It is hard to know where to begin when describing CareBright, a social care enterprise based in rural Limerick employing 250 staff and caring for 800 people, the vast majority of whom live in their own homes.
In the last few months the organisation opened a pioneering residential care facility for people living with dementia at Bruff in Co Limerick. Based on a 'household care model' developed in the Netherlands, the bright, modern and welcoming complex is the first of its kind in Ireland.
Colette Ryan, general manager of CareBright, knows where it all started. "It began as a FÁS scheme in 1997 and 1998 in Hospital in Co Limerick where the participants on the scheme provided home help for older people in their own homes," she recalls.
The scheme moved to Churchtown in north Cork, becoming a social economy project with the help of Ballyhoura Development, the local Leader company.
Known as the Rural Community Care Network (RCCN), it developed into a social enterprise under the Community Services Programme with continued support from Ballyhoura.
As the organisation grew, so did its reputation in designing and delivering homecare packages for the HSE and for private clients.
"Our ethos centres around making it possible for people with a range of conditions to remain in their own homes for as long as possible by promoting independence and choice," Colette says.
CareBright provides care companionship and general support to older people, to people with intellectual disabilities and people in need of post-operative care.
In its latest move, the organisation developed the complex in Bruff to provide a new form of care for people with dementia.
Opened since last March, the campus includes three individual bungalows, a range of communal facilities such as meeting rooms and activity rooms along with hairdressing and personal care facilities. A restaurant provides for the residents and is open to the public.
The complex also houses the administrative offices of CareBright.
"The primary purpose of the development is to provide a home from home for people living with dementia. It is based on a household model pioneered in Hogewey in the Netherlands," Colette explains.
The village of Hogewey, on the outskirts of Amsterdam, incorporates a community called Hogeweyk made up of 23 houses that are home to 150 people with dementia.
There are six people in each household and, with the support of carers, the residents live a normal life; they go shopping, they help with household chores, pursue their hobbies and get involved in community activities.
"We are applying the Hogewey model," Colette explains, "but we have modified it to fit the needs of our people. Nevertheless, it is very similar. There are three households here where people live as normal a life as they can. They have their own ensuite bedroom, there is a kitchen, a dining area, a living room, a garden and a utility - just as you would have in any modern home. The only difference is there is always a carer in the house and nearby."
Colette takes us on a tour of the site and a visit to one of the bungalows. It is a spacious and comfortable house with a standard of finish that I have rarely seen anywhere.
Limerick architect John Quinn applied much of the Dutch design lessons to the development, producing a finished product that is welcoming and homely. Each house includes a range of spaces where people can be together as a household, but it also has a number of nooks and smaller spaces where the residents can have some personal space.
The ensuite bedrooms open out to their own patio, while a wider garden includes raised beds for flowers and vegetables, along with benches and paved walks. During our visit, some residents were enjoying the fine December day walking around the garden, while others came in to the café for a cuppa.
There were also a few tables with local people in to have a coffee and a chat.
The 4ac site on which the campus is built is located across the road from the Bruff GAA grounds. Once home to a German factory, the abandoned buildings had to be cleared and everything built from scratch, at a cost of €5m.
"We have huge support here in Bruff," Colette says. "We chose this location because we wanted a rural village setting where people could go out shopping, go to church, to bingo or the local community cafe."
Community manager and nurse Nisha Joy explains that people coming to take up residence are living early to mid-stage dementia.
"As long as a person is in a position to establish friendships, to connect with the staff and to recognise people, he or she can join the community here.
"It is also good if they can assist in the running of the house like helping with basic housekeeping. We try to keep life normal for the residents; whatever routine they had at home, we try to continue it here."
During our tour of the bungalows we met Patch, a little dog, that moved in with one of the residents.
"Above all we have to remember that it is OK to live normally with dementia," Nisha says.
"Nothing should change, it is simply a condition of the brain. So in terms of our approach, we primarily use a household model rather than just a clinical model to help people with the condition."
The residents enjoy a range of organised activities including music, pottery classes, art therapy and cards, along with shopping in the village, and trips to the community café. Those for whom daily Mass was part of their routine can attend the local church.
"Being here is like living in their own home with support," Nisha explains.
"It is what you might call assisted living. The residents are never alone or isolated, there is somebody from the staff in the house with them all the time participating in the normal things people do in their own homes."
Colette and Nisha hope the Government will look at the model and consider including it with the current models of elder care in operation.
"This could be integrated into nursing homes," Colette says. There are currently 14 residents in the Bruff complex, with spaces for four more. Staff numbers stand at 30. Nisha recognises the model is labour intensive.
"It is about providing not just physical support but psychological support; it's about helping people with dementia to continue making connections and having meaningful communication."
The Hogeweyk housing development (weyk being the collective Dutch name for a number of houses) is a specially designed village with 23 houses catering for 152 older people with dementia.
Located in Hogewey in the Weesp area outside Amsterdam the village has streets, squares, gardens and a park where the residents can roam freely. Just like any other village, Hogeweyk offers a selection of facilities including a restaurant, a bar and a theatre.
These can be frequented by Hogeweyk residents and people from the surrounding neighbourhoods.
Hogewey’s approach to care is founded on a replication of normal society.
According to the Hogewey publicity, normal living means “having your own space to live and managing your own household.
Hogeweyk residents have already lived a life where they shaped their own life, where they made choices about their own household and standards.
“The fact that a resident cannot function ‘normally’ in certain areas, because of dementia, does not mean that they no longer have a valid opinion on their day-to-day life and surroundings.”
Every Hogeweyk home houses six to eight people and manages its own household with the assistance of permanent staff. Residents are able to move freely inside the house and outside. “A normal house in a normal village in a safe environment gives the residents of Hogeweyk this freedom in safety.”