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Elderly Care

International Visitors Programme 2017

Break-out session

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Agenda

ROOM 7.04

Elderly Care

10:45 Elderly care in the NetherlandsMartin Holling, Ministry of Health, Welfare & Sport

11:00 Q&A

11:20 From PPP to innovation: Fall Prevention Project TOMInge Mohede, Nutricia Advanced Medical NutritionRuud van Vessum, PhilipsSaskia Kloet, Veiligheid NL

12:00 End

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Elderly care in the Netherlands

Martin Holling, Ministry of Health Welfare & Sport

Wet langdurige zorg (Wlz)Long term care act

HEALTH (CARE) IN THE NETHERLANDS

vno-ncw

Martin Holling

27-9-2017

Content

•LTC changes: motives

•Main differences before and after 2015

•Wlz main topics

•Innovation agenda

5

International differences

6

topics:

• Broad public

• insurance

• Low rate

• informal care

• High rate

• Institutional care

7 source: Health at a glance OECD

Reform of Long Term Care: Process

•Goals:

oDecrease LTC expenditures

oImprove balance formal and informal care

oImprove quality of care => more person-centred care

8

Measures

• Focus on care at home, reduce institutional care

• Stimulate informal care

• Budget household care (cleaning): -/-40%

• The Long-term Care Act (Wlz) has replaced the Exceptional Medical Expenses Act (AWBZ)

• Parts of the former ‘AWBZ’ are shifted to:

• the Health Care Insurance Act (ZVW)

• the renewed Social Support Act (Wmo 2015) and

• the Youth Care Act

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Present system LTC Expenditures 2015

Social Support Act (Wmo)Social participation; Municipality

Youth Care ActCare for young people and their parents, Social participation , Municipality

Health Insurance Act (Zvw)(mandatory) private healthcare insurance: GP’s / therapists / medication / hospital care / specialists / ambulance transport / audiovisual and locomotory aids

Long-term Care Act (Wlz)Replaced the Exceptional Medical Expenses Act (AWBZ). The Wlz is a (mandatory) public long-term care insurance: nursing homes / homes for the elderly / home care / institutional care for disabled people and people with chronic psychiatric disorders

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66%

16%

13%4%

Wlz structure

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Cliënt CIZ

Regional care

offices

Care provider

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Wlz highlights I

Entry barriers

Criteria connected to care:

• Structural care need and

• Clients in need for 24 h surveillance or

• 24 h care nearby

Wlz highlights II

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• Integral package

➢Care in institution or care at home

➢Personal care, guidance and nursing

➢Medical treatment

➢Transport (in combination with care)

• Several clients

➢Older persons

➢Handicapped persons

➢Persons with psychiatric problems (> 3 years care)

Innovation Agenda

Letter to Parliament: February 2016

“You can live in dignity while receiving care”

(“waardig leven met zorg”).

-Topics:

- More care arrangements for clients: experiment “Personal care”

- More care innovation (E-Health-Technology)

- More care at home

- Improving quality (new quality framework 2017)

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Agenda

ROOM 7.04

Elderly Care

10:45 Elderly care in the NetherlandsMartin Holling, Ministry of Health, Welfare & Sport

11:00 Q&A

11:20 From PPP to innovation: Fall Prevention Project TOMInge Mohede, Nutricia Advanced Medical NutritionRuud van Vessum, PhilipsSaskia Kloet, Veiligheid NL

12:00 End

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From PPP to innovation:

Fall Prevention Project TOM

Inge Mohede, Nutricia Advanced Medical NutritionRuud van Vessum, PhilipsVeiligheid NL

Fall prevention program:A practical multi-partner approach

Content

• WHY: Important facts about falls and seniors

• HOW: a coalition of multi-partners

• WHAT: a sustainable multifactorial approach-program TOM

• FIRST impression and next steps!

Source: UNDESA Population division, World population prospects: the 2015 revision, DVD Edition, 2015

Portion of population aged 60 or over.

AgeingOne of the dominating trends in the world

AgeingRequires a proactive approach

AgeingCan create as many opportunities as issues

AgeingIs only partially a medical topic

AgeingIs changing society

Facts about ageing

Definition of health 2011:• The ability to adapt and self manage in the face of social, physical, and

emotional challenges• Health is the capacity of people to adapt and orchestrate, in the sense of

the physical, emotional and social challenges of life. Being healthy means being able to adapt to disruption, being resilient, being able to maintain or rediscover a balance both physically, mentally and socially (taken from Huber et al., 2011).

Definition of health 1948:• Health is a state of full physical, mental and social wellbeing (WHO).

Definition of health

MobilityIndependence

( self-reliance)

Loneliness Safety

Seniors and key areas of concern

Source: Indicatie zorgvraag 2030

TNO study on behalf of the Dutch Ministry of health

Source: Indicatie zorgvraag 2030

TNO study on behalf of the Dutch Ministry of health

Forecast on functioning of older people in 2030

Most commonproblem

50-60% of the population above 65 years of

age

Mobility+/- dementia/

moderate dementia

Key facts: • Falls are the second leading cause of accidental or unintentional injury

deaths worldwide.

• Each year an estimated 646 000 individuals die from falls globally of which over 80% are in low- and middle-income countries.

• Adults older than 65 years of age suffer the greatest number of fatal falls.

• 37.3 million falls that are severe enough to require medical attention occur each year.

Falls: threat for seniors’ safety and independenceand generate enormous economic and personal costs

Urgency

• “Ministry encourages regional collaboration in order to live longer at home” (letter to parliament, 2014)

• “Seven out of ten 75+ would prefer to live in their own house until death” (WoON, 2010)

Focus: on treatment Focus: early diagnosis /prevention

TODAY TOMORROW

Care services mainly provided in formal setting (e.g. hospital)

Care services are increasingly provided in informal setting (e.g. community centers, home)

Doctor-centric model Patient-centric model (pro-active self management becomes key!)

Payments of health-care services: predominantly Health Insurance Companies

Payment shared:Health Insurance Companies & Municipalities

Budge

t pre

ssure

Prof. care

Informal care

Tools + Technology

Self + Network

NL: Shift of care to the community due to budget pressure

Professional care

Informal care

Tools + Technology

Self + Network

Content

• WHY: Important facts about falls and seniors

• HOW: a coalition of multi-partners

• WHAT: a sustainable multifactorial approach-program TOM

• FIRST impression and next steps!

Motivation: Call for action

Our purpose as ONVZ is to create added value for both healthy and unhealthy insured. A patient centric approach: involve the insured involved, improving outcomes that matter to them.

PostNL seeks to find smart solutions for societal challenges like ageing and individualism, by i.e. developing new services that involve personal contact with the well-known an trusted mailmen at the home address mostly digital world.

At Nutricia Danone, we believe in the power of nutrition at the heart of health and healthcare. We pioneer new business relationship. One that co-creates and even co-owns solutions with non for profit organizations, the public sector, local stakeholders, other companies and academics.

An unique opportunity and coalition that combines effective interventions into an appealing program for seniors, enhances professionals with added skills and prevent fall related injuries.

At Philips, we strive to make the world healthier and more sustainable through innovation.Our goal is to improve the lives of 3 billion people a year by 2025.

To support seniors to preserve the highest degree of autonomy in order to longer live independently (at home)

by offering an innovative and sustainable care path with prevention solutions reducing number of falls or fall related injuries

Our Mission

• 4 companies and 1 NGO taking the lead

• Focus on: Focus, Cooperation, Implementation and Continuation

• Working and investing in the cooperation

• We use proven concepts and solutions

• Clear common goals (KPIs) and project plan.

A business like approachWith full attention to the human aspects

What is different

Our focus is implementation & continuation

Implementation with local relevant partners:Selection based on:• Added value in the project

• Drive for real improvement

• Ability to scale and maintain

Content

• WHY:Important facts about falls and seniors

• HOW: a coalition of multi-partners

• WHAT: a sustainable multifactorial approach-program TOM

• FIRST impression and next steps!

TOM approach

Nutrition Exercise

Monitoring Social support

Senior

TOM participant

• 65 year and older

• Increased fall risk

• Access to a PC and an email address

• No internal electronic equipment

TOM evaluation

We evaluate effect

• Mobility

• Health,

• QOL

We evaluate the proces

• Impact (seniors, health & social carers)

We evaluate the cost-efficiency

We optimize TOM for future implementation

• Execution in 4 Living Labs: Test-Learn-Adapt

• Develop a blueprint

4 Living Labs

Living Lab 4 – Den Haag & A’dam

• Recruitment participants: policyholders

ONVZ (national)

• Medical care: Combination Face-to-face and

video support; if needed they are referred by

the platform to the relevant Health care

professionals.

• Social care:

• PostNL

Living Lab 3 - Houten

• Recruitment participants: local first line

healthcare professionals

• Medical care:. Through specially trained

district nurse, physiotherapists and dieticians

• Social care:

• PostNL

Living Lab 2 – VITAAL VECHTDAAL

• Recruitment participants: Municipality &

local healthcare professionals

• Medical care: Through specially trained

district nurse, physiotherapists and dieticians

• Social care:

• PostNL

Living Lab 1 - BEST

• Recruitment participants: Senior

associations

• Medical care: Through specially trained

physiotherapists, dietician

• Social care:

• PostNL

• Active involvement specially

trained students

wellbeing/household support .

Senior associations

Municipality1 line HCPs

1 line HCPsPharmacies

HIC policyholders

e-HCPs

1st living lab in Best

Start: March 2017

Participants: n=50

Finish: August 2017

First Data: Q1 2018

Content

• WHY: Important facts about falls and seniors

• HOW: a coalition of multi-partners

• WHAT: a sustainable multifactorial approach-program TOM

• FIRST impression and next steps!

• Collaboration with local senior association key driver for attention

• Coalition of big national organizations gives

• Confidence to participants

• Lot of media attention

• Project needs several “local incubators” to learn-adapt-optimize before expansion

First observations

Second impressions

‘Thanks to TOM we get a chanceThis chance has been given to usAnd now we are in balanceThis is an enrichment to our life’

TOM Buddies

First learnings and feedback

Majority of participants in 1st Living Lab:

• Gave a high report mark for overall project

• Has more social contacts in local environment

• Improved their level of physical activity

• Felt better

- Location criteria- Various timeslots

- Presentation- Personal feedback

- Availability

- Usability

- Contact moments

Next steps…

• Experience and evaluate following Living Lab’s

• Elements of TOM tailored in various local settings and infrastructures

• Develop “TOM tools” 2.0 (e.g. education for PT’s, Nurses and seniors)

• Develop a Blue Print for the TOM approach (learnings of 4 LL’s)

• Public availability of TOM approach (business model)

TOM approach

• Optimize TOM for a sustainable future implementation in The Netherlands

• TOM scope with an international ambition

The “how-to” (form / model / partnerships/ founding fathers) is a constantly evolving process with current partners.

THANK YOU!

Questions and discussion

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Thank you!Let’s have some lunch