The cost of care is nearly $8,000 per month, but the Dutch government subsidizes the residents—all of whom receive private rooms—to varying degrees; the amount each family pays is based on income, but never exceeds $3,600.
To put it into perspective, a private room at a U.S. nursing home cost an average of $248 per day in 2012, or more than $90,500 annually—a figure that’s even more staggering when applied to the rapid increase in dementia patients globally.
Making me do the math in my head only to find out that the private room in the US is actually cheaper than the Dutch one (at $96,000/year) feels pretty misleading. Sure, I bet the quality of care is much much better than what you'd find in the average US nursing home, but that's exactly why you don't need to be sneaky with the numbers!
solumunus 773 days ago [-]
It’s cheaper but the government isn’t paying for more than half of it, I guess that’s the comparison. Poorly written though, for sure.
fastball 773 days ago [-]
Sure, but subsidizing elderly care is a different discussion than how the elderly care is carried out. I'm sure the Dutch government would also be capping family expenses at $3600 even if this was just a run-of-the-mill nursing home we were talking about.
paulluuk 773 days ago [-]
The amount of money that the families pay is considerably lower, though ($43,200/year).
Though honestly, that's still a lot of money.
carlmr 773 days ago [-]
Especially if you adjust for Dutch salaries which are on average lower than American salaries.
AlecSchueler 773 days ago [-]
Isn't that driven up by more extreme outliers in the US? From my expertience "on the street" the people of the Netherlands generally seem better off.
carlmr 773 days ago [-]
The people are better off in the median because there's more social services, but that means higher taxes and lower net income. Which makes paying x amount even harder.
AlecSchueler 773 days ago [-]
From my quick searches it looks like people in the Netherlands have about double the bank balance, again on average, than people in the US.
I'm not sure why being better off makes it harder to make purchases? The social services actually help people, they're not just a money vacuum.
carlmr 772 days ago [-]
The social services help people, but having to spend an amount for additional services on top of what you already pay more than Americans is extra hard, no?
AlecSchueler 770 days ago [-]
No? I disagree. If people are safe, healthy and comfortable then they're in a better position to cover their costs.
ljlolel 773 days ago [-]
I agree that was purposely chosen to hide the comparison
dutchdev 773 days ago [-]
How much of that figure is paid by the government/insurance? I think it's more about comparing the costs that are actually paid by patients.
The family of the patient never pays more then €43,200, and probably more close to half of that for most the families.
jacquesm 773 days ago [-]
It's also off by a factor of 10 on the residents side. Not sure where that figure came from, and the residents do not have much privacy, they live with 6 people to a home, which has a fixed team of caretakers.
bell-cot 774 days ago [-]
Reaction: Lovely - but the article notes that it has 152 residents, vs. 250 full- and part-time staff. If more than a very small percentage of a country's older folks develop dementia, and the country's population is not growing exponentially...then such well-staffed solutions are physically impossible to implement at scale, for lack of working-age care staff.
rqtwteye 774 days ago [-]
My father has dementia. I have some hope that robotics together with AI will make good caretakers for people with dementia. Interacting with him is not very complex. It’s basically just a repeat of the same conversations. Very labor intensive for humans but an AI would have way more patience.
jtbayly 773 days ago [-]
I can understand the impulse, but boy do I hope my family won’t turn me over to a computer in my dotage. I’d rather be loved than managed.
rqtwteye 773 days ago [-]
Caring for a dementia patient properly is all consuming for the caretakers. You don’t want to do this to your family. Getting help from a robot would be a win win for all.
cm2012 773 days ago [-]
Seriously. My grandpa had dementia for 10 years. Pretty much everyone in my family doesn't want to inflict that on anyone else.
cm2012 773 days ago [-]
Senile people are going to love the AIs of 10 years from now, I guarantee you. Once it has perfect audio control and responses, it's going to be like the perfect friend for an old person.
wernercd 773 days ago [-]
I would hope the solution would be both... humans augmented by computers so that the humans aren't overloaded and overly burdened.
vanattab 773 days ago [-]
Love is a burden no way around it. Some burdens are worth carrying however.
concordDance 773 days ago [-]
Don't engage in negative sum transactions. The burden on families by a dementia patient is often higher than the benefit the dementia patient gets.
kergonath 773 days ago [-]
Let us reimplement love in Rust from first principles to solve this inconvenience. Nothing can go wrong, it’ll be so disruptive and innovative.
nayaketo 773 days ago [-]
We'll just need to create an AI that'll emulate love semi-perfectly.
zonkerdonker 774 days ago [-]
Wow, yeah, I've never thought about this use case for AI. Honestly seems pretty ideal. A relative of mine afflicted with dementia recently passed, and while they still needed physical care, an AI "person" to bounce questions off of and talk to would have done wonders for them, and saved their carer a lot of stress and effort in a difficult time.
Interesting to hear someone articulate this dynamic. I do not believe my father has dementia but there are similarities in regards to “repeat of the same conversations”.
Wish you and your family well.
rerdavies 774 days ago [-]
My mother has dementia. At present, conversations repeat on about 3 minute intervals. There is significant value to catching early signs of dementia.
btilly 773 days ago [-]
What is the value in catching early signs of dementia given that we have no useful treatments for it?
lkuty 773 days ago [-]
You might want to read Drop Acid by Perlmutter, stuff about sugar by Robert Lustig and maybe Fiber Fueled by Bulsiewicz. They give pointers to why Alzheimer might happen in the first place and how to avoid it. Those are life-long advices.
rerdavies 772 days ago [-]
There are no cures; but there are treatments that can delay onset, slow progression, and improve quality of life to varying extents depending on which disease.
smetj 773 days ago [-]
Getting prepared for what is to come for everyone involved?
iJohnDoe 773 days ago [-]
I always thought healthcare for people is not well suited for humans to do. Doctors, yes. Everything else, no. It’s such a demanding job for nurses and hospice care workers to deal with such terrible human situations. Sadly, it will probably be decades before robots could take over for nurses
jacooper 774 days ago [-]
Rather more like infinite patience.
lostlogin 774 days ago [-]
There was a great post here recently about automating some of this work.
Working age adults work from their early 20s to their 60s and end of life care does not typically last that long.
EA-3167 774 days ago [-]
EOL with dementia can linger for well over a decade, and it only gets more expensive as it goes on.
Retric 774 days ago [-]
Most people don’t experience dementia, and most of those who have it don’t need such extreme care. Taken to an extreme, this radio suggests under 5% of a steady state population would either have significant dementia or need to treat it. But again most such people are cared for by family members.
The point of this Village is to minimize the cost of treating
significant outliers while maximizing their quality of life.
bookofjoe 774 days ago [-]
>Most people don’t experience dementia
>In the first nationally representative study of cognitive impairment prevalence in more than 20 years, Columbia University researchers have found almost 10% of U.S. adults ages 65 and older have dementia, while another 22% have mild cognitive impairment.
Sure, though don’t forget 1/4th of American men don’t live past 65, and less than half make it to 79. Dying young isn’t necessarily preferable, but it does impact these statistics.
rerdavies 773 days ago [-]
Dementia is the between the 3rd and the 5th largest cause of death in first world countries, depending on the country, and how you count. Most people aren't currently experiencing dementia, but there's a very significant chance that you're going to end up with it eventually.
The actual question should not be what percentage of the population has it; the question should be what percentage of people will be suffering from dementia to the point that they need assisted living care when they die.
DiggyJohnson 774 days ago [-]
So it would need to scale out to 10s of thousands, no?
Retric 774 days ago [-]
If everyone with dementia went to such a facility then we would need ~30,000 of them in the US. However, most people with dementia either don’t need such extreme care or have more severe medical issues, so the real number is probably a several hundred such facilities.
bombcar 774 days ago [-]
To compare, there are about 4,000 Walmarts in the USA. Each employs about 300 people.
ck2 773 days ago [-]
Covid "solves" long-term care sadly.
One worker insists on going to work anyway knowing they are sick because they need the paycheck and no health insurance or days off, and wipes the place out a few weeks later. Top that off with states that insist on allowing workers to not mask and it's almost on purpose.
Ironically covid may also cause a surge in dementia years from now so it's an ouroboros.
roughly 773 days ago [-]
What's the patient to staff ratio at typical elder-care facilities?
atleastoptimal 773 days ago [-]
What's a problem now that won't be around in 2070? Elderly and the disabled...
watersb 773 days ago [-]
Dementia is often horrible and I shouldn't joke about it... but I read this headline and immediately thought it sounded like my kind of town. :-)
More seriously, this town is a beautiful, compassionate idea and I'm glad it's there.
Here in the United States, the final years of a person's life are usually overwhelmingly expensive. Either paying many thousands of dollars per month in an assisted living facility, or paying almost nothing to a family member who sacrifices their own life for a time to provide care at home.
I've seen great results in mixed-generational care, where childcare and elder care have close interaction at least a couple of days per week. Amazing improvement in the elders living in relatively modest assisted living homes, and possible to provide at scale, more commonplace... But a global pandemic shut that down hard.
jacquesm 773 days ago [-]
The costs quoted in the article are not at all in line with the costs that the facility quotes:
Also, pretty sloppy to quote the name wrong in the article, it's not 'Hogeway' but 'Hogewey', the difference in dutch is between 'road' and 'meadow' (the latter in a weird spelling). On the facility website they also use 'weyk' which has yet another connotation (borough).
I've seen and am seeing some family members and close friends at very advanced age go through this. They are utterly unaware that they are dementing, to them everything is fine and their memories of the things that go wrong fade so fast that you can't really have a meaningful conversation on the subject. Some 80+ year olds are sharp as can be, but they are the exception around me, the default is a body that is still there coupled with a mind that is slowly leaving, too slow for the mind itself to notice.
Good genes may help keep your body alive but without a mind to go with it I'm not sure whether that's worth it. Personally I live in fear of ending up like that, depending on others for even the most basic needs.
m4lvin 773 days ago [-]
They also wrote Wheesp but it should be Weesp.
jacquesm 773 days ago [-]
Indeed, I've never before seen 'Wheesp'. Makes you wonder how that happened.
I just had auto-correct change Philippines change to Philistines, so maybe it was something like that.
zial 774 days ago [-]
Some funny math there saying it only costs $8k a month and then saying US costs an astonishing 90k a year. Do they realize 8*12 is 96k a year?
roughly 773 days ago [-]
I think the comparison is between a lovely Dutch village in which the residents live comfortable fulfilling lives and whatever the hell it is that’s happening in US elder care facilities. Like an awful lot of things, it seems like the Dutch are getting a heck of a lot more for their money than we are.
themerone 774 days ago [-]
More than half that cost is subsidized. The maximum cost to residents is $43k, and it is on a sliding scale based on family income.
773 days ago [-]
johnea 773 days ago [-]
Do HN users just generally prefer to talk about whatever interests them, while totally ignoring the article they are allegedly "commenting" on?
There was nothing in the article about robots or AI, OK? Maybe that's what you like, but this article isn't about that.
Current estimates are that ~6M people in the US have dementia today, out of a population of ~340M. Let's call that about 2%. Immediately obvious conclusion: There is not shortage of population to serve as caregivers.
What there is a shortage of is anyone who would actually want to work in a US dementia care facility. It's one of the lowest paid, least appreciated and most grueling occupations. Emotionally grueling as well as physically. How many 80 year old's butts did you wipe on Zoom today?
In spite of this, most staff I encountered were dedicated to the residents.
Maybe you're ready to lock your senile parents in a room with a robot dog, but I'm here to tell you that the human interaction is one of the only decent things in US assisted living. This is 100% from the people n the trenches. Healthcare ownership are bloodsucking jackals. Once you remove that person to person contact, the only thing left is ownership exploiting the defenseless.
science4sail 773 days ago [-]
> Do HN users just generally prefer to talk about whatever interests them, while totally ignoring the article they are allegedly "commenting" on?
Yep. Users frequently treat the link title as a writing prompt rather than clicking through to read the article. This can generate pretty jarring results if there are several different ways to interpret the title.
rhelz 774 days ago [-]
Now ask yourself: how do you know you are not already a resident of a village like that?
wyldfire 774 days ago [-]
Signs to look for:
1. romantic opportunity stolen by a beachfront kidnapping by your love interest's father, who she claims not to know.
2. your father's untimely demise in a sailing accident.
3. falling lighting equipment, e.g. like a light to represent the dogstar.
4. radio station peculiarly addressing your specific concerns.
5. your wife and friends always enthusiastically endorsing particular brands.
6. no near future departures for Fiji at your local travel agent.
BoxOfRain 773 days ago [-]
Alternatively:
1. Only local maps being available.
2. Being addressed as 'number six'.
3. Being followed around by eerie white ball things.
4. Everything looks like the 1960s.
orblivion 774 days ago [-]
I don't know anything about dementia but I gotta wonder how many people with it would even contemplate such a question.
praptak 773 days ago [-]
Why would I care?
sinenomine 773 days ago [-]
Remember, this is going to be "it" instead of full-on science-driven "war on Alzheimer's".
It is not that we cannot do more; it looks like the US public & private investment arms decided to avoid maximizing the research bandwidth available, with many life sciences grads not being able to find a research job.
A shame, really, given the inflation happens anyway - except that without spending the other side of this equation on medical R&D you stall the pipeline and rob yourself of your future.
Why is there not enough job openings for life scientists, given the urgency? Real tough question.
ElFitz 774 days ago [-]
It has already been posted here before [1], but given how little nursing homes seem to have changed, I find it still relevant, and perhaps of interest to others who like me hadn’t read about it until today.
There are a lot of activities organised on a city/town level by the Dutch Alzheimer Foundation chapters, such as Alzheimer Cafe, Creatieve Werkplaats, Bijzonder ontmoeten, Cooking Together, Choir, hiking/walking, etc
mahathu 774 days ago [-]
That's not all, besides Alzheimer Cafe, Creatieve Werkplaats and Bijzonder ontmoeten, there are also Gezellige Kletsen, Gronkelstoot Spelletjes and Zorgzame Knoetelbijeenkomsten.
isoprophlex 773 days ago [-]
Did you run that through a GPT? What the hell is a Gronkelstoot, what is a Knoetel, and don't you need to drop the -e in "Gezellige Kletsen"?!
Something fishy going on here ;)
oefnak 773 days ago [-]
And of course the AAA: allemachtig, achtentachtig al?
mahathu 773 days ago [-]
Yes. Chat GPT 4!
wdb 773 days ago [-]
That’s great. Yeah, I am aware it’s not complete. Listed a few I am aware off because my mom helped organising them. Haven’t kept up-to-date with since she passed away
mike_hock 774 days ago [-]
I just visited a place called "Alzheimer's Cafe," but I can't remember the name of the place.
Shingles is an awful affliction, so if you or a loved one is eligible for the vaccine, then you may also be helping to prevent dementia by getting it.
LatteLazy 773 days ago [-]
I continues to concern me that we spend enormous resources on people who cannot appreciate them (the old, the severely disabled) but nothing on normal people...
praptak 773 days ago [-]
Maybe they cannot appreciate them but I kinda appreciate the society won't just let me die if I become disabled or old.
This is true even though I am 100% intent of getting euthanasia one day.
LatteLazy 773 days ago [-]
<cynical I know>
I think we absolutely will just let most people die when they get sick and disabled unless you fall into one of these special groups. If you need 2k a month for insulin and cannot afford it, you will absolutely be allowed to slowly die because you are not old/disabled enough to be saved. But 10k a month for a special village because you checked-out with dementia? Sure!
Sorry to be the kill joy...
londons_explore 774 days ago [-]
Some people with dementia get violent. I bet it isn't a pretty sight when a bunch of 80 year olds start fighting over who stole Theodore's false teeth!
swader999 774 days ago [-]
Or tabs versus spaces. It's best just to hide the keyboards after 78.
acumenical 773 days ago [-]
After 78 characters on a line... right?
773 days ago [-]
b212 773 days ago [-]
My grandma has Alzheimer’s disease.
I want to be euthanized if I ever get that. So do my siblings and my parents. Euthanasia is illegal in my country and my grandma never agreed how to proceed once she gets severe dementia but what she has is simply a hell not a life anymore. Not only for her but also for my mom. Terrible disease.
I'm not sure why being better off makes it harder to make purchases? The social services actually help people, they're not just a money vacuum.
The family of the patient never pays more then €43,200, and probably more close to half of that for most the families.
Wish you and your family well.
https://news.ycombinator.com/item?id=35749579
Working age adults work from their early 20s to their 60s and end of life care does not typically last that long.
The point of this Village is to minimize the cost of treating significant outliers while maximizing their quality of life.
>In the first nationally representative study of cognitive impairment prevalence in more than 20 years, Columbia University researchers have found almost 10% of U.S. adults ages 65 and older have dementia, while another 22% have mild cognitive impairment.
https://www.cuimc.columbia.edu/news/one-10-older-americans-h...
https://jamanetwork.com/journals/jamaneurology/article-abstr...
The actual question should not be what percentage of the population has it; the question should be what percentage of people will be suffering from dementia to the point that they need assisted living care when they die.
One worker insists on going to work anyway knowing they are sick because they need the paycheck and no health insurance or days off, and wipes the place out a few weeks later. Top that off with states that insist on allowing workers to not mask and it's almost on purpose.
Ironically covid may also cause a surge in dementia years from now so it's an ouroboros.
More seriously, this town is a beautiful, compassionate idea and I'm glad it's there.
Here in the United States, the final years of a person's life are usually overwhelmingly expensive. Either paying many thousands of dollars per month in an assisted living facility, or paying almost nothing to a family member who sacrifices their own life for a time to provide care at home.
I've seen great results in mixed-generational care, where childcare and elder care have close interaction at least a couple of days per week. Amazing improvement in the elders living in relatively modest assisted living homes, and possible to provide at scale, more commonplace... But a global pandemic shut that down hard.
https://www.vivium.nl/zorgeloos-wonen-concept
More about this particular facility:
https://www.vivium.nl/verpleeghuis-dementie-hogewey-de-hogew...
Also, pretty sloppy to quote the name wrong in the article, it's not 'Hogeway' but 'Hogewey', the difference in dutch is between 'road' and 'meadow' (the latter in a weird spelling). On the facility website they also use 'weyk' which has yet another connotation (borough).
I've seen and am seeing some family members and close friends at very advanced age go through this. They are utterly unaware that they are dementing, to them everything is fine and their memories of the things that go wrong fade so fast that you can't really have a meaningful conversation on the subject. Some 80+ year olds are sharp as can be, but they are the exception around me, the default is a body that is still there coupled with a mind that is slowly leaving, too slow for the mind itself to notice.
Good genes may help keep your body alive but without a mind to go with it I'm not sure whether that's worth it. Personally I live in fear of ending up like that, depending on others for even the most basic needs.
I just had auto-correct change Philippines change to Philistines, so maybe it was something like that.
There was nothing in the article about robots or AI, OK? Maybe that's what you like, but this article isn't about that.
Current estimates are that ~6M people in the US have dementia today, out of a population of ~340M. Let's call that about 2%. Immediately obvious conclusion: There is not shortage of population to serve as caregivers.
What there is a shortage of is anyone who would actually want to work in a US dementia care facility. It's one of the lowest paid, least appreciated and most grueling occupations. Emotionally grueling as well as physically. How many 80 year old's butts did you wipe on Zoom today?
In spite of this, most staff I encountered were dedicated to the residents.
Maybe you're ready to lock your senile parents in a room with a robot dog, but I'm here to tell you that the human interaction is one of the only decent things in US assisted living. This is 100% from the people n the trenches. Healthcare ownership are bloodsucking jackals. Once you remove that person to person contact, the only thing left is ownership exploiting the defenseless.
Yep. Users frequently treat the link title as a writing prompt rather than clicking through to read the article. This can generate pretty jarring results if there are several different ways to interpret the title.
1. romantic opportunity stolen by a beachfront kidnapping by your love interest's father, who she claims not to know.
2. your father's untimely demise in a sailing accident.
3. falling lighting equipment, e.g. like a light to represent the dogstar.
4. radio station peculiarly addressing your specific concerns.
5. your wife and friends always enthusiastically endorsing particular brands.
6. no near future departures for Fiji at your local travel agent.
1. Only local maps being available.
2. Being addressed as 'number six'.
3. Being followed around by eerie white ball things.
4. Everything looks like the 1960s.
It is not that we cannot do more; it looks like the US public & private investment arms decided to avoid maximizing the research bandwidth available, with many life sciences grads not being able to find a research job.
A shame, really, given the inflation happens anyway - except that without spending the other side of this equation on medical R&D you stall the pipeline and rob yourself of your future.
Why is there not enough job openings for life scientists, given the urgency? Real tough question.
[1]: https://news.ycombinator.com/item?id=8616383
Something fishy going on here ;)
Shingles is an awful affliction, so if you or a loved one is eligible for the vaccine, then you may also be helping to prevent dementia by getting it.
This is true even though I am 100% intent of getting euthanasia one day.
I think we absolutely will just let most people die when they get sick and disabled unless you fall into one of these special groups. If you need 2k a month for insulin and cannot afford it, you will absolutely be allowed to slowly die because you are not old/disabled enough to be saved. But 10k a month for a special village because you checked-out with dementia? Sure!
Sorry to be the kill joy...
I want to be euthanized if I ever get that. So do my siblings and my parents. Euthanasia is illegal in my country and my grandma never agreed how to proceed once she gets severe dementia but what she has is simply a hell not a life anymore. Not only for her but also for my mom. Terrible disease.