American Hogeweyk – an Interview with UMC’s Larry Carlson
Larry Carlson of United Methodist Communities is known as a thought leader in the aging services space. He’s always pushed his team and his communities to be more resident-focused and to come up with creative ways to meet their needs. Recently, Larry spent some time in Europe. While there, he visited the world-famous Hogeweyk memory-support community in the Netherlands. Profiled by CNN, Hogeweyk has become a model for dementia care that many American providers have dreamed of reproducing in the States. Its community-based design, open and spacious amenities and focus on daily living have made it a model for the rest of the world.
We took a minute to sit down and chat with Larry about his experience and what he thinks the future of memory-support communities might look like.
Varsity – How did you first hear about Hogeweyk and become interested in the work being done there?
Larry – In 2013, CNN profiled the community in an excellent 20-minute segment. Since then, I’ve always wanted to visit and see the community firsthand. (For reference, here’s a link to that piece https://www.youtube.com/watch?v=LwiOBlyWpko&app=desktop.)
Varsity – We know that Hogeweyk is centered on memory-support services. But, it seems it would be difficult to create such an environment for those with severe memory loss.
Larry – On the contrary! Residents don’t come to Hogeweyk because they are just mildly confused. Every person living in the community has a severe memory issue. Forty percent of the residents utilize some kind of mobility assistance. This isn’t a community created for those with onset dementia issues. It’s built to help those that are living with severe dementia.
Varsity – Wow! That’s not what would we would have expected at all. How can they care for such a population in a free and open environment like Hogeweyk?
Larry – Residents live in homes with six or seven other people. There are 23 such homes at Hogeweyk. Each resident has their own bedroom, sharing a kitchen and general living space with others. Team members are only in the homes between 7 a.m. and 10 p.m. each day. As the residents move about the community, every team member is there to assess their needs and ensure safety. At night, residents are monitored with advanced technology. Rather than keeping a team member in every home overnight, they utilize microphones to listen for movement and issues, deploying staff as needed.
Varsity – It seems like Hogeweyk takes the idea of ‘person-centered care’ to a whole new level. Can you describe the environment and vibe within the community as you toured?
Larry – While ‘care’ is important, it’s not the most important phrase in the lexicon at Hogeweyk. The entire team is focused on a single mission: ‘normalize life.’ Every team member’s goal is to provide as normal a daily living experience as possible for every resident. If a resident wants to go grocery shopping, help with laundry, clean the house or just go for a walk, they are allowed to do that. No one chases after a resident who wanders away on their own. Within the community, residents are safe and allowed to explore as they like. At Hogeweyk, they care for their residents by ensuring their independence.
Varsity – This sounds like an amazing community but also one that would be a regulatory and risk management nightmare here in the States. How do they handle these issues?
Larry – Communities like Hogeweyk are mostly government funded and heavily regulated. That provides some layer of protection. The Dutch have a saying, ‘Don’t shoot the bear until you see the bear.’ This means that you don’t restrict an activity or area because it could be a problem in the future. For instance, there was a balcony with a regular height handrail. My inner administrator was immediately fearful that someone could fall over such a railing. When I posed this question to my Dutch counterpart, he noted that no one has ever fallen, so why would they change it now? It’s definitely a different mindset than what I’m used to.
Varsity – With this in mind, do you think there’s a way to bring a Hogeweyk-type community to the United States?
Larry – Absolutely! It’s become my goal to do so. We’ve reviewed the staffing requirements and realized that Hogeweyk’s staffing is within a single FTE of the staffing we would provide for a similarly sized community. Also, the monthly cost to reside at Hogeweyk is nearly identical to what UMC charges in many of our communities. Yes, there will be some regulatory hurdles, but the model is completely viable, and we want to make it happen at UMC.
Varsity – Thank you so much for sharing your experiences and thoughts with us and our readers! Do you have any final thoughts you’d like to share?
Larry – I really appreciate this opportunity as well! I’d encourage all of my colleagues and counterparts to learn more about Hogeweyk. Even if they can’t create a replica of the services offered, I’d implore them to think beyond person-centered care when it comes to memory support. Think about how you can normalize life for each resident. That simple change in thought process is the first step in the Hogeweyk model.