Integrating Care forIntegrating Care for Vulnerable Older

Persons:Persons:Dementia care in the

Netherlands

Dr.Henk NiesVilans, Netherlands Centre of ExpertiseVilans, Netherlands Centre of Expertise

for Long-Term CareUtrecht, The Netherlands

PresentationPresentation• Dementia care in the Netherlands: policy context and dementia in the NLh i l i• The National Dementia Care

Program h i d i• Purchasing dementia care

• Examples of good practice• What works?

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Policy context: systemsPolicy context: systems• Acute care: Health Insurance Act• Long term care: Exceptional Medical Expenses Actp

• Social care: Social Support Act

• Private not-for-profit• For profit sector: very small

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Dementia in the NetherlandsNetherlands

• Netherlands 16.5 million population

• 270,000 dementia patients• On average 3.7 carers involved, 78% overburdened/at risk

• 740,000 carers involved • In 2030: 385,000 dementia patients, 1,400,000 carers

• On average: 6 years at home, 2 www.vilans.nlyears institionalized

Dementia care: The National Dementia Care Program (2005-2008)_

• Report National Health Council (2002)

• Networks in 57 regions across the country (>90% coverage)Vi f li t d l ti• Views of clients and relatives as point of departure by local Alzheimer associations (14Alzheimer associations (14 fields)

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Purchasing guidePurchasing guide• Facts and figures• Regional calculation models• ModelModel• 14 categories of problems• Components: ‘building blocks’• Components: ‘building blocks’• Forerunners (16 regions)• Performance indicators (draft)

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Top 5 categories of problemsproblems

F li i d• Feeling anxious, angry and confused

• It is getting me too much!It is getting me too much!• Resistance against admission in nursing home

• There’s something wrong…: what is going on and what might help?p

• Miscommunication with care professionals

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Funding

Single

Housing

DaySingle point

of entry/GP

gatekeeper

Multi-disciplinary

Team

Day activities/

work

Needs assessment/

Service plan Psycho-

Early detection/prevention gatekeeper

education

Home care/ nursing

prevention

nursing

Healthcare

Case management

Communication/infomation

www.vilans.nlEmpowerment

Three phases of dementia carecare

• Signalising and early detection• Diagnostics and access to careDiagnostics and access to care• Delivery of care and support

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Components:‘Building bl k f d iblocks’ of dementia care

• Information, education and support

• Case finding and referral• Case finding and referral• Screening en diagnostics• Casemanagement• Casemanagement• Treatment of patient and

systemsystem• Low threshold information and

support after the diagnosiswww.vilans.nl

pp g

‘Building bricks’ of d idementia care

• Casemanagement T t t f li t t• Treatment of client system

• Information and support for client systemy

• ADL support and personal care • Transport/social participation• Domestic support services• Activities• Respite care• Respite care• Carers relief (incl. holidays)• (Small scale) housing

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(Small scale) housing• Crisis intervention

Parties involvedParties involved• Care homes• Mental health services• Mental health services• Home care and district nursing• Single points of access• Municipalities• Old peoples advisors• General practitionerGeneral practitioner• Memory clinics• Geriatrics departments in hospitals• Housing companies• Buddies• Care hotels, respite services,

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Care hotels, respite services, Alzheimer cafes, care farms

• Local Alzheimer groups

Structure and Strategy Steering leadership Strategy instruments

ConnectingT t PConnectingcapacities

Trust Pressure

H it l Network PHuman capital information Processes

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Performance indicatorsPerformance indicators

• Information on dementia• Percentage diagnosed (young) patientsp

• Usage of users’ evaluations• Case manager and care planCase manager and care plan available

• Agreement on carers supportAgreement on carers support

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Performance indicators ( i d)(continued)

• Central monitoring system• Percentage crisisbeds• Respite care services• Developmental stage of networkp g

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What works?What works?

• Clients’ perspectives• Alzheimer Association involved• Non professional language• Campaigning• Connection with purchasing• Examples of good practice

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Thank you!Thank you!

h.nies@vilans.nl

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Examplesp

• Old people’s advisors

• Meeting centers• Care farms

• Local preventive health care

Care farms• Alzheimer Café

centers for older people

What works?www.vilans.nl

What works?

Preventive health care centres for older peoplecentres for older people

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Traditional prevention programs

• Uni-dimensional (healthy food, falls diabetes)falls, diabetes)

• No recognition of coherence b t h i l h l i lbetween physical, psychological and social problems

• Policy aims at youth and adolescents

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Health, social care & Active ageing model& Active ageing model

Social

Econo-mic Beha-

Social care

mic aspects viour

Active

Social t

Personal t

Aging

aspects

Physical environ-

aspects

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What is unique about it?

• Holistic view on health• Holistic view on health • Integrated approachL th h ld• Low threshold

• Nearby• Systematic prevention

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Objectives I• Social participation and quality

of lifeC ti d/ i lf• Continue and/or increase self management / mastery and responsibility for own lifep y

• To provide insight into their own health and life style self

tmanagement• Support healthy ageing

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Objectives II• Strengthen social cohesion and

social networksG id f h lth d i l• Guide for health and social services

• Prevention and early detection of• Prevention and early detection of health problems at physical, psychological, emotional,

iti d i l l lcognitive and social level• Reduction of utilization of health

carecare

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Target groupsTarget groupsInclusion• Risk groups:

Exclusion• Nursing homeRisk groups:

• low SES (especially men)

• Nursing home residents

• Those under intense medical• recently be

widowed• carers

ld i t

intense medical monitoring

• Palliative ti t• older migrants

• single older people

Yo ng and ital

patients

• Young and vital old

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Collaboration

Network (organization) of:Network (organization) of:• Public health services• Geriatric networksGeriatric networks• Home care • Patients organizationsPatients organizations• Older people’s associations• Social workSocial work• General practitioners• Municipalities

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Municipalities

Evaluation and ‘challenges’g

First outcomes• Older people feel more

responsibility for their own health / life stylehealth / life style

• They follow advice for healthy life styleslife styles

• Early detection of health care problemsp

• Older people appreciate this type of prevention (time and tt ti )

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Evaluation and ‘ h ll ’‘challenges’

Bottlenecks• FundingFunding• Collaboration with GP

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Care farmsCare farms

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Care farmsCare farms

1998 1999 2001 2003 2004 2005 2006 2007

75 214 323 372 432 591 720 839

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What is offered?What is offered?In 2007:• Day activities (N=759)• Social activation/

rehabilitation to work (N=238)• Work and lodging (N=100)• Combinations

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What type of farms?What type of farms?• Traditional operation• Biological• Small cattle• Poultry• AgricultureAgriculture• Cattle (cows, goats, etc)

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OrganizationOrganizationProviders•Farmers and their families•Care organisationsg

•Small scale operationSmall scale operation

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How is it paid?How is it paid?• Person related budgets• Exceptional Medical Expenses Act

• Municipalities• Personal payments

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Target groups: people withTarget groups: people with• Learning difficulties• Psychic or social problemsPsychic or social problems• Physical impairments• (Former) addiction• (Former) imprisonment• (Former) imprisonment• Dementia • Older people requiring meaningful activitiesactivities

• At large distance from labour market

• Autism• Acquired brain damage• Problems at school or in education

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Problems at school or in education• Burn outAnd combinations!

Evaluation and obstaclesEvaluation and obstaclesEvaluation:M i f l ti iti• Meaningful activities

• Less behavioural problems• Better achievement• Better achievement, strengthening competencies

• Structuring the day• Social contacts

Ob t lObstacles:• Funding• Culture: mixing the worlds of

www.vilans.nl• Culture: mixing the worlds of farming and care

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Old people’s advisorOld people s advisor

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Old people’s advisorOld people s advisor• Professional or volunteer• Independent• Well trained: case management, gknows local social map

• Acts at the request and on demand of the older person

• Social care, health, housing, finances

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TasksTasks• To contact people at risk• Signalise and explore needs• Information, education and adviceadvice

• Refer to services and to play an intermediate rolean intermediate role

• Support and consult older personp

• Organise and co-ordinate delivery of care and support

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CompetenciesCompetencies• Commitment• Empathy• AssertiveAssertive• Representative

t it• Integrity

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DiscussionDiscussion• Professional or volunteer?• Narrow or broad package of responsibilities?p

• Who pays?• And how about the social• And how about the social worker?

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Alzheimer café

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Ideas behind the conceptIdeas behind the concept• Low threshold• Safe place to explore disease and suffering in early stage

• To work on separation issues:• To work on separation issues: –For and from partner, familySociety–Society

–Aftercare after bereavement• As normal a life as possible• As normal a life as possible for as long as possible

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Just an ordinary cafe?Just an ordinary cafe?• Walk in without an appointmentR i• Remain anonymous

• Pass the time of day• Learn something new• Learn something new• Get things off chest• Find a willing earg• Enjoy a relaxed/friendly atmosphereE t d i k d li t t i• Eat, drink and listen to music

• Just get up and leave

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The formulaThe formula• Education and counselling; informal advice andinformal advice and consultation; self-help support; contact with peers; a pp ; p ;relaxed atmosphere

• Openness with which patients themselves speak about their disease and suffering

• A more or less fixed programme• A more or less fixed programme over the year

• Music informationwww.vilans.nl

Music, information, experiences, peers, patients and professionals

The formulaThe formula• Structured into 5 half an hour parts:parts:– Walk in– InformationInformation– Break with live-music– Group discussionp– Chat afterwards

• Interviews instead of ipresentations

• Informal setting, coffee, tea, drinks music

www.vilans.nldrinks, music

Growth of services (2008 160)(2008: 160)

120

140

60

80

100

20

40

60

0

20

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

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SpreadSpread • Within 10 km distance• Also in:

– Belgium (Flanders 10, Wallonie 10)g ( , )– UK > 20– Greece, Italy, Germany, USA,Greece, Italy, Germany, USA, Denmark, France, Canada?

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Outcomes/effectsOutcomes/effects• Sense of control and securityB fi i l f ll b i f• Beneficial for well-being of patient and partner/relatives

• Prevents emotional isolation• Recognition of individual trauma, drama and tragedyGi di i l t t• Gives disease a social status

• Ritual to help dealing with traumatrauma

• Gives the patient a voice• Gives the family a face

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y• Aftercare after dying

Evaluation: most important ffeffects

• Those suffering from the disease become visible, which ,means they can be helped

• Gateway to professional care and supportand support

• The unspoken becomes open to discussion

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Sources in English:Bère Miesen & Gemma Jones

(eds)

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Meeting centresMeeting centres

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Ideas behind the conceptIdeas behind the concept• Support for patients and carers• Information and training• Deal with own impairments and puncertainties of the future

• Maintain emotional balance and positive self-image (prevent elder abuse)

• Maintain social relationships• Develop adequate relationship

www.vilans.nlwith professional carers

The formula IThe formula ITarget groups:P l ith li ht t d t• People with light to moderate degrees of dementia

• Carers

Where:• Low threshold• Local, non clinical setting in social care settingsocial care setting

• In own community, nearby• Non-stigmatizing setting

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g g g• Since 1993; now 48

The formula IIThe formula IIWhat is offered:• Social club: three days a week: individual or group activities

• Carers groups (every two weeks)• Carers groups (every two weeks)• Joint activities of carers and people with dementiap p

• Practical support in organizing care and servicesConsulting hour: individual• Consulting hour: individual advice and counseling Integration of services

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g

In collaboration withIn collaboration with• Local social and long-term care providersproviders

• GP’s• Home care • Community mental health servicesL l t t f ld• Local support centre for older people

• Carers’ support centersCarers support centers• Care homes• Volunteers’ organizations

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g

OutcomesOutcomes • Less burdened carers• Larger social network• Postponed admission intoPostponed admission into residential care

• Less behavioral problems• Less behavioral problems

It is the tailored mix of services that works

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