Reablement in the Netherlands - VIVE · Older adults in NL (2016) Vital older adults Home care...
Transcript of Reablement in the Netherlands - VIVE · Older adults in NL (2016) Vital older adults Home care...
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Reablement in theNetherlands The ‘Stay Active at Home’ programme
Dr. Silke Metzelthin
Copenhagen, June 27 2019
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Domestic support District nursing Nursing home care
Older adults in NL (2016)
● Vital older adults● Home care● Nursing home
2016: 270,000 / 2025: 350,000 clients 2016: 110,000 / 2025: 141,000 clients2016: 270,000 / 2025: 350,000 cli
2025: 22% of the total population is ≥ 65 years
2016: 18% of the total population is ≥ 65 years
Care for older adults in the NetherlandsFacts and figures
Nursing home care
2016: 110,000 / 2025: 141,000 clients
Domestic support District nursing
2016: 270,000 / 2025: 350,000 clients
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Cross associations
Characteristics- Autonomous- Generalist- Nursing- Prevention
End 19th century
Autonomy/ generalist
Big home care organisations
Characteristics- Large-scale- Specialist- Nursing and
personal care
80s and 90s
Upscaling/ task differentiation
Self-directed teams
Characteristics- Small-scale- Self-directed- Needs assessment
on national level
2006
Self-directed teams
District nursing ‘new’ style
Characteristics- Autonomous- Generalist- Conducts needs
assessment- Connects health
and social services
2015 onwards
Spin in the web dddddd
The evolution of district nursing in the NL
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Professional home care in the NetherlandsDifferent kind of services and professionals
Domestic support Domestic support workers - Work individually
- Needs assessment: municipalities- Paid by municipalities
Personal care District nurse (RN, BSc) Nurses (RN, vocationally trained) Certified nurse assistants (practically trained)
Nursing care District nurse (RN, BSc) Nurses (RN, vocationally trained)
- Work in small ‘self-directed’ teams (approx. 12 nurses)
- Needs assessment: district nurse- Paid by national health insurance
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Doing for…Doing for…
Nu
rses
Do
mes
tic
sup
po
rt w
ork
ers
Doing with…
Implement reablement
Development of the ‘Stay Active at Home’
programme
Change in care philosophy is needed
2
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* DSW = domestic support workers
‘Stay Active at Home’ programme
Months1 2 3 4 5 6 7 8 9
Nurses
K
T
B
Kick-off
Team meeting
Booster session
Practical assignment
Weekly newsletter
K
K
T T T
T
T
T
B
B
T
TDSW
P P P P P P
P P P P
Weekly newsletter
Weekly newsletter
P
4
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Programme content• Kick-off (knowledge, attitude)
- Consequences of task completion/ sedentary behaviour- Benefits of engaging older adults in daily and physical activities
• Team meetings (attitude, skills, social support)- Assessing capabilities - Motivating - Increasing engagement in daily and physical activities- Implementing and evaluating goal-setting and action planning- Involving the social network
• Booster session (reinforcement of knowledge, attitude, skills and social support)- Communication skills
5
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Research
1. Pilot study (Nov 2015 – Jul 2016)
aim: evaluate feasibility of the programme
2. Early trial (Sept 2016 – Jul 2017)
aim: evaluating feasibility of study design
3. Randomised controlled trial (Sept 2017 – Aug 2021)
aim: evaluating feasibility, effectiveness and cost-effectiveness of the programme
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Randomised controlled trial
10 district nursing teams
Intervention group: 5 teams Control group: 5 teams
Baseline Baseline
Follow-up: 6, 12 months Follow-up: 6, 12 months
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Results so far…
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Results I• Opinions about the training
- Practice-based scope useful for daily work- Exchange of experiences they learn from each other- Role plays useful for self-reflection- Tip of the Week useful reminder- Mixed opinions about theory and practical assignments
• Self-perceived outcomes in professionals- Most professionals believe in benefits of reablement- ‘Doing with’ is not new for them- Increased awareness and self-efficacy regarding reablement- Improved collaboration and communication- Positive reactions of clients- Increased work satisfaction
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Results II
• Implementation challenges- Resistance clients and families- Complexity of clients- Inconsistent behaviour of professionals- Professionals have problems to critically reflect on their behaviour
- Professionals think they perform better than they actually do- Professionals have an extern locus of control
• Facilitating factors for implementation- Organisational support- New funding
- Lump sum funding (€700 per person/ per month) instead of fee-for-service
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Partners: