Dutch Dementia Care Plan
National Dementia Plans
The three-year Dutch “Dementia Care Plan” was announced by the State Secretary for Health, Welfare and Sports, Dr. J Bussemaker, in 2008. This followed the evaluation of the earlier Dutch National Dementia Programme (2004-2008).
Julie Meerveld and Marco Blom of Alzheimer Nederland talk about their organisations’ involvement with National Dementia Programme (2004-2008) and, together with Alzheimer Europe, take a look at the new Dutch Dementia Care Plan
In 2008 the four-year Dutch National Dementia Programme (LDP) came to an end and the evaluation of this, together with the call for improvements to the care provided to people with dementia (presented as the “Dementia Delta Plan” to the Dutch Lower House by the Member of Parliament, Agnes Wolbert), highlighted how better provision of care for people with dementia and their carers may be achieved. As a result, and in order to build on earlier progress made within the context of the LDP, Dr J Bussemaker, the State Secretary of Health, Welfare and Sports, announced the “Dementia Care Plan” (DCP).
The National Dementia Programme (2004-2008)
“Alzheimer Nederland” both initiated and participated in the National Dementia Programme. Alongside the Ministry of Public Health, Welfare and Sport and the Netherlands Institute for Care and Welfare (Vilans), Alzheimer Nederland coordinated a programme for regional providers of care, welfare and cure of dementia to improve dementia care from a clients’ perspective. The results were impressive: 90% of the country participated with 206 improvement projects fitting the needs of patients and families and 50 “beauties” were selected for their good results from a client’ perspective. Providers of care, welfare and cure worked together with volunteers of Alzheimer Nederland. The wishes and demands of families of patients in 160 focus groups were complied by Alzheimer Nederland using the “LDP-questionnaire” (N=900). Nevertheless more incentives were necessary to integrate help for people with dementia and their families from the beginning until the end of the dementia.
The Dementia Care Plan
In response to the outcome of the earlier LDP, as well as the calls for improvement from Alzheimer Nederland to care providers for people with dementia, the Dutch Dementia Care Plan (DCP) began to be developed in 2008. The overall aim of the DCP is to “improve the quality of life of people with dementia and their carers and the provision of the right tools to professionals, enabling them to deliver good quality dementia care”. This will be achieved by realising three objectives (1) the creation a coordinated range of care options that meet the client’s needs and wishes; (2) the provision of sufficient guidance and support for people with dementia and their carers and (3) the monitoring of the quality of dementia care annually.
Objective 1: The creation of a coordinated range of care options throughout the Netherlands that meet the client’s needs and wishes
To successfully meet the client’s needs and wishes there needs first to be a true understanding of what those needs are, an awareness of the care options available as well as their cost and, lastly, examples of best practice from which to draw upon. Alzheimer Nederland did two polls (in 2007 and 2008) to investigate the needs and wishes of informal carers. The other elements are being developed and should soon be available in the DCP
Recent improvements to the assessment process in the Netherlands will hopefully result in quicker and more accurate assessments being made which should ensure the client’s needs and wishes are identified. A guide for the purchase of coordinate care is being developed to ensure that care providers are aware of the care options and their cost, which are available to them. This development is being carried out by the representative body of the providers of care insurance in the Netherlands, Zorgverzekeraars Nederland, the Ministry of Public Health, Welfare and Sports, together with Alzheimer Nederland. Pilots of the guide will be carried out, enabling final adjustments to be made, but the aim is to have the range of coordinated dementia care options and their purchase options available and in practice throughout all regions by 2011. A set of best practices containing concrete examples should be available soon in the Netherlands as they will be part of the final evaluation of the previous dementia strategy (LDP) and this is due for publication soon.
Objective 2: People with dementia and their carers have sufficient access to guidance and support
A lack of information can delay a diagnosis of dementia and hence also delay any support and/treatment that could benefit a person with dementia and their carers. As Dr Bussemaker, said, “This subject is undeservedly taboo, so people will often keep it to themselves. And yet the more people who are aware that a person has dementia, the more we are able to support that person and their family. The importance of supporting people with dementia and their families must not be underestimated.” Whilst recognising the key role which Alzheimer Nederland plays in the dissemination of information, Dr Bussemaker also called on the municipalities to play their role, indeed legal obligation (under the social support act “Wet maatschappelijke ondersteuning”), of supporting informal carers.
Another way in which people with dementia and their carers can be assured the appropriate support they need is by operating a case management system. Many benefits have been shown across the board when such systems are operational. Examples include an increased satisfaction from the client and carer with the care and support they receive, a greater ability to cope by the informal carer, a reduced burden on the informal carer and GP, fewer admissions into residential care and/or crisis admissions and also that resources are used more effectively.
Case management is already being used across the Netherlands, with the application enjoying a degree of flexibility, to allow for regional differences and solutions. Indeed the role of case manager is taken on by different people (from district nurses to a specialist in case management for people with dementia) according to the local situation. This same flexible approach was also used in the LDP which adhered to the principle “Let 100 flowers boom” allowing for each region to search for its own solutions and resulted in many innovative approaches being employed. Whilst flexibility is a key element, Dr Bussemaker has stipulated some basic requirements which must be fulfilled when operating a case management system: case managers must be independent and have knowledge of dementia and the system must be available for the client in their home setting, being offered as a natural point of contact. Another issue which needs to be addressed is the fact that although many innovative approaches have been created, many of them remain unknown outside of their own regions.
Objective 3: Measuring the quality of dementia care annually
Thirty-five indicators, divided into ten themes (care, communication and information, physical well-being, care-related safety, living and life circumstances, participation, mental well-being, safety at home and in residential care, sufficient and killed staff and, lastly, coordinate care) are being developed to execute this. These measures hope to ensure that transparent information is available, enabling “clients to make choices, support insurers in their contracting activities, support the IGZ (inspection of public health) in its supervisory role and encourage internal quality improvements” says Dr Bussemaker.
Funding for the DCP, says Dr Bussemaker, already exists and can be found within the National Elderly Care Programme (2008-2011), the rules on building and small-scale living (2009-2011), the budget for development of outcome-indicators for dementia care (2008) and the care innovation fund (2009) and therefore there are no additional monies being allocated. Alzheimer Nederland doesn’t agree with this statement of the Secretary about funding. The 100 flowers of the LDP are known as ‘beauties’ and have been positively reviewed by patients and informal carers. But these improvements are only available to a restricted number of patients and carers. Also, more than half of all people with dementia are not known by professionals and careproviders. They cope with the disease alone until crisis occurs. Also care providers complain they don’t find budgets to provide the necessarry care like described in the guide for the purchase of integrated dementia care in the DCP. Consequently, Alzheimer Nederland is lobbying those politicians running for next years’ elections to get a more solid financial basis for the purchase of integrated care for all patients with dementia.
“By implementing this plan I am taking a major step towards achieving client-orientated, coordinated dementia care which can impact the entire care sector” said Dr Bussemaker. For people with dementia and their carers, we hope the Dutch Dementia Care Plan will soon be fully realised.
Last Updated: mercredi 14 mars 2012