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Innovation in dementia care: stories from Het Gastenhuis

Leadership & Governance

24 August 2017

Last year, the first branch of the NPM-participation Het Gastenhuis opened. Located on Dordrecht’s historical Vest canal, this small-scale residential facility for people with dementia is managed by a pair of live-in carers, the married couple Ronald and Trudie Zwiers. The two pioneers took some time out to reflect on the home’s busy start-up period.

Last year, the first branch of the NPM-participation Het Gastenhuis opened. Located on Dordrecht’s historical Vest canal, this small-scale residential facility for people with dementia is managed by a pair of live-in carers, the married couple Ronald and Trudie Zwiers. The two pioneers took some time out to reflect on the home’s busy start-up period.

Everything in the landmark building, a converted school, still smells brand new. This is no surprise since, as Ronald Zwiers tells us, the refurbishment has only just been completed. You’d be hard-pressed to find a more desirable location in this southern Dutch town: featuring a waterfront terrace, the home sits on the periphery of Dordrecht’s picturesque old town centre. This is where Ronald and Trudie Zwiers will be managing their team of caregivers over the next few years, sharing responsibility with them for the care and wellbeing of a total of 20 dementia patients.

When we kick off the interview by asking ‘But let’s be serious for a moment, do you know what you’ve let yourselves in for?’ Trudie Zwiers looks over to her husband before letting out a laugh and answering: ‘To be perfectly honest, no. But while we don’t quite know what to expect exactly, we certainly have a plan in place. We did our homework: we visited many other, similar small-scale residential facilities all over the country, and we made sure to ask a lot of critical questions. Of course, we also spoke at length with the two women behind the Het Gastenhuis concept, and found that their approach to care was very similar to our own. That’s what eventually clinched the decision to take on this project.’

Both Ronald and Trudie are long-time healthcare professionals, having experience as a manager in the home care sector and as an assistant at a primary care clinic, respectively. Ronald: ‘We’d always tell the other person about our day when we got home in the evening, but actually working together is a completely different story. Running this home together, we’re not only partners but immediate colleagues as well. Since we work together so closely, we‘ve had to become familiar with each other’s work styles and figure out what duties each of us is best at. But all in all, it’s been pretty smooth sailing so far.’

“Our team members a great deal of personal responsibility.”

Keeping the team on their toes

Trudie: ‘There are certain things we make a point of always doing together, like having feedback meetings with family members, running team meetings and collecting information on prospective new residents. We also conducted all the job interviews together. While Ronald is a born leader, my forte is more on the organisational side, but we’ve found that, by and large, we share the same views on the things that matter.’

Ronald, describing the whirlwind three months following the opening of the home in December 2016: ‘There were weeks where we barely even left the house due to the sheer amount of work involved. Now that things are starting to fall into place, we can actually take the odd evening or weekend off.’ The couple are supported by a team of qualified healthcare professionals who are responsible for keeping everything running smoothly round the clock. But Ronald and Trudie also put in regular shifts themselves, so as to remain firmly grounded in the day-to-day realities of the home, right alongside the staff and residents.

Ronald: ‘I would say our main responsibility in running this home is keeping the team on its toes and keeping the focus on the home’s mission. Our formal mission is to provide residents with a high standard of living in an environment that’s warm and welcoming, while delivering high-quality care and services. We do our bit every day to try to make that into a reality.’

Time needed to adjust

With Dordrecht’s attractive old town centre just a five-minute walk away, the members of Ronald and Trudie’s team can take some of the residents out for a visit to the local, weekly open-air market or a walk in the area virtually every day. Trudie: ‘This is really a unique location, one that people tend to describe as warm and peaceful and that at the same time is right in the centre of things. Family members who have come to visit often tell us that they left feeling their loved one is in the perfect place.’

Ronald: ‘Of course, you can tell whether or not residents are happy, but ultimately we can only gauge how we’re doing in terms of objective quality standards through the feedback we receive from family members. If they tell us they feel their relative is well looked after here, we know we’re doing something right. At the end of the day, we want the residents to find a place that really feels like home again.’

The beautifully restored landmark building and attractive central location have proved to be somewhat of a magnet for healthcare professionals, and the couple have no shortage of job applicants. Ronald: ‘But the way the home is organised and our approach to delivering care are also a big draw. We give our team members a great deal of personal responsibility – after all, they are qualified professionals who know what they’re doing. It’s quite a demanding job, too: we have to make do with a limited number of staff, as we’re working within a budget.

We have found, incidentally, that employees with a background in a regular healthcare setting need a bit of time to adjust at first. We tell them it’s OK to spend a bit more time on a particular resident if the situation calls for it, and explain that we make a point of ensuring that all residents are showered every day. Those are things that ideally should be the standard everywhere, but going back to that way of working often takes some getting used to.’

“It's important that couples adapt the concept to suit their particular set of circumstances.”

Residents' needs greater than anticipated

With the Het Gastenhuis model now rapidly being rolled out on a larger scale, several couples with experience in healthcare have already visited the Dordrecht facility to get a taste of how the concept works in practice. Trudie: ‘I always make sure to tell people that it’s important they adapt the concept as they see fit. A Gastenhuis-style home near a new housing estate in a small town is inevitably going to be quite different from our home. We have our own way of doing things here, tailored to our specific set of circumstances, and the same should apply elsewhere.’

When meeting other couples who are exploring the possibility of running a home, Ronald and Trudie are always upfront about just how much care the residents require. Ronald: ‘We’ve found that the demand on us and our team is greater than we initially anticipated. Those are the ramifications of the policies introduced by the previous government, under which people are expected to continue living in their own homes for as long as possible, in some cases supported by a network of informal carers. This means that by the time they move into our home, they’re at a more advanced stage of dementia. This is also reflected in the needs assessments (a score is assigned to dementia patients on a scale from 1 to 5, based on the level of care required) for patients: a few years ago, people with a less severe form of dementia were given the same assessment as people with a more serious form now.’

Yet in spite of the serious mental impairment associated with dementia, there is plenty of human interaction between the team and the residents. Trudie: ‘People sometimes ask us whether we get anything in return, and I always tell them: absolutely. Perhaps not so much in terms of direct communication, but certainly in terms of the moments we get to witness. You might see someone’s face light up when we’re playing music, or they’ll be grinning with glee while tucking into a bowl of strawberries and cream. Those are the times when you remember why you’re doing this work in the first place; it’s when you realise there’s a real difference between paint-by-numbers care and quality care with a personal approach.’

Interested in innovative methods in the care sector? Also read: New working methods in the care sector