IIt’s the dementia care complex with an air of The Truman Show. Residents shop at a mini-mart, hang out at the Cup Above cafe, get groomed at Cutters Hair and Beauty. There is even a miniature golf course.
Woodside Care Village in Warwick is presented as a miniature town centre, with benches and a fountain, cafe tables and front doors to ‘town’, ‘country’ or ‘classic’ style houses. But none of the places is what it seems, because everything here has a greater purpose: to improve the well-being of people with dementia.
modeled on a innovative dutch experiment In caring for people with Alzheimer’s disease, the purpose-built facility, which opened in 2019, is quietly breaking new ground for a better kind of dementia care.
As inspectors care discover terrible conditions In a minority of dementia homes where standards have plummeted since the start of the pandemic, The Guardian visited a place that offers hope for the UK’s fast-growing population living with dementia, set to grow from almost 1 million today to 1.6 million by the middle of the century.
“Everything is decorated and arranged to look familiar,” said Jo Cheshire, communications manager for the home operator, WCS. “We try to make sure that people don’t break their ties to the past. We have a lady who works in the laundry with a badge, because that’s what she did before. She feels like they are contributing to the community.”
The store stocks food and snacks, but its main goal is to give residents the autonomy that many nursing homes deny. So every morning, people like Pam, 69, get to choose what to eat for lunch before taking it back to her home, which they share with four or five other residents. She is called Ethelfleda, after a 9th century Mercian queen. There, a caretaker prepares their food, or they can cook it themselves. They can choose between fresh and dry ingredients. If you want to clean, there are products for that too. Everything is geared towards creating a sense of normalcy and that life goes on, regardless of the dementia diagnosis.
“People think that when they move into a house, everything stops, but this is what they want to do,” said Lorraine Herbert, deputy director of care. “It’s the same world as the world they’ve been living in.”
When I arrive, Pam is finishing lunch at home with her classmates Sandra, Jean, and Maureen. The first thing she notices when you enter her house is the appetizing smell of the meals that she has just prepared by her caretaker, Wendy. It is nothing like the stale aroma of school dinners from the mass caterers in many other care facilities. The house feels a bit like the setting for a sitcom: a comfortable sofa, lots of photos, a large open kitchen, and private rooms for each resident.
Sitting together around the table, they talk about where they are from: “Brum”, Wolverhampton, Scotland.
“I can do the Highland adventure,” says Sandra from Aberdeen.
“You may?” Pam asks, smiling.
“Not now, dear!” responds Sandra with a wink.
They all exhibit the passing climate of dementia: confusion, then concentration. A man sleeps in a chair. But there is a feeling that life goes on. Plans are made for after lunch. There’s a knitting club in the cafe.
“We could go for a walk,” Pam said. “There is a seat and you can look at the cars.” The roads are laid out in long loops so that no one strays too far. All but the perimeter gates are open.
“The idea is that you have freedom,” Cheshire said. “If you find yourself with a closed door, it can increase agitation, which is unsettling for the other residents and makes the job of the caretaker difficult.”
In many nursing homes, residents with dementia are housed on a separate floor from other people without the disease. A relative who described that floor said that “it was like going to another planet.” Woodside is trying to keep people with dementia on the same planet and living alongside people without the disease.
The home is run by a not-for-profit organisation, one of many that provide care homes for the elderly, although 84% of care places in the UK are in for-profit communities. Rates are around £1,400 per week, which is above local authority budgets but below the £2,400 of the so-called luxury care market. Crucially, the staffing ratios are higher than normal, at two employees for every five or six people instead of the usual. This means that staff can spend more time interacting with residents.
Staff are informed with a ‘this is me’ document, which details the likes and dislikes of each person with dementia and has photos of their lives, what time they like to get up, when they like to eat. On the wall next to each private room is a frame filled with photos and memories of the resident’s life thus far.
“It’s just that I know them before they had the disease,” said Wendy, who also has photos on her walls of people who used to live in Ethelfleda. “I say they are still part of us.” It is the reality of life in a nursing home.
The home is also innovating in other aspects. Each room has acoustic and camera monitoring, if the residents consent. The purpose is to quickly detect if someone is getting up in the night or agitated, so that a caretaker can go to them and prevent the whole house from waking up. A better night’s sleep means less daytime sleepiness, better eating, more exercise, and less agitation. Monitoring also means 55% fewer falls, both night and day, Cheshire said.
There are calculated incentives for the kids, which encourages family visits: ping pong, a Nintendo Wii, and bikes, plus goodies at the mini mart.
a clinic judgment of such ‘person-centred’ dementia care in 69 nursing homes in London and Buckinghamshire published in 2020 showed that it improved the quality of life of people with dementia and reduced agitation and the burden of depression or aggression. It also reduced hospital and GP visits.
Herbert believes that the quality of life for residents stays higher for longer in Woodside. Cheshire said they had also seen a reduction in the use of antidepressants. She visited Hogeweyk, the Dutch dementia town in which Woodside is based, and wondered, “This is so obvious, why isn’t it?” [all] I like this?”
The nursing home still has its problems. As in industry, staff pay is low relative to the overall economy. If residents do not get along with their housemates, they sometimes have to be moved to other accommodation. And of course, there is death. When I visited, there were a few rooms available after what Cheshire described as “a flurry of the inevitable.”
But the place crackles with opportunities for stimulation. Inspectors from the Care Quality Commission rated it “good” last month, saying “the staff were friendly and celebrated people’s individual personalities. People were supported to have maximum choice and control of their lives.”
In her room filled with photos and memorabilia, Pam flipped through her 1974 wedding album and read the wedding cables.
“It’s very important that they have a sense of purpose and a sense of belonging,” Herbert said. “It’s about what they want to do every day, the friendships they build. If one of them is not well, they recognize it. There is a closeness.”
Before I left, Pam got up from her place in the cafe’s knitting circle to show me a long-haired robotic cat that she likes to pet. She tickled her tummy to keep her purring. I joined her in stroking it and she took my other hand and squeezed it. She was smiling.