Harry Beckers (81) would love to participate in the bingo in his nursing home. He has carefully stored the bingo cards in his room. Too careful. The dementia makes his head a chaos. But he must and will find those cards. The main prize of the bingo is his favorite flan: eggnog whipped cream.
Mr. Beckers is a fictitious person. It was invented by the founders of De Mobiel Verwarring, an escape room where healthcare staff can experience the confusion in the mind of people with dementia. The caravan of De Mobiel Verwarring travels, on request, to care institutions, training places and dementia-themed days throughout the country. The aging population has ensured that the number of people with dementia has increased fivefold since 1950, to almost 300,000 now, according to figures from Alzheimer Nederland. This number is expected to more than double by 2050 at 620,000 people. Every hour, five people with dementia are added. How good care can be provided to this growing group is a pressing issue.
Green soap
Today the caravan is in the parking lot of the head office of Domus Magnus in Hilversum, a private care institution with several residential locations. The outside of the caravan is covered with a brick motif, the inside is supposed to represent Harry Beckers’ room: a rich collection of furniture from the sixties, red carpet, blue wallpaper. Today five different groups will spend 45 minutes in this escape room. Through riddles, puzzles and challenges they must complete their task: find Harry’s bingo cards.
This group, the third of the day, consists of an office manager, a marketer, a health care psychologist and an activity supervisor. As they walk into the caravan, they are greeted by disorder: the radio is murmuring, the chair is upside down, the TV is on, clothes are everywhere. Overstimulated, which is what people with dementia often are, the participants first try to create order. One goes to fold clothes, another pulls the plug on the radio. Peace. Now they can find the bingo card.
René Vertegaal watches the scene through the window of the caravan. In 2019, originally an IC nurse, he came up with the concept for De Mobiel Verwarring with nursing teacher Karin Schokker. “We hope that participants experience what it does to you to be constantly lost, so that you learn to put yourself in the shoes of someone with dementia,” says Vertegaal. According to him, the escape room is valuable for healthcare staff, in the broadest sense: from nurses to domestic staff, from board members to carers. Some organizations require participation, others are voluntary. “The more understanding there is of the environment, the better these people are doing and the less the staff has to intervene with medication.”
In the caravan, the group looks behind paintings and picture frames to collect the numbers for a code for a safe in which the next clue is hidden. Furniture and personal items also play a major role in the game. The Limburg flag hangs on the wall, as well as a photo of Harry’s old village marching band. There is also a large music collection, including a Christmas CD by André Rieu. The underlying idea: to be able to treat dementia properly, you have to get to know the person behind the disease.
In the escape room, hints are hidden in nursery rhymes, old photos, in typical smells of the past. In the demented brain, ‘the past’ is a safe place, a place of recognition. “Everyone of that generation has cleaned with green soap, so when you smell that you think: oh yes, in the past,” says Vertegaal. According to Vertegaal, by generating associations and memories, you can “bring people back to activity.”
The escape room is based on the eight principles of dementia that were developed by geriatrician Anneke van der Plaats. For example, the participants have to close the curtains for a puzzle (naps are good for people with dementia). For the next riddle, they have to connect old-fashioned and modern pictures (a laptop doesn’t recognize Harry, an old PC does). The amygdala, the fear core of the brain, is central to Van der Place’s theory. If it is triggered too much, a feeling of insecurity arises. This can lead to emotional, aggressive behavior. The less stress, the better people with dementia function.
shredded puzzle
The Netherlands is a pioneer in dementia care, wrote The New York Times in 2018. According to Robbert Huijsman, professor of Management & Organization of Elderly Care at Erasmus University, this is right. “Other countries may be a bit further when it comes to specialist medical techniques and diagnostics. But in the Netherlands we look at the whole: at the social consequences, well-being, at different behavioral components.”
Care institutions and nursing homes here do not rely on medication and bed rest, but increasingly focus on creating a soothing environment. Sterile white corridors give way to cozy corners with old-fashioned stuff and lots of greenery. Room doors are covered with prints of the resident’s old front door. Everything to offer recognition, comfort and comfort. Huijsman emphasizes: dementia care is still a complex puzzle. The individual puzzle pieces are known, but it remains difficult to connect them. “Knowledge in the field of well-being, care and technology must be better integrated in order to arrive at solutions. That is our big challenge.”
guestbook
With nine minutes and nineteen seconds left on the clock, the group manages to solve the last riddle and get the bingo card. They are the fastest of the day.
“I never want to have dementia”, sighs Isabelle Ronday as she steps down the steps of the caravan. Ronday is an activity counselor and welfare coordinator at several Domus Magnus care homes. “The incentives in the escape room make you frustrated right away. I recognize this in people with dementia. You see them struggling, they feel there should be another way, but they don’t know how. I had that feeling now too.”
Participant Freya van der Meer agrees. She calls the escape room “a piece of awareness”. Van der Meer is a health care psychologist at Domus Magnus, where she guides people with advanced dementia and provides information to healthcare staff. “You know it all, because you come across it all day, but when you have to do it yourself, you think: this is so frustrating. You feel powerless and shame.”
“Dear Harry” the participants write in the guestbook at the end. “Thank you for letting us help you, we hope you win the bingo!”