In this autumn newsletter, the cheerful and always driven Francien van de Ven talks about her work and life at the Ouderenlandgoed Grootenhout in Mariahout in Brabant. Grootenhout is a care farm located in a rural and wooded area, spread over 4 addresses. It offers elderly people with dementia a versatile daytime experience in an attractive, open and stimulating (living) environment. In this interview everything about the special “homecoming experience”, living in freedom, and the pursuit of “moments of happiness” for the residents in Grootenhout.
“I'll just stay here myself!”
Francien's career perhaps started somewhat unusually as an insurance advisor, before accidentally moving into elderly care. Father-in-law Herman, with advanced dementia, certainly did not want to move to a regular nursing home. “I'd rather die”, he said. For years, Francien, together with her sister-in-law, lovingly took over the daily care of Herman. At that time, Francien studied the disease, read books about the treatment of dementia and her interest in dementia care was awakened.
Fortunately, Herman was able to go to the recently opened care farm “Grootenhout” for daytime experiences. Already 13 years ago, the owners of this farmhouse in the countryside, Doris and Noudje, had the wish to give dementia care a freer and less regulated interpretation. Noudje's mother with dementia was the first resident to find a new home in the cozy and messy farmhouse. This type of living, surrounded by horses, dogs and cats, and close to nature also immediately appealed to Herman and Francien. So much so that Francien simply started helping with the daily care and guidance of the residents on the farm and immediately felt a new passion arise for this unique form of elderly care, so closely intertwined with the Brabant outdoors. The Grootenhout estate has now grown into 11 houses with 80 residents, spread over 4 addresses, all with the rural and free appearance of the original estate. Everyone with dementia is welcome. Preferably first with the daytime activities, after which the transition to a private bedroom internally on the elderly estate will almost be accepted as self-evident by the resident and his or her environment. “The special thing is that anyone can come and live with us, even with an AOW income. The only house rules are that smokers are refused and that serious aggression is not tolerated.”
Thinking and acting differently in healthcare
During the same period, Francien followed the “dementia reference person” training in Belgium, comparable to the “dementia case manager” in the Netherlands. In the Netherlands, this independent intermediary guides the person with dementia and their environment through the complicated process from initial care indication to the move.
to the nursing home. During the training to become a dementia reference person in Belgium, you will receive more extensive training to become a case manager for people who are already staying in a care institution. In this position you are employed by the institution and you supervise people with dementia in the care home itself. “You provide a meaningful daytime experience, conduct discussions with the family and provide on-site training for the staff.” Within Grootenhout, Francien also provides internally the one-year training course “Supervisor for specific target groups”, a recognized training course in collaboration with the Care and Work Academy in Ede. “Thinking differently” in healthcare also receives a lot of attention here – an integrated change approach in healthcare, welfare and living, in which personal autonomy and dignity, livability of the living environment, and quality of life and work are central. Related to this, Grootenhout has two important selection criteria to be allowed to work on the farm: a positive appearance and a passion for people with dementia.
Francien van de Ven is known in the dementia world for her successful seduction techniques; the art of getting residents with dementia to come out of their apathy without coercion and to participate enthusiastically in daily activities. “We cannot change the disease, but we can change the way we look at it and how we deal with it.” About her beautiful experiences and dealing with the disease during the years in which she cared for her father-in-law Herman, who lived at home, a photo book with texts by her hand, “Dementia in Image”, was published in 2018. Two years later, a more practical book followed entitled, “How?”, including handy and useful tips and special stories from practice to improve care for people with dementia. This book is also used as teaching material for internal training.
“The ordinary part of life at Grootenhout is actually very special”
Residents who live on Grootenhout often first participate in daytime activities during the day for years, after which the progression to a suitable place on a farm almost happens automatically. Experience has shown that this process often guarantees a more uncomplicated transition phase from home to the care home.
One of the biggest success factors of the care farm is the “homecoming experience”. Every morning, after breakfast, we walk to a different location to spend the rest of the day in a different environment - just as people without dementia alternate between being at home, at work or at school. “In the afternoon, the coat is put on again and we all walk back to our own house, just like before. You stay mobile and move, there is a change of scenery and a purpose to go somewhere that day.”
Encouraging walking and exercise fits in with the philosophy of Grootenhout's open doors policy and was part of daily life long before the Care and Compulsion Act. “Running away” is also simply called “walking” where people are encouraged to go their own way.
Francien is an outspoken advocate of as much personal freedom as possible for people with dementia: “Locking people up based on their diagnosis is a no-go.” She is convinced that closed departments invite apathy. “More than
Half of the people in a closed department are already in a wheelchair after 6 weeks. Our system is often designed for limitations, focused on safety, in which the care worker's sense of responsibility, including from basic training, plays a major role. “Thinking differently” in healthcare is not yet common practice when dealing with people with dementia.”
Thresholds and uneven floors stimulate the alertness of the resident with dementia...
Francien regularly gives tours of the care farm - also because of the unique living and care concept that is only available in a few places in the Netherlands. For years, students from Eindhoven University of Technology (TU/e) and the ECDT have been warmly welcomed to Grootenhout to meet elderly people with dementia in the context of their own research. Francien receives and guides the young people, enthusiastically shares her experiences, Grootenhout's vision and listens to the ideas of the young researchers with a constructive, critical and honest view.
The collaboration with the ECDT started during a meeting within the Dementia Learning Network in Brabant, where Francien shared a number of questions she was having at the time. For example, a TU/e student conducted research into the effect of the presence of thresholds and uneven floors on the well-being of the person with dementia. In many places in healthcare, these barriers are removed to reduce the risk of falling, but Francien wondered whether this was necessary and might even be counterproductive. A historic farm such as Grootenhout, made up of various old living areas, is of course rich in uneven surfaces, thresholds, cobblestones, lawns and romantic overgrown paths, both indoors and outdoors in the garden. Research was therefore necessary in order to obtain the necessary certifications in the field of safety. The observations and interviews of the TU/e student ultimately revealed that the person with dementia at Grootenhout is not at greater risk than elsewhere, but in fact remains alert longer by approaching the uneven floors cautiously and attentively - with or without a walker - to take small steps. A special start to the collaboration between the ECDT and Grootenhout.
Healthcare technology: only where and when it really adds something
Until recently, little or no use was made of technology. For example, to date no use has been made of the so-called Living Circles – complete freedom for everyone is the starting point at Grootenhout. “But a few people are sometimes given a GPS tracker, especially if that person can no longer easily find their way on their own.”
But now technology as a supplement to healthcare also seems to be making its debut at Grootenhout: “The implementation of the sleeping shifts at all locations became a problem and that is why we installed a simple camera so that we could respond alertly in the event of trouble during the night.” There is even a house where a baby monitor works well as a solution.
During the winter months, when the outdoors is less accessible, special care technology is sometimes used, such as a
Magic table. “Instead of purchasing this, we rent the Tovertafel. Then it is a new experience to which people respond enthusiastically. After a few sessions the novelty wears off and then it goes out again.” In addition, despite the presence of live animals on the farm, robot dogs are often used. “A healthcare technology that is literally and figuratively embraced enthusiastically by the residents.”
But technology is no substitute for normal life. Throughout the day there are many normal activities such as walking back and forth to the day experience, past the horses and cattle, drinking coffee and chatting together, participating in cooking or folding the laundry. It feels like an active program and the residents usually don't miss anything.
According to Francien, there will be a bigger challenge in the near future in terms of recruiting enough staff. Labor-saving technologies – such as smart incontinence materials – can help with this, although an overkill of surveillance can also cause unrest among the family and informal caregivers. “You shouldn't want to know everything all the time, because then nothing will let you go.” And it is precisely in being able to let go of rules and restrictions, and allowing people with dementia to have freedom of movement and self-direction - including all the uncertainty that comes with it - that is precisely where Grootenhout's great strength lies.
Ans Tummers-Heemels, Wijnand IJsselsteijn.
