome.
Talk about the different typesof homes and there is a
caregiver in the home that theycome in and they discuss what do
(08:42):
we want to have to eat today?
And they prepare and plan theirmenu for the day and they go to
the grocery store.
So someone you know, a few ofthe residents, may go with them
to the grocery store and theyactually buy their food from
that grocery store and they justkeep a tally for the house to
(09:02):
determine how much they spentthere and whatnot.
But if a resident goes into thegrocery store and takes a box
of macaroni and cheese, they cantake a box of macaroni and
cheese and take it back to theirhome and prepare it or whatever
they need to do with it.
But there are real.
There's milk, there's bread,everything that you would think
(09:25):
of a grocery store.
Now it's very small stocks andthey have fresh vegetables and
fruit and all of the things thatthey have brought in.
Even they said that otherpeople from other communities
come there to grab a gallon ofmilk to take home.
Speaker 2 (09:39):
that day you can come in from the community and get a
drink at the bar.
You can go to the grocery store.
Yeah, go to the restaurant.
Speaker 1 (09:46):
Yeah, it's just amazing, and the activities that
they have the music center thetheater, they have movies, they
have tons of open outdoor space.
So when it's nice outside whichit was when we were there it was
beautiful weather and they justwalk around outside.
One gentleman watched him forthe two days that we were there
(10:09):
and he just walked around.
Once in a while he would stopand speak with someone, but he
just walked around and that'swhat he wanted to do.
He just, he just walked aroundand that's what he wanted to do.
And, um, you know, he was happy, he was very happy with that,
just walking around.
And honestly, I would be thesame way, you know, if you just
(10:33):
let me, don't lock me in a room,let me let me walk around and
have interactions with people.
Speaker 2 (10:35):
It was just very nice to see that.
So I had a question, cause Iwas still kind of stuck in the
way that we do things here, andso we were standing outside the
grocery store and so I talked toIris and I said I'm not really
understanding this, so what ifsomebody comes in?
So before I go on to this story, we want to make it clear these
(10:57):
are not light dementia, this isnot early dementia, so they
have in the Netherlands.
They are not light dementia,this is not early dementia, so
they have in the Netherlands.
They have definitions of levels, and so the top two levels are
five and seven.
I don't know why they skip six,but they do.
So there's five, and five is areally high level of dementia.
Okay, you cannot be a residentof the dementia village of
(11:18):
Hokevich until you're at levelfive.
So all of the early stages ofdementia are not you can't.
So I think both of us imaginedthat they were going to be.
Oh, these are folks that youknow maybe they need a little
help, but they just need alittle guidance, but they really
don't.
You know, they're not reallysevere dementia.
These were severe dementia andit's a requirement that you be
there, and so my question wasokay.
(11:40):
So you have these folks kind ofwalking around.
I'm still not quite getting thisbecause, like in the United
States, we're all about safetyand making sure that nobody
falls.
You know, this is not what wedo for regular folks.
This is what you know.
If somebody's following mearound to make sure I don't fall
, I fall all the time.
I'm clumsy.
So you know, amy currentlybroke her ankles.
(12:04):
The idea is that's not what wedo for regular.
You know situations and yet,for some reason, when somebody
has dementia, we're like oh, wecan't allow them to have any
risk.
Okay, well, I believed that foryears and this was the.
This is why it was kind oftransformational for us to.
They're like okay, but you know, people fall sometimes.
You know that's is that that'sokay.
(12:26):
You know, if it's about qualityof life, you have to have a
little bit of risk involved inthat.
But that's not what weunderstood.
That's not what I understood.
One of the things I was likeokay, there's this grocery store
and you've got people withreally pretty severe dementia
and Alzheimer's.
What if somebody walks in andjust takes something off of the
shelf and walks out?
(12:47):
And I said, well, I imagine youjust try to distract them and
then put it back, and they don'tuse the word distraction there.
This is something I have beentelling people for 20 years now,
that when you have somebodythat has behaviors, we try to
distract them and put them ontosomething else and they're just
like no.
We deal with it on acase-by-case basis.
(13:07):
Sometimes it's something thatwe'll work with their caregiver
and it might be returned.
Sometimes we charge the account, sometimes we just charge it to
their house.
They're there, you know whichis part of their.
You know each.
We're going to talk about housesin a minute here, but each
person is assigned to a specifichouse with six to what about
(13:29):
six people in each house, and sothat was just.
You know, that was not the wayI normally expect things.
When we have what we wouldnormally call bad behavior,
their answer is well, that's notnecessarily bad behavior, we
just just deal with it.
Everybody's a little bitdifferent.
Some people we might say, hey,you know, what are we doing with
that?
Some people, that's not thebest answer because they might
get upset by it and so we justlet them take it and maybe
(13:52):
assign it to their house, ormaybe, if they have some money,
we assign it to their account.
You know, let's talk aboutbehaviors, because that was the
fascinating thing about this.
I think that was the mostinteresting thing in our office.
So we're an elder law office.
We help a lot of people with alot of different long-term care
needs, but a good portion of ourclients have a loved one with
(14:14):
dementia and what's coming upmore and more is what we call
behaviors, and that might bewandering, that might be
aggression, that might bewhatever it is, and they have
very little behaviors at Hogevec.
Speaker 1 (14:26):
We never saw it.
Yeah, why is that it's?
Speaker 2 (14:28):
not that they don't have any behaviors in Holland.
It's not that they don't haveany behaviors in the Netherlands
, it's they don't have it there.
And there's a couple of reasons, and I want to get into one of
them in a minute, but one ofthem was freedom, right?
Yes, so I'm the type of personthat needs to be alone sometimes
.
I don't always like to bearound a lot of people, and so
(14:50):
if you tell me I can't go andwalk around, you know what does
that sound like?
Wandering?
Speaker 1 (14:56):
Right.
Speaker 2 (15:01):
And so if you tell me I can't, they would say, have a
behavior of wandering and Ican't go and just be by myself
and walk around by myself for alittle bit, I might have some
behaviors.
Exactly, exactly the idea isthey don't, and then talk about
sundowners and how, if you wantto talk about because that's a
big thing that we hear here andthey said, really, sundowners is
not really a big thing inHokebeck.
Speaker 1 (15:20):
No, that's why they let them have their freedom.
They're able to walk around allday.
The gentleman in question.
So one of the things Bob hadbrought up about the falls, he
had weights on his ankle.
Yeah, which is new.
Speaker 2 (15:36):
I asked.
My wife is an occupationaltherapist and I asked her about
it and she said no, I've neverheard of that, but it makes a
ton of sense so that they canfeel their steps, because part
of the thing about dementia isthe brain's not always
connecting everything.
But if you, if you emphasize itby putting ankle weights on,
you're more likely to feel yoursteps and less likely to fall.
Speaker 1 (15:56):
That was.
That was just amazinginformation I'd never heard, and
that was one of the firstthings that I brought back here
to the social workers that thiscould actually be
transformational because, firstof all, it actually triggers
their brain to make bigger steps, so they're not shuffling and
(16:18):
they're not falling, but it alsoall of that walking all day
long with ankle weights aroundyour ankles will make you kind
of tired, right, and they don'thave sundowner problems because
they give them that freedom, theability to just walk around,
interact with others.
(16:38):
They're not necessarily no, insome cases maybe, but they're
not laying in a bed all day.
They're not cooped up in a roomall day where they're not able
to get around.
Remember, we only said there'sone caregiver for six or seven
people in a home and they don'thave a caregiver at night.
(17:00):
There's no one there at nightwith them, but there are people
workers in the village.
Speaker 2 (17:05):
I know a lot of you are scared by that.
We're going to talk about thatin a second.
Speaker 1 (17:07):
There are workers in the village and they can deal
with things as they come about,because they don't need it.
Because they don't need it.
They go to sleep, so they usedto they sleep.
Speaker 2 (17:17):
They told us about it .
They used to have the caregiverstay in the house at night and
then they realized it wasunnecessary because of the
nature of things.
So the one thing I want topoint out in relation to that is
care is always present.
So it sounds like this is alllike hippie, free for all kind
of stuff, right, and so thereality is care is always
present.
So the woman that followed usand she really did stay with us
(17:40):
for the whole tour and it wasamazing because she was
interested she didn't understand, and the guy, iris, told us
that she could not haveunderstood everything that we
were talking about because shedoesn't speak English and we
were speaking mostly in English,but she was engaged, she was
leaning in, she had a good daythat day because she got to
spend time with the Americansand she just had a good day that
(18:01):
day.
And it didn't matter that shedidn't understand, because
probably somebody with dementiais not going to understand that
but she had an opportunity toparticipate, to be respected, to
be heard, to be acknowledged asa person and not as a invalid.
That needs to be served, whichis something you know.
The service mentality issomething that they really try
(18:22):
to avoid there.
But the key on this was care isalways present.
So, as we were concluding ourwalk through the village, it was
fascinating to me because myquestion was okay, I know, you
have lunch in your houses.
Like, each house has their ownlunch, each house has their own
dinner and it might be different, and we'll talk about that in a
second, about how each housemight have a different dinner.
It's not everybody gets thesame thing.
(18:44):
And so I was like, okay, howdoes this work?
Because people are wanderingaround and we never did get the
name of the woman.
I'm not sure that we would beable to pronounce her name
because it would have been aDutch name and there's a lot of
consonants in Dutch names.
But we did not get her name.
But we saw a caregiver walkingher back to her house at
(19:08):
lunchtime and it was justnatural.
It was very natural.
So let's talk a little bitabout the houses, because I
think that's important for folksthat are really interested in
Hokovic and the Menchie Villageabout how the houses are all
very different, and so tell us alittle bit about the cultural
differences between each house.
Speaker 1 (19:28):
So if you grew up in an urban area of the Netherlands
, then you would be in an urbanhome, and so you have residents
and people that you're stayingwith in your home that have
grown up basically in the sametype of environment.
(19:50):
So you might if you grew up ina rich area.
You influenced.
Speaker 2 (19:55):
Rich area.
Speaker 1 (19:59):
You grew up and you had the nicer things.
Those homes have fine china,where the other homes may not.
They don't care about that finechina, right, they have the
nicer china, they have thecrystal lamps, they have all of
those types of things whenanother home isn't like that.
(20:19):
But they didn't grow up thatway.
Speaker 2 (20:22):
So I would bet, amy, that you and I, when we were
growing up because it was, therewere some set plates that
everybody had.
There were set couches thateverybody had.
I would bet that in your houseyou had the same couches that my
parents had, the same platesthat my parents had, and that's
what they do.
They don't do the most modernthing because those plates and
(20:42):
couches are not that commonright now, but they go back to
what they would have known, youknow, would have been
comfortable for them.
And so the people.
Netherlands is very interestingbecause it's, you know, european
and all of that, and I want toget back to that just for a
second.
But there is a whole lot ofdifferent people.
There's people that grew up ona farm, and so those folks they
(21:04):
typically make their meal planmore of a meat and potatoes kind
of a thing, very traditionalDutch meal.
And for those people that havetraveled a lot internationally
or, you know, to differentcountries, and so they have a
more eclectic, you know, mealschedule, there's folks that
just lived in the cities, butthey try to set it up that way
(21:26):
cities, but they try to set itup that way.
One of the things and this isjust down a tangent here, but
the one thing I reallyappreciate about going to
Amsterdam, which was reallyinteresting in the United States
we have sliced bread, and thething about sliced bread is that
means it gets to be kept on the.
They put preservatives in itand then keep it on the shelves
for many months and then or Idon't know, I might be
exaggerating, but they keep iton the shelves and then we keep
it on the shelf and it doesn't,you know, turn green for a while
(21:47):
.
And it's traditional in Europethat you buy your bread every
day.
It's fresh bread every day, andso that's what they do there.
You know they don't skimp onthose types of things and it's
very traditional.
So they try to make sure thatthey, you know, match the people
with what their comfort levelis.
I want to tell one more storyand then we're going to wrap
(22:09):
things up here, because this isjust an introduction and we,
hopefully, will dive into this alittle deeper.
As far as I know, we haven'treally given you much
information about what could you?
I know this is pie in the skyfor America, I know this isn't
realistic, that we could do this, but Amy and I have talked a
lot about what could weimplement here, so we'll do
another presentation on whatcould we take from that and
(22:32):
implement here.
But I want you to tell thestory about the woman that we
saw walking around and I wasreally nervous for her because
she was carrying this actualglass cup and she was pretty
stable on her feet, but shewasn't really all that stable.
She's carrying this glass cup.
Did you see that?
Did you experience that?
Speaker 1 (22:51):
so tell that story in europe, apparently that is a
thing like they don't useplastic silverware they don't
use plastic cups.
Everything is glass.
Everything your uh, even yoursoda is in a glass uh bottle
right so everything is glass,which amazed me.
And it goes to even the pub.
(23:12):
You know they go into the puband they can walk out of the pub
with a glass and it's a normalthing.
If she were to drop it, theywould just sweep it up and she
did.
Speaker 2 (23:22):
Yeah, we saw somebody .
They dropped a glass in theUnited States.
We would have freaked out aboutthat.
How did you get that glass?
Whatever the safety you know.
Whatever, they just helped hermake sure she didn't get caught
and then immediately sweeped itup.
It was fine.
Speaker 1 (23:35):
Nobody cared, nobody cared.
Yeah, it wasn't a big deal.
Speaker 2 (23:39):
Yeah, so one of the things and we'll just kind of
wrap up with this is, you know,trying to sterilize and create
everything as a safety thing.
It tends to be our nature herein the United States,
particularly with somebody withdiminished capacity.
Somehow and it's our parents, Iget it we're more concerned
(23:59):
about their safety than theirquality of life.
I don't know about you.
Actually, I do know Both of usprobably make some bad.
Know about you.
Actually, I do know Both of usprobably make some bad decisions
about our health, right, and wechoose to do that Like we know,
it would be better if I got upat 6am and jogged every day.
It would be better if I only ate, you know, nonfat, low fat, but
(24:21):
I understand that's what wechoose to, and the idea of
taking those choices away fromfolks is the concept of Hokevich
is that we really want to givepeople the ability to have the
best quality of life.
So thank you for joining ustoday.
We will do more on this.
If you enjoyed this, don'tforget to subscribe to our
(24:42):
podcast at any of the placesthat you listen to podcasts.
Thank you so much.
You're listening to Advice from your Advocates, a
show where we provide elder lawadvice to professionals who work
with the elderly and theirfamilies.
Speaker 2 (00:10):
Welcome back to Advice from your Advocates.
I'm Bob Manor.
I'm a board-certified elder lawattorney in Michigan, and
today's topic is something thatI know a lot of.
You've been talking about thisfor a little bit and mentioned
this to a number of guests onour podcast that we had an
opportunity to go to Amsterdamand visit the dementia village
(00:31):
which is called Hokevik in theNetherlands, and it was a really
great opportunity to see adifferent way to plan for and to
care for dementia plan for andto care for dementia.
And so fortunately we were veryfortunate that it wasn't just
me, amy Persales, who is ourplanning services director, and
(00:53):
Kelly King Penner, the otherpartner in the law firm.
All three of us got to go with agroup of lawyers and social
workers who were able to look atand observe this dementia
village in Amsterdam.
It is the first dementiavillage and there are a few
places in America that aretrying to repeat this and
(01:13):
there's other places throughoutthe world that have you know,
are trying to repeat the successof Hogevik, and a lot of you
have heard of this.
You've read articles, you'reexcited about it.
Some of you put it on yourbucket list to go visit.
We experienced because it was sotransformational as far as our
(01:47):
thought process, and so I haveAmy here, who also did the tour,
and it was a multi-dayexperience where we were able to
really immerse ourselves intothe Dementia Village.
I thought it would be useful,instead of just me talking about
it, to have Amy here and kindof explain what we experienced
(02:07):
there, because it's a wholedifferent way of thinking about
caring for dementia.
So, amy, the first question Ihave for you is what are your
initial impressions of when westarted out at that, the first
day at Hokevick?
What were your initialimpressions?
Speaker 1 (02:26):
It was overwhelming.
I would say first the villageitself, the first interaction
that we had, and we saw a fewresidents walking around, but we
were taken into this theaterarea where they gave us more of
a background, some rules, nopictures.
(02:47):
Right, no pictures, just a lotof things that were very
enlightening.
Speaker 2 (02:51):
It was not a tourist opportunity to take selfies and
promote yourself.
That was not what this villageis about.
It's really about the residentsand it really is about the
residents.
Everything we saw was about theresidents.
So I want to expand on what yousaid about going into the
theater in the first day, thatwe kind of started there and you
know I'm a person that has lotsof questions, always right, I
(03:15):
can't help myself if they starttelling us about what's going on
and I just have questions.
And so I started asking allthese questions and they were
kind of like well, just wait andsee, wait and see, you know.
So I had questions like well,what happens when family visits?
Ok, but what happens ifsomebody falls?
But what happens if you knowwhat happens at night, you know?
(03:36):
And they were just OK, yep,we're going to answer all those
questions, but wait and see.
And I wasn't satisfied with that, but I was once I waited and it
was very interesting becauseall the questions I had
particularly as a lawyer,because lawyers tend to be very
skeptical about things and theywere all answered by observing
it.
So I want to start off with astory about our experience,
(04:02):
because I think they broke us upinto a couple different groups
and we had, you know, a guide.
One of our guide was one of thefounders, and then there was
another very talented andwell-spoken guide, so we had the
second one and she was great.
So we were just going to walkaround the village and they made
a point of you know, this isnot a tourist attraction.
(04:23):
We're not going to be takingselfies, we're not going to go
out, we're going to talk andpeople are going to interact
with us.
Tell us a little bit about ourexperience when we, you know,
kind of started our what wewould have said is a tour, but
really was just walking aroundthe village about the folks that
came up and kind of joined ourtour.
Speaker 1 (04:41):
They did tell us that some people may walk up and
join our tour, but until youexperience it, you just don't
understand what they'reexperiencing.
And we had a nice lady thatwalked up and this was our tour
guide and she explained.
You know, we were from Americaand In Dutch.
Speaker 2 (05:03):
Yes, because the person didn't speak English.
Speaker 1 (05:04):
She didn't speak English.
She didn't speak English.
She explained to her in Dutchand she told us after what she
talked to her about and invitedher along if she wanted to tour
with us.
And she did.
She stayed with us almost thewhole time.
She walked around with us.
She was very engaged and Iriswas speaking to us in English
(05:26):
the whole time.
She would stop and have aconversation here and there, but
the woman was very engaged.
She walked around with us.
She was just a part of her day.
She was enjoying herself andthey liked to have visitors.
All of the residents werefriendly.
Everyone just enjoyed havingpeople there.
Speaker 2 (05:49):
So and I know this is challenging so don't, if you're
a caregiver, if you work in thelong-term care industry, just
stop imagining how we might doit here first and just accept
how they do it there.
Let's just look at it that wayfirst, and then we can talk
(06:12):
about how some of it might beadapted here.
Because I know, as people inthe caregiving industry would be
like, okay, you allow them towander aimlessly?
And the answer there was yes,we do allow them to wander, and
it was built like a traditionalDutch village allow them to
wander.
And it was built like atraditional Dutch village,
meaning it was cobblestone,right, so not the safest
environment to be walking on.
We're going to talk a littlebit about that as far as safety
(06:32):
and all of that, in a minutehere, but I want to talk a
little bit about our visitor.
Amy and I have both visited alot of memory cares, a lot of
great places, and they're doinga fantastic job.
But the typical answer when apatient or resident you know
starts, you know, being curiousabout what we're doing is they
try to distract right.
(06:52):
Distract is a word that we usea lot.
I've used it so many times totry to help families understand
how okay somebody's gettingagitated, let's try to distract
them.
Distract is not a word they useat Hokebeck.
I was amazed by this.
She would stop our tour andanswer her question.
(07:13):
Now she later shared with ussome of the times that she was
talking in Dutch and this was anative Dutch speaker.
Right, iris is a native Dutchspeaker.
She said she was not speakingin ways that I could understand.
It was and this might be notthe best way to say it, but what
I would call gibberish.
She was not speaking in a waythat she could respond to, but
(07:33):
she was very patient, listenedcarefully, spoke to her and then
would stop our tour to talk toher.
There was such a respect forthe residents there and patients
there and never dismissing them, never distracting them to the
point that I had a question.
So before I tell you about thequestion that I asked that got
(07:55):
shot down pretty good, I wantyou to tell a little bit more
about the village with regard tothe grocery store and the bar
and the pub and the music centerand all the rest of the stuff.
Speaker 1 (08:07):
It was amazing.
So research online?
Right, we do research online,we check things out and I
thought, okay, a grocery store.
The questions were how doesthat work?
Speaker 2 (08:18):
Is it?
Speaker 1 (08:19):
fake.
Is it fake?
Do they just bring the stuffback after they take it?
No, they buy their groceriesfor that day, the meals for that
day, they plan out.
They have a caregiver in thehome.
Talk about the different typesof homes and there is a
caregiver in the home that theycome in and they discuss what do
(08:42):
we want to have to eat today?
And they prepare and plan theirmenu for the day and they go to
the grocery store.
So someone you know, a few ofthe residents, may go with them
to the grocery store and theyactually buy their food from
that grocery store and they justkeep a tally for the house to
(09:02):
determine how much they spentthere and whatnot.
But if a resident goes into thegrocery store and takes a box
of macaroni and cheese, they cantake a box of macaroni and
cheese and take it back to theirhome and prepare it or whatever
they need to do with it.
But there are real.
There's milk, there's bread,everything that you would think
(09:25):
of a grocery store.
Now it's very small stocks andthey have fresh vegetables and
fruit and all of the things thatthey have brought in.
Even they said that otherpeople from other communities
come there to grab a gallon ofmilk to take home.
Speaker 2 (09:39):
that day you can come in from the community and get a
drink at the bar.
You can go to the grocery store.
Yeah, go to the restaurant.
Speaker 1 (09:46):
Yeah, it's just amazing, and the activities that
they have the music center thetheater, they have movies, they
have tons of open outdoor space.
So when it's nice outside whichit was when we were there it was
beautiful weather and they justwalk around outside.
One gentleman watched him forthe two days that we were there
(10:09):
and he just walked around.
Once in a while he would stopand speak with someone, but he
just walked around and that'swhat he wanted to do.
He just, he just walked aroundand that's what he wanted to do.
And, um, you know, he was happy, he was very happy with that,
just walking around.
And honestly, I would be thesame way, you know, if you just
(10:33):
let me, don't lock me in a room,let me let me walk around and
have interactions with people.
Speaker 2 (10:35):
It was just very nice to see that.
So I had a question, cause Iwas still kind of stuck in the
way that we do things here, andso we were standing outside the
grocery store and so I talked toIris and I said I'm not really
understanding this, so what ifsomebody comes in?
So before I go on to this story, we want to make it clear these
(10:57):
are not light dementia, this isnot early dementia, so they
have in the Netherlands.
They are not light dementia,this is not early dementia, so
they have in the Netherlands.
They have definitions of levels, and so the top two levels are
five and seven.
I don't know why they skip six,but they do.
So there's five, and five is areally high level of dementia.
Okay, you cannot be a residentof the dementia village of
(11:18):
Hokevich until you're at levelfive.
So all of the early stages ofdementia are not you can't.
So I think both of us imaginedthat they were going to be.
Oh, these are folks that youknow maybe they need a little
help, but they just need alittle guidance, but they really
don't.
You know, they're not reallysevere dementia.
These were severe dementia andit's a requirement that you be
there, and so my question wasokay.
(11:40):
So you have these folks kind ofwalking around.
I'm still not quite getting thisbecause, like in the United
States, we're all about safetyand making sure that nobody
falls.
You know, this is not what wedo for regular folks.
This is what you know.
If somebody's following mearound to make sure I don't fall
, I fall all the time.
I'm clumsy.
So you know, amy currentlybroke her ankles.
(12:04):
The idea is that's not what wedo for regular.
You know situations and yet,for some reason, when somebody
has dementia, we're like oh, wecan't allow them to have any
risk.
Okay, well, I believed that foryears and this was the.
This is why it was kind oftransformational for us to.
They're like okay, but you know, people fall sometimes.
You know that's is that that'sokay.
(12:26):
You know, if it's about qualityof life, you have to have a
little bit of risk involved inthat.
But that's not what weunderstood.
That's not what I understood.
One of the things I was likeokay, there's this grocery store
and you've got people withreally pretty severe dementia
and Alzheimer's.
What if somebody walks in andjust takes something off of the
shelf and walks out?
(12:47):
And I said, well, I imagine youjust try to distract them and
then put it back, and they don'tuse the word distraction there.
This is something I have beentelling people for 20 years now,
that when you have somebodythat has behaviors, we try to
distract them and put them ontosomething else and they're just
like no.
We deal with it on acase-by-case basis.
(13:07):
Sometimes it's something thatwe'll work with their caregiver
and it might be returned.
Sometimes we charge the account, sometimes we just charge it to
their house.
They're there, you know whichis part of their.
You know each.
We're going to talk about housesin a minute here, but each
person is assigned to a specifichouse with six to what about
(13:29):
six people in each house, and sothat was just.
You know, that was not the wayI normally expect things.
When we have what we wouldnormally call bad behavior,
their answer is well, that's notnecessarily bad behavior, we
just just deal with it.
Everybody's a little bitdifferent.
Some people we might say, hey,you know, what are we doing with
that?
Some people, that's not thebest answer because they might
get upset by it and so we justlet them take it and maybe
(13:52):
assign it to their house, ormaybe, if they have some money,
we assign it to their account.
You know, let's talk aboutbehaviors, because that was the
fascinating thing about this.
I think that was the mostinteresting thing in our office.
So we're an elder law office.
We help a lot of people with alot of different long-term care
needs, but a good portion of ourclients have a loved one with
(14:14):
dementia and what's coming upmore and more is what we call
behaviors, and that might bewandering, that might be
aggression, that might bewhatever it is, and they have
very little behaviors at Hogevec.
Speaker 1 (14:26):
We never saw it.
Yeah, why is that it's?
Speaker 2 (14:28):
not that they don't have any behaviors in Holland.
It's not that they don't haveany behaviors in the Netherlands
, it's they don't have it there.
And there's a couple of reasons, and I want to get into one of
them in a minute, but one ofthem was freedom, right?
Yes, so I'm the type of personthat needs to be alone sometimes
.
I don't always like to bearound a lot of people, and so
(14:50):
if you tell me I can't go andwalk around, you know what does
that sound like?
Wandering?
Speaker 1 (14:56):
Right.
Speaker 2 (15:01):
And so if you tell me I can't, they would say, have a
behavior of wandering and Ican't go and just be by myself
and walk around by myself for alittle bit, I might have some
behaviors.
Exactly, exactly the idea isthey don't, and then talk about
sundowners and how, if you wantto talk about because that's a
big thing that we hear here andthey said, really, sundowners is
not really a big thing inHokebeck.
Speaker 1 (15:20):
No, that's why they let them have their freedom.
They're able to walk around allday.
The gentleman in question.
So one of the things Bob hadbrought up about the falls, he
had weights on his ankle.
Yeah, which is new.
Speaker 2 (15:36):
I asked.
My wife is an occupationaltherapist and I asked her about
it and she said no, I've neverheard of that, but it makes a
ton of sense so that they canfeel their steps, because part
of the thing about dementia isthe brain's not always
connecting everything.
But if you, if you emphasize itby putting ankle weights on,
you're more likely to feel yoursteps and less likely to fall.
Speaker 1 (15:56):
That was.
That was just amazinginformation I'd never heard, and
that was one of the firstthings that I brought back here
to the social workers that thiscould actually be
transformational because, firstof all, it actually triggers
their brain to make bigger steps, so they're not shuffling and
(16:18):
they're not falling, but it alsoall of that walking all day
long with ankle weights aroundyour ankles will make you kind
of tired, right, and they don'thave sundowner problems because
they give them that freedom, theability to just walk around,
interact with others.
(16:38):
They're not necessarily no, insome cases maybe, but they're
not laying in a bed all day.
They're not cooped up in a roomall day where they're not able
to get around.
Remember, we only said there'sone caregiver for six or seven
people in a home and they don'thave a caregiver at night.
(17:00):
There's no one there at nightwith them, but there are people
workers in the village.
Speaker 2 (17:05):
I know a lot of you are scared by that.
We're going to talk about thatin a second.
Speaker 1 (17:07):
There are workers in the village and they can deal
with things as they come about,because they don't need it.
Because they don't need it.
They go to sleep, so they usedto they sleep.
Speaker 2 (17:17):
They told us about it .
They used to have the caregiverstay in the house at night and
then they realized it wasunnecessary because of the
nature of things.
So the one thing I want topoint out in relation to that is
care is always present.
So it sounds like this is alllike hippie, free for all kind
of stuff, right, and so thereality is care is always
present.
So the woman that followed usand she really did stay with us
(17:40):
for the whole tour and it wasamazing because she was
interested she didn't understand, and the guy, iris, told us
that she could not haveunderstood everything that we
were talking about because shedoesn't speak English and we
were speaking mostly in English,but she was engaged, she was
leaning in, she had a good daythat day because she got to
spend time with the Americansand she just had a good day that
(18:01):
day.
And it didn't matter that shedidn't understand, because
probably somebody with dementiais not going to understand that
but she had an opportunity toparticipate, to be respected, to
be heard, to be acknowledged asa person and not as a invalid.
That needs to be served, whichis something you know.
The service mentality issomething that they really try
(18:22):
to avoid there.
But the key on this was care isalways present.
So, as we were concluding ourwalk through the village, it was
fascinating to me because myquestion was okay, I know, you
have lunch in your houses.
Like, each house has their ownlunch, each house has their own
dinner and it might be different, and we'll talk about that in a
second, about how each housemight have a different dinner.
It's not everybody gets thesame thing.
(18:44):
And so I was like, okay, howdoes this work?
Because people are wanderingaround and we never did get the
name of the woman.
I'm not sure that we would beable to pronounce her name
because it would have been aDutch name and there's a lot of
consonants in Dutch names.
But we did not get her name.
But we saw a caregiver walkingher back to her house at
(19:08):
lunchtime and it was justnatural.
It was very natural.
So let's talk a little bitabout the houses, because I
think that's important for folksthat are really interested in
Hokovic and the Menchie Villageabout how the houses are all
very different, and so tell us alittle bit about the cultural
differences between each house.
Speaker 1 (19:28):
So if you grew up in an urban area of the Netherlands
, then you would be in an urbanhome, and so you have residents
and people that you're stayingwith in your home that have
grown up basically in the sametype of environment.
(19:50):
So you might if you grew up ina rich area.
You influenced.
Speaker 2 (19:55):
Rich area.
Speaker 1 (19:59):
You grew up and you had the nicer things.
Those homes have fine china,where the other homes may not.
They don't care about that finechina, right, they have the
nicer china, they have thecrystal lamps, they have all of
those types of things whenanother home isn't like that.
(20:19):
But they didn't grow up thatway.
Speaker 2 (20:22):
So I would bet, amy, that you and I, when we were
growing up because it was, therewere some set plates that
everybody had.
There were set couches thateverybody had.
I would bet that in your houseyou had the same couches that my
parents had, the same platesthat my parents had, and that's
what they do.
They don't do the most modernthing because those plates and
(20:42):
couches are not that commonright now, but they go back to
what they would have known, youknow, would have been
comfortable for them.
And so the people.
Netherlands is very interestingbecause it's, you know, european
and all of that, and I want toget back to that just for a
second.
But there is a whole lot ofdifferent people.
There's people that grew up ona farm, and so those folks they
(21:04):
typically make their meal planmore of a meat and potatoes kind
of a thing, very traditionalDutch meal.
And for those people that havetraveled a lot internationally
or, you know, to differentcountries, and so they have a
more eclectic, you know, mealschedule, there's folks that
just lived in the cities, butthey try to set it up that way
(21:26):
cities, but they try to set itup that way.
One of the things and this isjust down a tangent here, but
the one thing I reallyappreciate about going to
Amsterdam, which was reallyinteresting in the United States
we have sliced bread, and thething about sliced bread is that
means it gets to be kept on the.
They put preservatives in itand then keep it on the shelves
for many months and then or Idon't know, I might be
exaggerating, but they keep iton the shelves and then we keep
it on the shelf and it doesn't,you know, turn green for a while
(21:47):
.
And it's traditional in Europethat you buy your bread every
day.
It's fresh bread every day, andso that's what they do there.
You know they don't skimp onthose types of things and it's
very traditional.
So they try to make sure thatthey, you know, match the people
with what their comfort levelis.
I want to tell one more storyand then we're going to wrap
(22:09):
things up here, because this isjust an introduction and we,
hopefully, will dive into this alittle deeper.
As far as I know, we haven'treally given you much
information about what could you?
I know this is pie in the skyfor America, I know this isn't
realistic, that we could do this, but Amy and I have talked a
lot about what could weimplement here, so we'll do
another presentation on whatcould we take from that and
(22:32):
implement here.
But I want you to tell thestory about the woman that we
saw walking around and I wasreally nervous for her because
she was carrying this actualglass cup and she was pretty
stable on her feet, but shewasn't really all that stable.
She's carrying this glass cup.
Did you see that?
Did you experience that?
Speaker 1 (22:51):
so tell that story in europe, apparently that is a
thing like they don't useplastic silverware they don't
use plastic cups.
Everything is glass.
Everything your uh, even yoursoda is in a glass uh bottle
right so everything is glass,which amazed me.
And it goes to even the pub.
(23:12):
You know they go into the puband they can walk out of the pub
with a glass and it's a normalthing.
If she were to drop it, theywould just sweep it up and she
did.
Speaker 2 (23:22):
Yeah, we saw somebody .
They dropped a glass in theUnited States.
We would have freaked out aboutthat.
How did you get that glass?
Whatever the safety you know.
Whatever, they just helped hermake sure she didn't get caught
and then immediately sweeped itup.
It was fine.
Speaker 1 (23:35):
Nobody cared, nobody cared.
Yeah, it wasn't a big deal.
Speaker 2 (23:39):
Yeah, so one of the things and we'll just kind of
wrap up with this is, you know,trying to sterilize and create
everything as a safety thing.
It tends to be our nature herein the United States,
particularly with somebody withdiminished capacity.
Somehow and it's our parents, Iget it we're more concerned
(23:59):
about their safety than theirquality of life.
I don't know about you.
Actually, I do know Both of usprobably make some bad.
Know about you.
Actually, I do know Both of usprobably make some bad decisions
about our health, right, and wechoose to do that Like we know,
it would be better if I got upat 6am and jogged every day.
It would be better if I only ate, you know, nonfat, low fat, but
(24:21):
I understand that's what wechoose to, and the idea of
taking those choices away fromfolks is the concept of Hokevich
is that we really want to givepeople the ability to have the
best quality of life.
So thank you for joining ustoday.
We will do more on this.
If you enjoyed this, don'tforget to subscribe to our
(24:42):
podcast at any of the placesthat you listen to podcasts.
Thank you so much.
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