The "dementia village" that's redefining elder care | Yvonne van Amerongen
100,255 views ・ 2019-04-08
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譯者: Lilian Chiu
審譯者: Bruce Sung
00:12
This is the Hogeweyk.
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這是霍格威。
00:14
It's a neighborhood in a small town
very near Amsterdam, in the Netherlands.
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它是荷蘭一個小鎮上的鄰里,
非常靠近阿姆斯特丹。
00:19
There are 27 houses
for six, seven people each.
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那裡有 27 間房子,
每間有 6~7 人。
00:23
There's a small mall with a restaurant,
a pub, a supermarket, a club room.
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有一個小型購物中心,內有餐廳、
酒吧、超級市場、俱樂部房間。
00:28
There are streets, alleys,
there's a theater.
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那裡有街道、巷弄,
也有一間戲院。
00:34
It actually is a nursing home.
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它其實是一間療養院。
00:37
A nursing home for people
that live with an advanced dementia
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這間療養院所住的是
重度失智症患者,
00:42
and that need 24-7 care and support.
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他們一天 24 小時,一週七天
都需要照護和支持。
00:47
Dementia is a terrible disease,
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失智是一種很糟的疾病,
00:50
and we still don't have any cure for it.
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我們仍然沒有方法治療它。
00:54
It's getting to be
a major problem in the world,
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它漸漸成為世界上的
一個重大問題,
00:57
for the people, for the politicians,
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對人民、對政治人物、
00:59
for the world -- it's getting
to be a big problem.
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對世界來說——
它漸漸成為一個大問題。
01:03
We see that we have waiting lists
in the nursing homes.
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我們知道,在療養院有等候名單。
01:07
Most people that come to the nursing homes
with dementia are women.
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大部分到療養院的
失智症患者是女性。
01:11
And that's also because women
are used to taking care of people,
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那也是因為女性很習慣照料人,
01:16
so they can manage to take care
of their husband with dementia,
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所以她們的先生若得了失智症,
她們也能負責照顧,
01:20
but the other way around
is not so easy for the gentlemen.
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但在相反的情況中,
對男性而言就沒這麼容易了。
01:26
Dementia is a disease
that affects the brain.
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失智是一種會影響大腦的疾病。
01:30
The brain is confused.
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大腦很困惑。
01:33
People don't know anymore
what the time is,
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患者不再知道現在是什麼時間、
01:36
what's going on, who people are.
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有什麼事有發生,也認不得人了。
01:39
They're very confused.
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他們非常困惑。
01:40
And because of that confusion,
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因為那種困惑,
01:43
they get to be anxious,
depressed, aggressive.
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他們會變得很焦慮、
憂鬱、有侵略性。
01:50
This is a traditional nursing home.
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這是一間傳統的療養院。
01:53
I worked there in 1992.
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1992 年時我在那裡工作。
01:55
I was a care manager.
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我是照護經理。
01:57
And we often spoke together about the fact
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我們常常聚在一起談,
02:00
that what we were doing there
was not what we wanted for our parents,
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說我們在那裡所做的事,
並不是我們希望我們的父母、
02:05
for our friends, for ourselves.
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我們的朋友、我們自己
若失智時會得到的照護。
02:09
And one day, we said,
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有一天,我們說:
02:11
"When we keep on saying this,
nothing is going to change.
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「我們一直說這些,
什麼都改變不了。
02:14
We are in charge here.
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這裡是我們主導的。
02:15
We should do something about this,
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我們應該要來採取行動,
02:18
so that we do want
to have our parents here."
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做到讓我們也希望
我們的父母住到這裡。」
02:22
We talked about that,
and what we saw every day
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我們談了這件事,
以及我們每天所看到的
02:25
was that the people
that lived in our nursing home
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都是住在我們療養院的病人
02:29
were confused about their environment,
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對於他們的環境感到非常困惑,
02:31
because what they saw
was a hospital-like environment,
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因為他們看到的是
一個像醫院的環境,
02:35
with doctors and nurses
and paramedics in uniform,
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都是穿著制服的醫生、
護士、急救護理人員,
02:39
and they lived on a ward.
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且他們住在病房中。
02:42
And they didn't understand
why they lived there.
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他們不了解為什麼他們住在那裡。
02:44
And they looked for the place to get away.
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他們會想要想辦法逃離。
02:48
They looked and hoped to find
the door to go home again.
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他們會尋找並希望
能找到回家的那扇門。
02:54
And we said what we are doing
in this situation
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我們說,在這個
情況下我們所做的事
02:57
is offering these people
that already have a confused brain
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是帶給這些頭腦已經
非常困惑的病人
03:02
some more confusion.
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更多的困惑。
03:04
We were adding confusion to confusion.
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我們在困惑上再加上困惑。
03:08
And that was not what these people needed.
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那並不是這些人所需要的。
03:11
These people wanted to have a life,
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這些人想要有個人生,
03:13
and the help, our help,
to deal with that dementia.
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想要得到協助,我們的協助,
來處理失智的問題。
03:17
These people wanted to live
in a normal house,
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這些人想要住在一般的房子裡,
03:22
not in a ward.
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而不是病房。
03:24
They wanted to have a normal household,
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他們想要有個正常的家庭,
03:27
where they would smell their dinner
on the stove in the kitchen.
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在這個家庭裡,能聞到
廚房的爐子傳來晚餐的香味。
03:32
Or be free to go to the kitchen
and grab something to eat or drink.
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或者他們能夠自由進入廚房,
隨手抓些東西來吃或喝。
03:37
That's what these people needed.
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那才是這些人需要的。
03:39
And that's what we should
organize for them.
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那才是我們應該為他們安排的。
03:43
And we said we should
organize this like at home,
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我們說,我們應該
把環境安排成像家一樣,
03:48
so they wouldn't live with a group
of 15 or 20 or 30, like in a ward.
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讓他們不用和 15、20,或 30 個人
住在一起,像住病房一樣。
03:53
No, a small group of people,
six or seven, family-like.
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不要,應該一小群人就好,
6 或 7 個人,就像個家庭。
03:59
Like living with friends.
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就像和朋友同住。
04:02
And we should find a way to select people
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我們得要想出一種方式來挑選人,
04:05
based on their ideas about life
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依據他們對於人生的想法來挑選,
04:08
so that they did have
a good chance to become friends,
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這麼一來,當他們住在一起時,
04:11
when they lived together.
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才會更有機會成為朋友。
04:14
And we interviewed
all the families of the residents
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我們和所有居民的家人進行面談,
04:18
about "what is important for your father,"
"what's important for your mother,"
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談「你父親重視什麼」、
「你母親重視什麼」、
04:22
"what is their life like,"
"what do they want."
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「他們的人生是什麼樣子的」、
「他們想要什麼」。
04:24
And we found seven groups,
and we call them lifestyle groups.
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我們分出了七種族群,
被我們命名為生活方式分組。
04:29
And for instance,
we found this formal lifestyle.
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比如,我們發現了
一種正式生活方式,
04:33
In this lifestyle,
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在這種生活方式中,
04:35
people have a more formal way
of interacting with each other,
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人們和彼此互動的方式比較正式,
04:38
a distant way.
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比較有距離。
04:39
Their daily rhythm
starts later in the day,
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他們每天的日常節奏
開始得比較晚,
04:42
ends later in the day.
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結束得也比較晚。
04:43
Classical music is more heard
in this lifestyle group
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比起其他生活方式分組,
在這種生活方式分組中
04:46
than in other lifestyle groups.
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更常聽到古典音樂。
04:48
And their menu,
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他們的菜單,
04:50
well, is more French cuisine
than traditional Dutch.
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比較多是法國菜
而不是傳統荷蘭菜。
04:53
(Laughter)
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(笑聲)
04:55
In contrary to the craftsman lifestyle.
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相對的分組則是工匠生活方式。
04:59
That's a very traditional lifestyle,
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那是種非常傳統的生活方式,
05:01
and they get up early
in the morning, go to bed early,
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他們早上很早起床,
很早上床睡覺,
05:03
because they have worked hard
their whole life, mostly with their hands,
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因為他們一生中都辛勤工作,
大部分都是要動手去做,
05:08
very often had a very small
family business, a small farm, a shop,
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很常見的是經營小型
家族事業、小農場、小店,
05:12
or like Mr. B, he was a farmhand.
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或像 B 先生,他是農場工人。
05:17
And he told me that he would go
to his work every morning
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他告訴我,他每天早上去工作時,
05:20
with a paper bag with his lunch
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會用紙袋裝著午餐一起帶去,
05:24
and one cigar.
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裡面還有一根雪茄。
05:26
That one cigar was the only luxury
he could afford for himself.
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那根雪茄是他唯一能
負擔得起的奢侈品。
05:31
And after lunch,
he would have that one cigar.
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午餐之後,他就會抽那根雪茄。
05:35
And until the day he died in the Hogeweyk,
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到他在霍格威過世的那一天之前,
05:38
he was in this little shed, every day,
after lunch, to smoke his cigar.
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每天午餐後他都在這間小屋抽雪茄。
05:47
This is my mother.
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這是我母親。
05:48
She's of the cultural lifestyle,
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她的分組是文化生活方式,
05:50
she's been living
in the Hogeweyk six weeks now.
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現在她已經在霍格威住了六週了。
05:53
And that lifestyle is about traveling,
meeting other people, other cultures,
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那種生活方式的特點是旅行、
認識其他人、其他文化、
05:58
interest in arts and music.
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對藝術和音樂感興趣。
06:02
There are more lifestyles.
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還有更多其他生活方式。
06:04
But that's what we talked about,
and that's what we did.
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但,那就是我們在談的,
也是我們所做的。
06:09
But that's not life in a house
with a group of people,
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但,那並不只是和一群人
住在一間房子裡的生活,
06:14
like-minded people, your own life,
your own household.
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和想法相似的人,
你自己的人生,你自己的家庭。
06:18
There's more in life,
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人生不只如此,
06:19
everybody wants fun in life
and a meaningful life.
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大家都希望人生有樂趣且有意義。
06:23
We are social animals --
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我們是社交的動物——
06:25
we need a social life.
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我們需要社交生活。
06:27
And that's what we started.
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那就是我們開始做的事。
06:30
We want to go out of our house
and do some shopping,
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我們想要走出
我們的房子,去購物,
06:34
and meet other people.
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去見見其他人。
06:36
Or go to the pub,
have a beer with friends.
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或是去酒吧,和朋友喝杯啤酒。
06:40
Or like Mr. W -- he likes
to go out every day,
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或像是 W 先生——
他喜歡每天都出門,
06:45
see if there are nice ladies around.
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看看附近有沒有美女。
06:48
(Laughter)
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(笑聲)
06:50
And he's very courteous to them,
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他對她們非常有禮,
06:52
and he hopes for smiles and he gets them.
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他希望能得到微笑,
也確實得到了。
06:54
And he dances with them in the pub.
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他和她們在酒吧跳舞。
06:58
It's a feast every day.
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每天都是盛宴。
06:59
There are people that would
rather go to the restaurant,
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有些人寧願去餐廳,
07:02
have a wine with friends,
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和朋友喝葡萄酒,
07:04
or lunch or dinner with friends
and celebrate life.
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或和朋友吃午餐
或晚餐,頌揚生命。
07:08
And my mother,
she takes a walk in the park,
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而我母親,她會在公園散步,
07:10
and sits on a bench in the sun,
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在太陽下坐在長凳上,
07:12
hoping that a passerby will come
and sit next to her
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希望有人路過,坐在她旁邊,
07:15
and have a conversation about life
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和她聊聊人生,
07:18
or about the ducks in the pond.
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或是池塘裡的鴨子。
07:22
That social life is important.
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那種社交生活很重要。
07:24
It means that you're part
of society, that you belong.
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那意味著你是社會的
一部分,你有歸屬。
07:29
And that's what we people need.
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那是我們人類的需求。
07:33
Even if you're living
with advanced dementia.
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即使你得到重度的失智症也一樣。
07:37
This is what I see from my office window.
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這是我從我辦公室的
窗戶所看見的景象。
07:40
And one day, I saw a lady
coming from one side,
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有一天,我看見
一位女士從一邊過來,
07:44
and the other lady from the other side,
and they met at the corner.
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另一位女士從另一邊過來,
她們在街角相遇。
07:48
And I knew both ladies very well.
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我很熟識這兩位女士。
07:50
I often saw them walking around outside.
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我常常看到她們在外面行走。
07:54
And now and then, I tried
to have a conversation with them,
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偶爾,我會試著和她們交談,
07:59
but their conversation was ...
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但她們的對話……
08:02
rather hard to understand.
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蠻難理解的。
08:05
But I saw them meeting,
and I saw them talking,
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但我看見她們相遇,
看見她們說話,
08:09
and I saw them gesturing.
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看見她們比手劃腳。
08:11
And they had fun together.
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她們在一起很開心。
08:13
And then they said goodbye,
and each went their own way.
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接著,她們道別,各自上路離開。
08:17
And that's what you want in life,
meeting other people
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這就是你在人生中想要的,
和其他人會面,
08:20
and being part of society.
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成為社會的一部分。
08:23
And that's what I saw happening.
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而我就看到了這樣的狀況發生。
08:26
The Hogeweyk has become a place
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霍格威變成了一個不同的地方,
08:28
where people with very advanced
dementia can live,
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在這裡,重度失智症病人可以
08:31
have freedom and safety,
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自由且安全地生活,
08:33
because the professionals working there
and the volunteers working there
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因為在那裡工作的
專業人士以及志工
08:38
know how to deal with dementia.
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知道如何處理失智。
08:41
And the professionals know
how to do their professional work
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專業人士知道如何
做他們的專業工作,
08:44
in a way that it fits in a natural way
in the life of our residents.
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且採用的方式能很自然地
融入到我們居民的生活中。
08:50
And that means that the management
has to provide everything
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那就表示,管理階層得要提供他們
08:55
those people need to do their work.
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工作所需要的一切。
08:58
It needs a management
that dares to do this.
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管理階層需要有膽識這麼做。
09:02
To do things differently
than we always have done
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採不同的方式來做事,
不同於傳統療養院慣用的方式。
09:05
in a traditional nursing home.
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09:10
We see that it works.
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我們知道這是行得通的。
09:14
We think this can be done everywhere,
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我們認為這種方式
可以用在任何地方,
09:17
because this is not for the rich.
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因為它不是給富人專用的。
09:19
We've been doing this with the same budget
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我們這麼做所使用的預算
09:24
as any traditional nursing home
has in our country.
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和我們國內任何傳統
療養院的預算都一樣。
09:28
We work only with the state budget.
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我們只用州提供的預算。
09:32
(Applause)
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(掌聲)
09:40
Because it has to do
with thinking different,
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因為它的重點在於
不同的思考方式,
09:43
and looking at the person in front of you
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以及看看你面前的人,
09:46
and looking at what
does this person need now.
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看看他現在需要的是什麼。
09:51
And it's about a smile,
it's about thinking different,
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重點是一個微笑,
重點是不同的思考方式,
09:54
it's about how you act,
and that costs nothing.
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重點是你怎麼做,
那些是不用花錢的。
09:59
And there's something else:
it's about making choices.
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還不只如此:重點是要做選擇。
10:03
It's about making choices
what you spend your money on.
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重點是要選擇你把
你的錢花在什麼地方。
10:08
I always say,
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我總是說:
10:11
"Red curtains are
as expensive as gray ones."
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「紅色窗簾和灰色窗簾一樣貴。」
10:16
(Laughter)
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(笑聲)
10:17
It's possible, everywhere.
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在任何地方,這都是有可能的。
10:21
Thank you.
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謝謝。
10:22
(Applause)
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(掌聲)
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