[100-Year Brain Health⑧] "People Over Disease"... Dementia Care 'Care Farm' Alongside Agriculture

'De Reijhershuver' Dedicated to Severe Dementia
Designed with a Homely Atmosphere Inside and Out
Emotionally Stabilized with Animals

On the 24th (local time), Mr. Henk Smith is taking care of the pig 'Ria' at De Reijershoover Care Farm.
Photo by Kim Young-won

Visiting the Netherlands, a Leading Country in Dementia Care

The Netherlands is the country that holds the most titles as the 'first' among advanced dementia care nations. In 2008, the first dementia village, where dementia patients are treated as 'residents,' was established, and the 'Alzheimer's Caf?,' a meeting place for dementia patients to interact with others, also started in the Netherlands in 1997. Asia Economy visited the Netherlands from the 23rd to 24th of last month to directly observe advanced dementia care cases, a crucial challenge to solve for brain health at 100 years of age.

[Asia Economy, Heemskerk (Netherlands) = Reporter Kim Young-won] "The vision here is welfare for people, not the disease. The goal is for everyone who comes here to have an enjoyable day."

On the 24th of last month (local time), at De Reigershoeve Care Farm located in Heemskerk, Netherlands. After about an hour's drive from the capital Amsterdam and another 20 minutes into a small alley in a rural village, this place felt more like a garden than a nursing facility. In the fenced area in front of the clustered houses resembling country homes, goats and ponies were taking naps. Right next to the fence, elderly people gathered on the terrace, enjoying tea and chatting under the sunlight.

De Reigershoeve Care Farm was established by Henk Smit and his daughter Dineke as a residential care facility for patients with severe dementia, focusing on the happiness of patients rather than the disease itself, unlike conventional nursing homes. Residents typically spend about one and a half to two years here living their daily lives before passing away.

Caring in Daily Life on the Farm

Care farms originated in Europe, including the Netherlands and Belgium, and have spread worldwide as a form of care. They utilize farms to provide various care and rehabilitation services not only for dementia patients but also for individuals with attention deficit hyperactivity disorder (ADHD), addiction, depression, and other conditions regardless of age. While many operate as day care centers accommodating various patients without distinction by disease or disability type, De Reigershoeve is a residential care farm exclusively for dementia patients.

The reason Henk and his daughter established a residential care farm solely for dementia patients stems from their personal experience with family members affected by dementia. Henk said, "My father-in-law, mother, and brother suffered from dementia, and when I visited nursing homes, I felt bad seeing them unable to go outside. I wanted to create a facility that was not an unhappy nursing home."

The interior living space of Care Farm can be decorated according to individual preferences, including the door.
Photo by Kim Young-won

Reflecting the father and daughter's philosophy, De Reigershoeve Care Farm consists of a communal living room building and four residential buildings for residents. Each building houses 6 to 7 dementia patients, totaling 27 residents. Although they are patients with severe dementia, residents freely come and go inside and outside the buildings, which resemble ordinary homes, spending their days as they wish. Considering the principle of 'people over disease,' Henk's greatest effort was to create a home-like atmosphere inside and outside the buildings. Residents have single rooms, and they sometimes bring personal items and beds from their original homes. Doors to the rooms are decorated with postcards, pictures, and other items according to individual preferences. Even smoking and drinking, which are generally prohibited for patients, are allowed freely as long as they do not disturb others.

Farm crops such as pumpkins and beans are used as ingredients, and residents can take care of animals, but these activities are not mandatory. Henk explained, "Staff members take care of the crops separately, and residents can participate if they want to," adding, "We keep animals to help residents feel comfortable." Elderly people interacting with animals on-site appeared emotionally stable. When one elderly person approached the central fenced area with feed, goats, ducks, and other animals naturally gathered. The person fed them and stayed for about ten minutes talking to the animals before leaving. Henk noted, "Another side effect of animals is that grandchildren of residents, who generally do not like visiting nursing homes, enjoy coming here. When children come to the farm, residents also feel happy."

In October, a guesthouse (Logeerhuis) for temporary accommodation for dementia patients is scheduled to open. Currently, space for up to three residents is secured, with plans to gradually increase to seven. Henk explained the background of this new facility concept: "Dementia patients often need temporary housing when their caregivers are hospitalized or ill and cannot be left alone."

Welfare Funding Covers Costs... Anyone Can Reside

De Reigershoeve and other care farms in the Netherlands operate under the national health and welfare system and are funded through nursing care benefits. Residents do not pay fees and can use the care farms regardless of wealth. Henk said, "The cost burden for users is zero, meaning anyone can come here," adding, "Donations are used to build greenhouses or stables." Because there is no cost burden and satisfaction is high, the current waiting list reaches about 200 people.

In the fence right in front of the residential building, you can see animals such as goats up close.
Photo by Kim Young-won

Although it is a farm-style facility, it must meet certain standards like nursing institutions, such as employing a sufficient number of certified nursing assistants, since it is operated with national welfare funds. Staffing standards vary depending on the region and capacity. All 60 staff members at De Reigershoeve Care Farm have completed care training courses, and some have received specialized 'care farm' education. Henk said, "This place has high satisfaction not only among patients but also among staff," explaining, "The patient-to-staff ratio is low, and there is no fixed schedule, so there is less time pressure."

Besides De Reigershoeve, there are care farms managing dementia throughout the Netherlands. Grootenhout Care Farm near Eindhoven is also a residential care farm for dementia care like De Reigershoeve. Eekhoeve Care Farm in Veenendaal serves clients with developmental disabilities but separates elderly spaces to care for dementia patients.

Experts cite diverse autonomous activities as the biggest difference between care farms and general nursing facilities. Jo Ye-won, director of the Bachningen Care Farm Research Institute, said, "On farms, various activities beyond agriculture are possible, through which patients gain a sense of accomplishment and self-esteem," adding, "Depending on individual characteristics, people can engage in activities such as animal care, cooking, woodworking, and more."

Similar 'healing agriculture' and 'social agriculture' projects are underway domestically, but they differ from the Dutch model. First, they are not linked to health insurance or welfare systems. Social agriculture is managed by the Ministry of Agriculture, Food and Rural Affairs, and healing agriculture by the Rural Development Administration and other agricultural departments. Moreover, these projects mainly follow instructor-led programs. Director Jo emphasized, "Unlike the domestic approach, which focuses on group therapy programs under instructor guidance for 2-3 hours, the goal of Dutch care farms is care and meaningful daily life."