Partner Judith Grimaldi recounts her trip to Amsterdam and Netherland’s Progressive Approach to Aging and Dying
By Judith Grimaldi, CELA, CAP
The NAELA Delegation to the Netherlands visits the government-run Dementia Village, learns about attitudes toward assisted suicide, and appreciates the culture of the Netherlands.
The NAELA Delegation to the Netherlands at the Village of Hogeweyk (“Dementia Village”).
On November 12, 2016, the NAELA delegation of 23 NAELA members gathered in Amsterdam, the Netherlands, to survey aging services in one of Europe’s most progressive countries. Amid the picturesque environment — which included a city of active working canals and waterways, bicycles in abundance, delicious cheese, and a free-spirited citizenry — we came to learn how they address their growing aging population. It seems they address it as they do everything in their lives, with industriousness, grace, and a buoyant activism. The country’s natural environment of being below sea level has developed a keen sense of inventiveness, vigilance, and order in the population as they strive to keep the always-present sea at bay. They bring this practicality and sensibility to their aging policies.
Dementia and Art Appreciation
Amsterdam’s Modern Art Museum gives docent-guided tours for individuals with dementia and their caregivers. Author Judith Grimalidi remarks that the group “learned to see how art appreciation transcends memory loss or cognitive impairment as colors, textures, and image remain constant.”
Our first visit was to the Amsterdam’s Modern Art Museum where we participated in a docent-guided tour geared for individuals with dementia and their caregivers that strived to engage all of our senses and our imagination in viewing the art. We learned to see how art appreciation transcends memory loss or cognitive impairment as colors, textures, and images remain constant. The person with dementia brings whatever he or she can to the experience as there is no right or wrong way to interpret art. People with cognitive impairment can enjoy art even if the ability to articulate what it means is limited. The Museum staff demonstrated how to use art to stimulate conversations with the dementia participant.
Their “Meet Me at MOMA” program has been operating for several years and is modeled after a similar program that operates in New York City’s Museum of Modern Art where guided sessions are offered weekly for persons with dementia, persons with disabilities, and their caregivers to give them full access to the museum. The museum considers this an important community outreach program and will provide “how-to” materials so it can be replicated in other community museums. The New York City and the Amsterdam MOMA programs serve as hubs for conversations on aging and creativity and each is a vital link for those who are interested in making art accessible to people with dementia. For more information on these continued efforts contact: firstname.lastname@example.org.
Death and Dying
The Delegation meets with two NVVE staff members who are part of the assisted suicide group. In the Netherlands, assisted suicide is legal – and not just for those with terminal illnesses. From left, two NVVE staff members with Gayle Reeves, Jennifer Lile, and Judith Grimaldi.
Our group visited the ground-breaking NVVE Organization (Nederlandse Vereniging voor Vrijwillige Euthanasie — Netherlands association for voluntary euthanasia) where we learned about Holland’s efforts in the field of death and dying. The meeting was held in a 17th century townhouse previously owned by the founders of the East Indian Trading Company. The home fronted one of Amsterdam’s canals and was built on a gracious double lot with a full garden and a coach house.
In the Netherlands, assisted suicide is legal – and not just for those with terminal illnesses. In 2001, the Netherlands became the first country in the world to legalize euthanasia for patients who were suffering unbearable pain and had no prospects of a cure. At one clinic in The Hague, anyone with “unbearable suffering” can be given the relief they seek.
NVVE provides information, consultation, and education about euthanasia and assisted suicide in the Netherlands. NVVE lobbies and supports research and other initiatives related to self-chosen death. The organization’s motto is: “A dignified life deserves a dignified death.” NVVE is a society with a membership of 165,000 members and growing annually. In the Netherlands it is not an offense for physicians to perform euthanasia, provided they comply with the due care criteria specified in the Termination of Life on Request and Assisted Suicide Act and report each case after it has been carried out. In accordance with the due care criteria, the physician must, among other things, be satisfied that the patient’s request for euthanasia is voluntary and well-considered and that his suffering is unbearable with no prospect of improvement.
Euthanasia can be performed only at the patient’s own request, not at the request of relatives or friends. Physicians are not obliged to grant a request for euthanasia. A physician who does not want to perform the procedure should discuss this with the patient and may decide to refer the patient to another physician. The Act is only applicable to people who have a medical relationship with a physician who is subject to Dutch law. This means that people who do not reside in the Netherlands cannot apply for euthanasia or physician-assisted suicide under the Act. Their continuing organizational goal is the advancement of social acceptance and continued legal regulation of free choice for the ending a life.
Amsterdam street scene.
Recognition of free choice for the ending of life (and assistance thereby) as a human right has led to a new debate over a law proposed in October 2016. The proposed law would allow people who are not suffering from a medical condition to seek assisted suicide if they feel they have “completed life.” Proponents of the law counter that limiting assisted death to patients with terminal illnesses is no longer enough and that older people have the right to end their lives with dignity and at a time of their choosing. The speakers at the NVVE introduced this debate at our visit. The discussions were lively on the bus ride home as we reviewed how our states are gingerly beginning to accept the first level of physician-assisted suicide, but have a long way to go before we reach the level of consensus on the topic found in the Netherlands. NVVE welcomes inquires and can be contacted at www.nvve.nl or to our guest speaker at email@example.com.
Judith Grimaldi stands at the sign for Dementia Village. The new Hogeweyk facility opened in December 2009, on four acres of land and consists of low, two-story brick buildings that house a supermarket, a theatre, workshops, a café, a bakery, a park, and an open plaza with a town square.
Our most memorable event of the trip was our visit to the Village of Hogeweyk, the pioneering facility for the elderly that specializes in the care of 152 residents with dementia. It is also known as the Dementia Village. Our private tour was led by the Director Eloy Van Hal, who explained the operation and financing of the Village, which is operated and owned by Vivium, a government owned not-for-profit group that manages nursing home facilities in Holland. The Village opened in 1992, when Yvonne van Amerongen and another member of staff at a traditional nursing home both had one of their own parents die. They were grateful that their elderly parents had not had to endure institutional care. After researching options, they decided that people generally prefer to be with other like-minded people of similar backgrounds and experiences. They used this approach at Hogeweyk, which groups residents with similar backgrounds to live together.
The new Hogeweyk facility opened in December 2009, on four acres of land and consists of low, two-story brick buildings that house a supermarket, a theatre, workshops, a café, a bakery, a park, and an open plaza with a town square. The construction of the facilities cost $25 million and was funded primarily by the Dutch government. The cost per resident is similar to more traditional nursing homes at around $8,000 per month, which is paid by the government. An individual living in the Netherlands can select this residence as a government-subsidized nursing home equivalent as it is funded on par with other more traditionally state-funded facilities. The out-of-pocket cost to the Dutch individual after the government subsidy will never exceed $3,600 per month.
The goal of life in Hogeweyk is to allow the dementia resident to live life as normally as possible in an everyday setting even though they are qualified for nursing home status. Housing is arranged in group homes for 6 to 8 persons who still perform household chores as they are able. The group plans their daily routine with the help of two on-site care givers who supervise and fill in the skill gaps. Washing, cooking and so on is done every day in all of the houses. Daily groceries are done in the Hogeweyk supermarket.
There are 23 free-standing households representing seven different “life-style” choices. People are grouped by their “like mindedness.” For example: Goois (upper class), homey, Christian, artisan, Indonesian, and cultural.
The homes are furnished around the time period when residents’ short-term memories stopped properly functioning because it helps residents feel as if they’re home. There are homes resembling the 1950s, 1970s, and 2000s, accurate down to the tablecloths.
Residents are cared for by 250 full- and part-time geriatric nurses and specialists, who wander the town and hold a myriad of occupations in the village, like cashiers, grocery store attendees, and post office clerks. Finances are often one of the trickier life skills for dementia or Alzheimer’s patients to retain, which is why Hogeweyk takes money out of the equation; everything is included with the family’s payment plan, and there is no currency exchanged within the confines of the village.
The group enjoyed lunch at the cafe in Dementia Village. The goal of life in Dementia Village is to allow dementia residents to live life as normally as possible in an everyday setting even though they are qualified for nursing home status. Residents of the surrounding neighborhoods are welcomed to use the shops and theatre in Dementia Village.
The village has streets, squares, gardens, and a park where the residents can safely roam free. Just like any other village, Hogeweyk offers a selection of facilities, such as a restaurant, a bar, and a theatre. These facilities can be used by Hogeweyk residents as well as by the residents of the surrounding neighborhoods. Everyone is welcome and while our group was there, we enjoyed a delicious lunch with our tour. We left inspired that there is a workable alternative to meeting the housing and care needs of the dementia patient that goes beyond the traditional and mostly unsatisfying nursing home option most of our clients face. The Vivium management offers to introduce this model to other countries to replicate what they have done in the Netherlands. There are currently similar villages in England, Switzerland, Canada, and Italy. For more information, contact: firstname.lastname@example.org.
Future Delegations — Let Us Hear From You
The Delegation trip also included a session at The Hague, a visits to traditional villages, and a boat trip across Holland’s largest lake, all ably coordinated by NAELA’s President Catherine Anne Seal and the planning committee, which is open to suggestions for future delegations to locations which can provide new and innovations in the aging policies. Contact email@example.com with your suggestion for future locations.
About the Author
Judith Grimaldi, CELA, CAP, practices elder law in Brooklyn, New York. She is a member of the NAELA Board of Directors.
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