Nursing home carein the Netherlands

Frank HoekVU university

hospitalAmsterdam

The Netherlands Europe

Netherlands Below sea level

Netherlands 2008 GermanyPopulation 16,539,000 (82,069,000)

> 65 years 13.8 % (17%)

> 80 years 3.2% (4.8%)

Population density 391 (230) per sq km

Health Care expenditures

8.6% (10.1%) of GNP

Source: Max Planck Institute for Demographic Research

Hospital Nursing Home53.000 beds

1 : 300 inhabitants

415 beds (250 –1200)

€ 1500 first day

60.000 beds

1 : 270 inhabitants

180 beds (30 – 600)

€ 200 all in

Nursing homes Physically disabled

29.000 beds Seperate wards for

Geriatric Rehabilitation

Chronic care Palliative care Special care units

Day clinic facilities 4500 places

Alzheimer units 35.000 beds

Seperate wards for Chronic care Geriatric evaluation

centre

Day clinic facilities 5000 places

Reasons for admission Physically disabled

Stroke 26.3% neurological (Parkinson, MS, ALS, etc.)

9.1% Post-surgical conditions (hip, knee, ankle,

amputation) 26.1% Cancer 9.0% Heart / lung diseases

10.0%

Reasons for admissionAlzheimer units

Dementia 90%Other psychiatric disorders 10%

Care objectives

55 % long-term institutional care 35 % rehabilitative services 5 % hospice care (palliative care) 5 % special care (coma, people on

respirators, Huntington, AIDS)

Nursing Home staff Nursing Home physician (1 : 100) Physical, occupational and speech therapists

(1 : 35) Dieticians Psychologists (1 : 150) Social and recreational workers

All employed by the nursing home

Largest medical professions

General practice 11000Public and Occupational Health 4200Internal Medicine 1800Psychiatry 1500NURSING HOME MEDICINE 1450Surgery 1100Anesthetics 1075

Source: Royal Dutch Medical Association 2008

Multi approach (1)On admission:Patient examination by- Nursing home physician

- Psychologist (behavior, MMSE, GDS, etc.)- Physiotherapist- Observation by nursing staff- Others

Problem areas Physical Activities of daily life (functional) Social Psychological Sensory (hearing, view, smell, taste)

Care goals

Clarify Problem becomes evident

Solve Problem disappears

Improve Problem gets better

Limit Problem doesn’t increase / expand

Releave Problem stays bearable

Prevent Problem doesn’t arise

Multi approach (2)Follow up:Multi disciplinary care plan discussions

- for every patient- frequency depends on care plan and

diagnosis (every 2-8 weeks)- Aim:

evaluation care plan and setting goals for the next period

Multi approach (3)Support:- Alzheimer cafe (for family and relatives)- Training nursing staff in dealing with

behavioral problems- Day care and day clinic facilities- Meals on Wheels- Domotica (video monitoring, etc)- Short stay admission

Lower referral rate to hospital

Treatment of Nursing Home Residents with Dementia and Lower Respiratory Tract Infection in the United States and the Netherlands: An Ocean Apart

Jenny T. van der Steen, PhD, Robin L. Kruse, PhD, MSPH, Marcel E. Ooms, MD, PhD, Miel W. Ribbe, MD, PhD, Gerrit van der Wal, MD, PhD, Lawrence L. Heintz, PhD, and David R. Mehr, MD, MS

J Am Geriatr Soc 52:691–699, 2004

LRI in NH-patients with dementia

Treatment Mild to moderate

Severe dementia

US (n=421)

NL (n=223)

US (n=280)

NL (n=328)

Hospital transfer within 30 days after diagnosis

28.5% 0.9% 22.1% 0.3%

Intensive care unit 2.0% 0 4.0% 0

Antibiotics 83.6% 89.2% 75.7% 67.2%

Fields of nursing home medicine

Physically disabled patientsPsychogeriatricsGeriatric RehabilatationPalliative care

The Target Group

frail elderly and chronically ill individuals with complex problems and one or more of the following disorders:

Most common disorders

Dementia syndrome Cerebrovascular

disorders Post orthopaedic

surgery conditions Diabetes mellitus Parkinson's disease Osteoporosis

Heart failure COPD Depression Multiple Sclerosis Arthritis/arthrosis Delirium

Structure (practical course)Year 1 Year 2 Year 3

PGHosp AMB

Choice

AMBPG

PDP PDP

PG Nursing Home: psychogeriatric department

PDP Nursing Home: department for physically disabled patients

Hosp Hospital: geriatrics, internal medicine, neurology, surgery

AMB: Day clinic, Outpatient clinic, GP practice

Choice For choice by the resident: e.g. Rehab centre, Hospice, Research project

Structure (theoretical part)

1 day per week at the university hospital grouped with 12 trainees 2 staffmembers (NHP and psychologist) starting with an experience round two teaching topics each day

Main teaching topics

1. Acute care2. Geriatric giants3. Rehabilitation4. Psychogeriatrics5. Chronic disaeses6. Palliative Care

7. Methodology of care

8. Communication skills

9. Multidisciplinary collaboration

10.Ethics and legislation

11.Professional attitude

12.Management13.Out-patient care

R h

Take home message Cheap nursing home care rather than expensive

hospital care better care + lower expenditures

Nursing Homes in the Netherlands are staffed by physicians and psychologists, specially trained for chronic and elderly care

Dutch nursing homes rarely transfer patients to hospitals and have a very low drug use