腦退化者的自由天地 2019-06-25

 

如果你要入住老安院社,你希望過甚麽樣的生活呢?相信大家會不約而同地說:「像在家生活一樣。」就是基於這個原因,全世界首個專為患有腦退化症的長者而設的小鎮霍格威(Hogeweyk) 便在2009年落成,由構思到啟用衹花了一年時間。

 

這確實是一個小鎮,沒有傳統安老院舍的規劃,更沒有穿白袍的護理人員。患有腦退化症的長者處身在一個自己不認得、缺乏與外界連結的地方時,容易感到惶恐與焦慮。所以小鎮使用懷舊療法,建築風格仿造1950、1970及2000年代的設計,為長者增添熟悉感。小鎮上有一條大街,路線清楚, 設有餐廳、理髮店、超市、酒吧、  CD租賃店等。另一條通道連接劇院和公園,環境優美閒適。長者可自由地在鎮上走動,如購物、到酒吧聊天,或參與各式社交活動。這些活動大大減低他們的行為問題和焦慮情緒,令他們減少依賴藥物。由於白天有足夠的活動量,晚上就自然能安睡。

 

一般院舍會按長者需要接受護理的程度去分類。這裏則摒棄傳統的做法,大膽地以生活方式作劃分。23套房子的設計刻意分為6種主題風格,包括城市風格、商務風格、熱帶印尼風格、傳統居家風格、文化風格和宗教風格。在具有文化生活方式的房子內播放古典音樂和影片;在都市式的房子則會播放流行音樂。每套房子可容納6-8名生活方式接近的長者,每人有自己的房間,可以按個人喜好佈置。起居室、飯廳和廚房則是共用。長者可按照自己的時間作息,在家務助理員的協助下打理自己的起居生活,就像平時在家生活般。他們可以亦可付費搭乘雙人單車到小鎮外遊玩。

 

霍格威另一特點是打破對腦退化症的護理,重構一套真正以人為本的服務。小鎮上的的店員和服務員,都受過專業的醫療訓練。但上至醫護人員下至清潔工人,都要學習聆聽長者的需要和瞭解他們原來的背景;他們的工作重點不是提供治療或討論長者的行為問題,而是營造一個舒適安全的生活環境,鼓勵長者做他們能力所及的事。他們的職責不是要盯著長者,而是盡可能讓他們像生活在社區般;當然在他們走失或有需要時要提供適當協助。

 

霍格威雖然聞名世界,但卻沒有安裝昂貴或新頴的樂齡科技。全鎮只有一個出口,由接待員控制出入。每座建築上都安裝了攝錄機,確保長者的安全。其中最特別的就是聲音聽覺系統,讓夜更的照護人員在接待區監聽房子內的聲音。如有異動才會進入房間,免得騷擾入睡的長者。

 

院方認為患有腦退化症的長者既未能在原來的社區生活,便把社區帶入霍格威。除了營造一個小型的市鎮外,院方歡迎長者的家人和朋友隨時到訪,他們可以在餐廳用膳,或在超市購物,又可陪伴長者參與活動。據評估,客戶的滿意度非常高,長者需要服藥及使用成人止尿片的程度亦大幅下降。

 

然而,小鎮的成本不輕,建築費約為2500萬美元,其中2200萬美元由荷蘭政府出資。政府每日津貼入住的長者250歐羅,或每月7500歐羅,但申請入住的人數仍是遠遠供不應求。歐美等多個國家正以霍格威為藍本,建造類似的安老院舍,提供優質的服務。本港患有腦退化症的長者人數節節上升,我們又如何應對呢?

A Free World for Dementia patients 2019-06-25


What would you expect if you had to stay in an elderly home? Everyone would probably agree on "just like living at home." For this reason, the first town in the world built specially for the elderly with dementia, Hogeweyk, was established in 2009. It took only one year from concept development to actual completion. 

 

Hogeweyk looks more like a small town, rather than a traditional residential care home. The nursing personnel here does not wear white uniforms. Elders with dementia are prone to having fear and anxiety when they are in environments that they are not familiar with and lack connections with the outside world. Therefore, the town adopts the reminiscence therapy.  The architectural style imitates the design of the 1950s, 1970s and 2000s, which can build up a sense of familiarity for the elderly.  It is easy to get around the town – there is only one boulevard; the routes are clearly marked with restaurants, beauty salons, supermarkets, bars, CD rental shops and others along the way. Another passage connects the theatre with the park, and all together provide a beautiful and relaxing environment. The elderly is free to move around the town, such as shopping, chatting in the bar, or participating in various social activities. These activities greatly reduce their behavioral problems and anxiety, leading to less dependency on drugs. Since there are enough physical activities during the day, the residents fall into sleep easier at night.

 

Traditional nursing homes usually classify the elderly by the intensity of the care they need. However, here they abandon the traditional approach and innovatively divide the residents by the lifestyles they choose. The designs of the 23 houses are in six themes, including urban style, formal style, tropical Indonesian style, traditional/ homely style, cultural style and Christian style. Classical music and films are played in the cultural style houses; pop music is played in the urban style houses. Each house can accommodate 6-8 elders with similar lifestyles, each with their own room, which can be decorated to suit their personal preferences. The living room, dining room and kitchen are shared.  Just like living at home, the residents here follow their own life routine and take care of themselves with assistance from household helpers. They can also join double-bicycle trip outside the town with a rental tandem.

 

Another feature is that Hogeweyk breaks the traditional way of providing treatment for dementia patients and builds a truly people-oriented service. The shop-keepers and waiters working there have received professional medical training.  From the nursing personnel to the cleaners, they learn to listen to the needs of the elderly and understand their backgrounds. Their aims are not to provide treatment or discuss the behavioural problems of the elderly, but to create a comfortable and safe living environment and to encourage them to do what they are capable of doing. Their duty is not to guard the elders, but to make them as comfortable as if they are living in a community.  Of course, they will provide appropriate assistance when the elders are lost or in need.

 

Although Hogeweyk is famous all over the world, it does not adopt expensive or trendy geron-technology. There is only one exit in the town, stationed by the receptionist. Each building has installed security cameras to ensure the elders’ safety. The most special one is the acoustic listening system, which allows the night care staff to monitor the houses in the reception area. If there are any noises, it will alert the staff to check on the elders. This reduces the frequency of in-person checks, which often disturb residents from sleep.

 

Hogeweyk’s philosophy is that: since the elderly with dementia are unable to live in their original community, so it brings the community to them instead. In addition to creating a small town, the management welcomes families and friends of the elderly to visit them. They can dine at the restaurant, shop at the supermarket, and accompany the elderly to participate in various activities.  According to the feedback, the satisfaction rate of the participants is very high, and the frequency of which the elderly need to take medicine or use adult diapers have also been greatly reduced.

 

However, it is not cheap to build such an elderly-friendly town. The construction cost was about US$25 million, of which US$22 million was funded by the Dutch government. The government has to provide a subsidy of 250 Euros per day, or 7,500 Euros monthly per resident. Applicants to the elderly town still outnumber the available spots. Some European countries and the United States are building similar care homes using Hogeweyk as the blueprint to provide quality home-care services for the elderly. Looking back to Hong Kong, what should we do to deal with the rising number of elderly people with dementia?
 

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