Home Sweet Home… For Dementia

UCSD Event_Picture 6_091416When first planning a new concept in dementia living in The Netherlands, Yvonne Van Amerongen had trouble explaining that she wanted a real world village — not the sterile confines of a nursing home.

“It took us three months to explain to the first architect what a normal house meant,” says Van Amerongen during a recent appearance at San Francisco’s Aging 2.0 conference.

Since opening in 1993 just outside Amsterdam, de Hogeweyk village has been heralded as a beacon for dementia care. With personal kitchens and terraces, a theater, hair salon, grocery store, theater, pub, restaurant, and plenty of room to roam, its 152 advanced dementia residents live a life of surprising freedom in a “facility” where no one wears a uniform.

It has spawned fascination and development plans worldwide, including a December opening in New Zealand.

But not, so far, in the United States.

“Their first question was ‘How often have you been sued?’” sighs Van Amerongen, recalling a meeting with a group of American visitors. “They say ‘I’m going to find the investors’ and so forth. But the investors don’t believe it.”

Scott Tarde does.

Tarde is the driving force behind Town Square, a small dementia-friendly “city” now being constructed inside an industrial complex in Chula Vista just south of San Diego.

Tarde serves as CEO for the George G. Glenner Alzheimer’s Family Centers, which operates three adult day centers in the San Diego area. (Town Square will be its fourth.)

At Town Square, set designers from the San Diego Opera are busy creating 25 storefronts: a movie theater, City Hall, a 1950’s-style diner, barber and beauty shops, a sports bar, pet shop, library, and art studio, along with street lamps, phone booths and a newsstand. Neighborhoods will include Olde Towne, Gaslamp Commons, Pacific Plaza, Little Italia, Balboa Greens, and Armed Forces Avenue.

The goal: a completely immersive experience.

Although the stores won’t have actual staff — there are no barbers or beauticians — visitors can still see classic movies in the theater, shoot pool in the bar, eat catered hot lunches in the diner, and try on vintage clothes in the department store.

Tarde was inspired to create Town Square after his daughter returned from Junior Achievement’s BizTown, a city where kids shop while improving their financial literacy.

The psychological core of Town Square is Reminiscence therapy, which taps into the bountiful memories of an earlier time and spawns greater psychological and emotional health. Tarde says the years from 15 through 35 in particular create life’s most cherished memories.

“To be able to create an environment that allows people to unlock those strongest long-term memories, I truly believe will be transformative,” he says.

Yet there are significant differences between the Netherlands’ de Hogeweyk village and California’s Town Square.

Instead of 24/7 residential living, Town Square is being built for short-term adult day care — which typically provides respite for overworked caregivers six or eight hours a day. Town Square hopes to extend these hours to make care available for 12 hours daily, allowing family members to work a full day.

And while de Hogeweyk offers a truly outdoor experience on four acres of land, Town Square is being housed within a 19,000 square-foot industrial building. Tarde affirms there will be plenty of natural light via skylights, with the ultimate design feature a planned retractable roof around city center Balboa Greens — inspired by San Diego’s Balboa Park.

Scheduled to open in early 2017, Town Square will offer a homegrown feel for about 75 adult day care clients daily who will explore the “town” in groups of five escorted by staff.

The village has already procured a 1959 Ford Thunderbird which elicited this observation from one Glenner client with Parkinson’s disease:

“Those two headlamps?” he pointed out to Tarde. “1959 or later.”

The design and construction of Town Square has introduced Tarde to a series of talented artisans.

First was architect Douglas Pancake, with expertise in dementia-related therapeutic design, who immediately understood Tarde’s plan: “You’re describing a fully-functional environment where people are really transported.”

Others quickly followed.

Interior designer Marsha Sewell chairs San Diego’s Gaslamp Quarter Historical Foundation Land Use and Planning committee. Set designers for the San Diego Opera have also created environments for San Diego’s annual Comic-Con. And Regional Occupational Program teachers will offer art and music classes in Town Square’s art studio.

“It’s been such a great merging of these bright minds,” says Tarde.

In the future, he hopes to open Town Square at night and on weekends for exhausted caregivers seeking refuge from the confines of home.

“I know so many family members who said ‘I could never go the movies again,’” says Tarde. His ultimate goal is to create a refuge “where they can go to engage their loved ones instead of sitting in their house and struggling.”

Overseas, life at de Hogeweyk has produced several health benefits. None of its residents are bed-ridden. Falls have declined since residents walk more and have better balance. And during its first year, half of all residents were taking anti-psychotic medications; last year, that number dropped to one in 10.

Will a residential nursing facility like de Hogeweyk ever be built in the United States?

“Absolutely — I think we’ll have many,” says Anabel Pelham, who has visited de Hogeweyk as head of the Center for Age-Friendly Excellence in Los Altos, California. “Almost nothing is impossible in human group life. We have to understand demographics. Demography is destiny.”

About 10,000 Americans turn 65 each day. By 2030, nearly one in five Californians will be over 65 — a whopping 8.4 million older adults.

Both de Hogeweyk village and Town Square are breaking conventions inside a fast-growing long-term care revolution that includes The Green House Project, which offers small-scale nursing home care inside a welcoming environment.

“We took a nursing home and turned it into normal life,” says Van Amerongen. “It takes time, a piece of land, and people who believe in it.”

Tarde hopes Town Square will be a day care model that can be replicated far and wide.

“We have a big vision,” he says. “We want to bring it to every city in America.”



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