Intergenerational Housing and the Loner

There is a lot of research going on about housing for seniors and how we can provide optimal care.

Innovations include dementia villages, intergenerational day cares, student housing in the unused rooms of seniors and a lot of Scandinavian models of all the above.  I am the recipient of numerous Facebook posts about these creative models, and I peruse them with interest.  They look like a Utopian version of ageing, where vital, gentle, smiling seniors roam about a village that is safe and harmonious.

A great fit for all?

Sounds great, and many care partners of people living with dementia mention these models with some wistfulness and desire.  However, before we invest too much in these innovations, some points to consider come to mind.  Living in a small village would be ideal – if you’ve spent your entire life in a small village.  Most seniors in Canada live in urban areas, but 25% are in rural or remote locations, and transplantation to a European-style village could be disconcerting and traumatizing.  There are a few seniors for whom village life would not be suitable.

The Loner. 

This is an individual who has enjoyed privacy and independence throughout life.  Family, if there is any, describes The Loner as, well, a loner, or at least, not a “joiner”.  Communal dining may be the extent to which The Loner would wish to interface with others, and the simulated village would not offer additional enjoyment, and may add to stress.

The Feet Firster. 

This type of individual is frequently encountered in the Geriatric office and can be recognized by the battle cry: “I’m never leaving my house!”  This is often followed up with information about the number of years the individual has lived in the house, sometimes the year that the individual built said house, and the case is then closed.  Family members will support these statements, indicating that the individual will need to be taken out of the house “feet first” (i.e. when deceased). 

The Person with Severe Dementia. 

Unfortunately, many of the simulated “real-life” experiences that make a dementia village so innovative and expensive, would not be accessible for one at an advanced stage of dementia.  This can be difficult for family members to grasp, as their desire is for the person with dementia to experience as much entertainment and pleasure as possible, at a stage where simpler, less elaborate activities would be more suitable.

Who is really benefitting?

Those who have been critical of the dementia village model say that it is more appealing to those who are not living with dementia than those who are (i.e. care partners and staff).  Others have expressed that a simulated “village” is deceptive to those with dementia and thus not ethical.  Most would agree that the dementia village is not a feasible solution for all of those living with a major neurocognitive disorder.

A compromise might be found in the Buurtzorg model (www.buurtzorg.com), which has been implemented in the Netherlands.  The  “self-managing” Buurtzorg team leverages the patient’s existing social networks and skills, with a visiting nurse who collaborates closely with primary care providers but has a great deal of autonomy and an expanded scope.  The emphasis is not just on clinical care, but on the social relationship with the patient, such that the motto of Buurtzorg is : “First coffee, then care.”  A small back-office team is part of the streamlined bureaucratic structure.  This model responds to the individual’s definition of quality care and preferred lifestyle, and most of the interaction is on the patient’s “home turf”. 

It may take a village to do a lot of things, including provide optimal care to a senior with dementia.  Sometimes we need to bring the village to the senior, and not the other way around.

References

Drennan, V., Calestani, M., Ross, F., Saunders, M., West, P. Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study. BMJ Open8(6), January 2018.

Peoples, H., Pedersen, L.F., Moestrup L.. Creating a meaningful everyday life: Perceptions of relatives of people with dementia and healthcare professionals in the context of a Danish dementia village. Dementia (London). 2018 Dec 24:1471301218820480.