This is the Hogeweyk. It's a neighborhood in a small town very near Amsterdam, in the Netherlands. There are 27 houses for six, seven people each. There's a small mall with a restaurant, a pub, a supermarket, a club room. There are streets, alleys, there's a theater. It actually is a nursing home. A nursing home for people that live with an advanced dementia and that need 24-7 care and support.
這是霍格威。 它是荷蘭一個小鎮上的鄰里, 非常靠近阿姆斯特丹。 那裡有 27 間房子, 每間有 6~7 人。 有一個小型購物中心,內有餐廳、 酒吧、超級市場、俱樂部房間。 那裡有街道、巷弄, 也有一間戲院。 它其實是一間療養院。 這間療養院所住的是 重度失智症患者, 他們一天 24 小時,一週七天 都需要照護和支持。
Dementia is a terrible disease, and we still don't have any cure for it. It's getting to be a major problem in the world, for the people, for the politicians, for the world -- it's getting to be a big problem. We see that we have waiting lists in the nursing homes. Most people that come to the nursing homes with dementia are women. And that's also because women are used to taking care of people, so they can manage to take care of their husband with dementia, but the other way around is not so easy for the gentlemen.
失智是一種很糟的疾病, 我們仍然沒有方法治療它。 它漸漸成為世界上的 一個重大問題, 對人民、對政治人物、 對世界來說—— 它漸漸成為一個大問題。 我們知道,在療養院有等候名單。 大部分到療養院的 失智症患者是女性。 那也是因為女性很習慣照料人, 所以她們的先生若得了失智症, 她們也能負責照顧, 但在相反的情況中, 對男性而言就沒這麼容易了。
Dementia is a disease that affects the brain. The brain is confused. People don't know anymore what the time is, what's going on, who people are. They're very confused. And because of that confusion, they get to be anxious, depressed, aggressive.
失智是一種會影響大腦的疾病。 大腦很困惑。 患者不再知道現在是什麼時間、 有什麼事有發生,也認不得人了。 他們非常困惑。 因為那種困惑, 他們會變得很焦慮、 憂鬱、有侵略性。
This is a traditional nursing home. I worked there in 1992. I was a care manager. And we often spoke together about the fact that what we were doing there was not what we wanted for our parents, for our friends, for ourselves. And one day, we said, "When we keep on saying this, nothing is going to change. We are in charge here. We should do something about this, so that we do want to have our parents here."
這是一間傳統的療養院。 1992 年時我在那裡工作。 我是照護經理。 我們常常聚在一起談, 說我們在那裡所做的事, 並不是我們希望我們的父母、 我們的朋友、我們自己 若失智時會得到的照護。 有一天,我們說: 「我們一直說這些, 什麼都改變不了。 這裡是我們主導的。 我們應該要來採取行動, 做到讓我們也希望 我們的父母住到這裡。」
We talked about that, and what we saw every day was that the people that lived in our nursing home were confused about their environment, because what they saw was a hospital-like environment, with doctors and nurses and paramedics in uniform, and they lived on a ward. And they didn't understand why they lived there. And they looked for the place to get away. They looked and hoped to find the door to go home again. And we said what we are doing in this situation is offering these people that already have a confused brain some more confusion. We were adding confusion to confusion. And that was not what these people needed.
我們談了這件事, 以及我們每天所看到的 都是住在我們療養院的病人 對於他們的環境感到非常困惑, 因為他們看到的是 一個像醫院的環境, 都是穿著制服的醫生、 護士、急救護理人員, 且他們住在病房中。 他們不了解為什麼他們住在那裡。 他們會想要想辦法逃離。 他們會尋找並希望 能找到回家的那扇門。 我們說,在這個 情況下我們所做的事 是帶給這些頭腦已經 非常困惑的病人 更多的困惑。 我們在困惑上再加上困惑。 那並不是這些人所需要的。
These people wanted to have a life, and the help, our help, to deal with that dementia. These people wanted to live in a normal house, not in a ward. They wanted to have a normal household, where they would smell their dinner on the stove in the kitchen. Or be free to go to the kitchen and grab something to eat or drink. That's what these people needed. And that's what we should organize for them.
這些人想要有個人生, 想要得到協助,我們的協助, 來處理失智的問題。 這些人想要住在一般的房子裡, 而不是病房。 他們想要有個正常的家庭, 在這個家庭裡,能聞到 廚房的爐子傳來晚餐的香味。 或者他們能夠自由進入廚房, 隨手抓些東西來吃或喝。 那才是這些人需要的。 那才是我們應該為他們安排的。
And we said we should organize this like at home, so they wouldn't live with a group of 15 or 20 or 30, like in a ward. No, a small group of people, six or seven, family-like. Like living with friends. And we should find a way to select people based on their ideas about life so that they did have a good chance to become friends, when they lived together. And we interviewed all the families of the residents about "what is important for your father," "what's important for your mother," "what is their life like," "what do they want." And we found seven groups, and we call them lifestyle groups.
我們說,我們應該 把環境安排成像家一樣, 讓他們不用和 15、20,或 30 個人 住在一起,像住病房一樣。 不要,應該一小群人就好, 6 或 7 個人,就像個家庭。 就像和朋友同住。 我們得要想出一種方式來挑選人, 依據他們對於人生的想法來挑選, 這麼一來,當他們住在一起時, 才會更有機會成為朋友。 我們和所有居民的家人進行面談, 談「你父親重視什麼」、 「你母親重視什麼」、 「他們的人生是什麼樣子的」、 「他們想要什麼」。 我們分出了七種族群, 被我們命名為生活方式分組。
And for instance, we found this formal lifestyle. In this lifestyle, people have a more formal way of interacting with each other, a distant way. Their daily rhythm starts later in the day, ends later in the day. Classical music is more heard in this lifestyle group than in other lifestyle groups. And their menu, well, is more French cuisine than traditional Dutch.
比如,我們發現了 一種正式生活方式, 在這種生活方式中, 人們和彼此互動的方式比較正式, 比較有距離。 他們每天的日常節奏 開始得比較晚, 結束得也比較晚。 比起其他生活方式分組, 在這種生活方式分組中 更常聽到古典音樂。 他們的菜單, 比較多是法國菜 而不是傳統荷蘭菜。
(Laughter)
(笑聲)
In contrary to the craftsman lifestyle. That's a very traditional lifestyle, and they get up early in the morning, go to bed early, because they have worked hard their whole life, mostly with their hands, very often had a very small family business, a small farm, a shop, or like Mr. B, he was a farmhand. And he told me that he would go to his work every morning with a paper bag with his lunch and one cigar. That one cigar was the only luxury he could afford for himself. And after lunch, he would have that one cigar. And until the day he died in the Hogeweyk, he was in this little shed, every day, after lunch, to smoke his cigar.
相對的分組則是工匠生活方式。 那是種非常傳統的生活方式, 他們早上很早起床, 很早上床睡覺, 因為他們一生中都辛勤工作, 大部分都是要動手去做, 很常見的是經營小型 家族事業、小農場、小店, 或像 B 先生,他是農場工人。 他告訴我,他每天早上去工作時, 會用紙袋裝著午餐一起帶去, 裡面還有一根雪茄。 那根雪茄是他唯一能 負擔得起的奢侈品。 午餐之後,他就會抽那根雪茄。 到他在霍格威過世的那一天之前, 每天午餐後他都在這間小屋抽雪茄。
This is my mother. She's of the cultural lifestyle, she's been living in the Hogeweyk six weeks now. And that lifestyle is about traveling, meeting other people, other cultures, interest in arts and music. There are more lifestyles. But that's what we talked about, and that's what we did.
這是我母親。 她的分組是文化生活方式, 現在她已經在霍格威住了六週了。 那種生活方式的特點是旅行、 認識其他人、其他文化、 對藝術和音樂感興趣。 還有更多其他生活方式。 但,那就是我們在談的, 也是我們所做的。
But that's not life in a house with a group of people, like-minded people, your own life, your own household. There's more in life, everybody wants fun in life and a meaningful life. We are social animals -- we need a social life. And that's what we started. We want to go out of our house and do some shopping, and meet other people. Or go to the pub, have a beer with friends. Or like Mr. W -- he likes to go out every day, see if there are nice ladies around.
但,那並不只是和一群人 住在一間房子裡的生活, 和想法相似的人, 你自己的人生,你自己的家庭。 人生不只如此, 大家都希望人生有樂趣且有意義。 我們是社交的動物—— 我們需要社交生活。 那就是我們開始做的事。 我們想要走出 我們的房子,去購物, 去見見其他人。 或是去酒吧,和朋友喝杯啤酒。 或像是 W 先生—— 他喜歡每天都出門, 看看附近有沒有美女。
(Laughter)
(笑聲)
And he's very courteous to them, and he hopes for smiles and he gets them. And he dances with them in the pub. It's a feast every day.
他對她們非常有禮, 他希望能得到微笑, 也確實得到了。 他和她們在酒吧跳舞。 每天都是盛宴。
There are people that would rather go to the restaurant, have a wine with friends, or lunch or dinner with friends and celebrate life. And my mother, she takes a walk in the park, and sits on a bench in the sun, hoping that a passerby will come and sit next to her and have a conversation about life or about the ducks in the pond.
有些人寧願去餐廳, 和朋友喝葡萄酒, 或和朋友吃午餐 或晚餐,頌揚生命。 而我母親,她會在公園散步, 在太陽下坐在長凳上, 希望有人路過,坐在她旁邊, 和她聊聊人生, 或是池塘裡的鴨子。
That social life is important. It means that you're part of society, that you belong. And that's what we people need. Even if you're living with advanced dementia.
那種社交生活很重要。 那意味著你是社會的 一部分,你有歸屬。 那是我們人類的需求。 即使你得到重度的失智症也一樣。
This is what I see from my office window. And one day, I saw a lady coming from one side, and the other lady from the other side, and they met at the corner. And I knew both ladies very well. I often saw them walking around outside. And now and then, I tried to have a conversation with them, but their conversation was ... rather hard to understand. But I saw them meeting, and I saw them talking, and I saw them gesturing. And they had fun together. And then they said goodbye, and each went their own way. And that's what you want in life, meeting other people and being part of society. And that's what I saw happening.
這是我從我辦公室的 窗戶所看見的景象。 有一天,我看見 一位女士從一邊過來, 另一位女士從另一邊過來, 她們在街角相遇。 我很熟識這兩位女士。 我常常看到她們在外面行走。 偶爾,我會試著和她們交談, 但她們的對話…… 蠻難理解的。 但我看見她們相遇, 看見她們說話, 看見她們比手劃腳。 她們在一起很開心。 接著,她們道別,各自上路離開。 這就是你在人生中想要的, 和其他人會面, 成為社會的一部分。 而我就看到了這樣的狀況發生。
The Hogeweyk has become a place where people with very advanced dementia can live, have freedom and safety, because the professionals working there and the volunteers working there know how to deal with dementia. And the professionals know how to do their professional work in a way that it fits in a natural way in the life of our residents. And that means that the management has to provide everything those people need to do their work. It needs a management that dares to do this. To do things differently than we always have done in a traditional nursing home.
霍格威變成了一個不同的地方, 在這裡,重度失智症病人可以 自由且安全地生活, 因為在那裡工作的 專業人士以及志工 知道如何處理失智。 專業人士知道如何 做他們的專業工作, 且採用的方式能很自然地 融入到我們居民的生活中。 那就表示,管理階層得要提供他們 工作所需要的一切。 管理階層需要有膽識這麼做。 採不同的方式來做事, 不同於傳統療養院慣用的方式。
We see that it works. We think this can be done everywhere, because this is not for the rich. We've been doing this with the same budget as any traditional nursing home has in our country. We work only with the state budget.
我們知道這是行得通的。 我們認為這種方式 可以用在任何地方, 因為它不是給富人專用的。 我們這麼做所使用的預算 和我們國內任何傳統 療養院的預算都一樣。 我們只用州提供的預算。
(Applause)
(掌聲)
Because it has to do with thinking different, and looking at the person in front of you and looking at what does this person need now. And it's about a smile, it's about thinking different, it's about how you act, and that costs nothing. And there's something else: it's about making choices. It's about making choices what you spend your money on. I always say, "Red curtains are as expensive as gray ones."
因為它的重點在於 不同的思考方式, 以及看看你面前的人, 看看他現在需要的是什麼。 重點是一個微笑, 重點是不同的思考方式, 重點是你怎麼做, 那些是不用花錢的。 還不只如此:重點是要做選擇。 重點是要選擇你把 你的錢花在什麼地方。 我總是說: 「紅色窗簾和灰色窗簾一樣貴。」
(Laughter)
(笑聲)
It's possible, everywhere.
在任何地方,這都是有可能的。
Thank you.
謝謝。
(Applause)
(掌聲)