Geriatric rehabilitation at Laurens:Vision and ambition

Mr. Hans Stravers Msc BA COO of the short-term care and rehabilitation business unit at Laurens

Contents of the presentation

● Laurens in context● Developments in care hotel rehabilitation model in the Netherlands

● Vision of the care rehabilitation model, Laurens-style

● Financial sustainability of short-term care

● Benefits of short term transitional care to reduce re-

hospitalization

● Care hotel, the future for Asia Pacific?● Practice of "Business Unusual" at Laurens

● Treatment with cytostatics in home care

● COPD rehabilitation at Laurens

Laurens in context

● Established in Rotterdam since 1886

● Population Rotterdam area: 1.2 m

● Not for profit care organization

● Dementia care, 2600 patients. Market share 30%

● Home care, 8000 patients. Market share 40%

● Rehabilitation, 300 patients. Market share 70%, €31

million

● Laurens total turnover €300,000,000

● 35 nursing homes

● 6 residential buildings for the elderly

● 9000 employees

Laurens' area of work

Developments in the care hotel rehabilitation model

● Arose in the Netherlands in the early 1960s.

● Post-treatment refuge for the elderly became a multifunctional

center.

● Multifunctional center became a specialized facility for specific target

groups.

● Individual facility became part of integrated care

● Hospital = curing disease

● Care hotel = rehabilitation

● Rest makes you rust!

Care hotel rehabilitation model l

Laurens has many years' experience in accelerating turnover of

patients from hospital to rehabilitation

● 1997, Rotterdam Stroke Service established

● www.rotterdamstrokeservice.nl ● In 2016, every stroke patient is in a rehabilitation center within 5

days

● 1500 admissions per year

● Continuing development into other disorders such as:● COPD, heart failure, oncology, orthopedics, etc.

● Building expertise amongst practitioners/nursing by developing

care paths in cooperation with professionals from hospitals

Definitions, 3 types of recovery-focused care

Specialized rehabilitation: complex treatment which eliminates

or minimizes disabilities and/or participation problems

Reactivation: “getting active again”. Essential part of integrated

nursing and care; not complex, not multidisciplinary

Geriatric rehabilitation: rehabilitation focused on the frail elderly

with complex multimorbidity. multidisciplinary care

● The latter two groups of patients are Laurens' target groups

● Important distinction in connection with intensity of treatment

Geriatric rehabilitation

Integrated multidisciplinary care focused on

foreseeable recovery of functioning and participation

in the frail elderly after an acute disorder or functional

deterioration.

Geriatric rehabilitation

Laurens' vision of the care hotel rehabilitation model

Rehabilitation care must be reinvented.

● Because of competition and new entrants

Our goal is:

Patients come to us from near and far, because Laurens offers:

● the proven best (integrated) care

● skilled professionals

● interdisciplinary cooperation

● in a welcoming environment

● care and attention for the individual are foremost

Laurens' vision Reinvention means:

Adding value in use by

● renewing services

● reducing costs

For short-term care, this means:

● attracting new target groups

● focusing even more on hospitals (forward integration)

● adding quality to the entire integrated chain for the customer

● home-hospital-rehabilitation-home

● quality is more than working properly and lean

● providing facilities services on a higher plane

Renewing services

Survival of the fittest

It won't be the strongest care provider who survives, but the care

provider that knows best how to adapt to new circumstances

Innovation and entrepreneurship = Customer value +

Good Service is giving people a little more than they expect

Excellent service is enjoying giving people a little more than they expect

Learn from Schiphol, main airport of the Netherlands

● Think about the entire ‘journey’

● Focus on behavior

● Friendly staff

● Patient profiles

● Influence of Social Media

● Perception of hygiene

● Wayfinding

● Continue to create WOW moments

● Catering concept

Points to consider

The quality of non-clinical services is critical to a patient’s

evaluation of a stay and can define their overall experienceB.J. Pine & J.H. Gilmore

It may be that many guests do not know the difference between an

ECG or an EEG, but all guests can tell if a bowl of soup is cold when

it's served

Intermezzo

160 rooms for geriatric rehabilitation ( https://youtu.be/xzXdhQNr20U )

● disorders of the central nervous system, stroke/trauma

● organ failure, heart and lung conditions

● oncology, focused on recovery

● musculoskeletal traumata

● orthopedics, total hip/knee

Staff

● nurses, nurse practitioners

● doctors/psychologists

● occupational, physio, speech therapists

Costs of rehabilitation in the Netherlands

● Patient's medical insurance pays the costs.

● The patient pays €1500 (in 12x monthly instalments) and €385

excess per year.

● Hospital admission costs €1000 (non-intensive care) per day

● Rehabilitation admission costs €300 per day, all inclusive:

● food, treatment, medication, room.

● Rehabilitation admission varies in length from:

● 10 days, orthopedics.

● max. 6 months, stroke care.

Benefits of geriatricrehabilitation

Geriatric rehabilitation worthwhile?

● Yes, for interdisciplinary working

● Yes, for CVA rehabilitation (entire group) positive for mortality

and functioning

● Yes, for hip fracture rehabilitation for functioning and speed of

recovery

● Yes, for COPD rehabilitation (entire group) on quality of life

● Yes, for orthopedics

● Yes, for oncology rehabilitation

Benefits of geriatric rehabilitation

1995-2010 stroke care in hospital, start of the RSS in 1997Length of admission men down from 20.3 to 8.5 daysLength of admission women down from 25 to 9 daysNow fallen further to max. 5 days in hospital

Index number, men Index number, women

Clinical admissionsAverage length of admission

Clinical admissionsAverage length of admissionClinical admission days Clinical admission days

Benefits of geriatric rehabilitation

Length of admission down from 26 to 9 days (2012) for hip

fracture

Fully-integrated hospital and recovery

Clinical admissionsAverage length of admission

Clinical admission days Clinical admissionsAverage length of admission

Clinical admission days

Index number, men Index number, women

Evidence

● Bachman S. et al. In-patient rehabilitation specifically

designed for geriatric patients: systematic review and meta-

analysis of randomized controlled trials. BMJ 2010

hip fractures: better functioning, fewer hospital admissions, reduced

mortality. Costs not clear.

● Murray. Outcomes of rehabilitation services for nursing home

residents. Arch Phys Med Rehabil 2003.

Retrospective; n= 11500, extensive monitoring of 112 variables.

58% received rehabilitation and this was associated with more discharges

home, and reduced mortality.

Care hotel, the future for Asia Pacific?

For Laurens it is "Business Unusual" because there are several

destabilizing changes in the Dutch-language context

● doubling of ageing population

● new and other competitors

● new and other business models

● new and other customer requirements

● new and other attitudes and values of employees

How should we respond? Redefine our products

● How is the taxi world doing this with Uber?

● How is the hotel world doing this with Airbnb?

Care hotel, the future for Asia Pacific?

● Hard to say, I have insufficient knowledge about the context

● The same problems in Asia Pacific? Ageing population? Rising

costs of health care?

What can you learn from the Netherlands?

● Growth of an ageing population = growth in age-related

diseases

● Hospital is the wrong place for the frail elderly

● Redefine your product and business case

● Hospital for the sickness

● Care hotel for the sick people who are focused on recovery

● Hospital costs higher than care hotel in the Netherlands

"Business Unusual", an example

Administration of cytostatics at home● customer wishes = prefer treatment at home

● changing financing,

● hospital now has to pay costs of treatment, previously it was the patient

● Laurens is setting up specialist home care team, specialist nurses

● award of contract: start with 800 customers on an annual basis = interesting

market

● shape care path and quality requirements together with hospital professionals

● Use of e-health for patient to doctor contact

● benefit: costs to hospital €800/treatment at home €120 per day

"Business Unusual", COPD care

● An integrated care path since 2010

● Now:

● patients come via GP or hospital Emergency Department

(EHBO) direct to Laurens Intermezzo

● Before:

● often acute exacerbation and/or lung infection afterwards,

admission to hospital.

Inclusion criteria:

● Gold stage II, III and IV

● Motivation

● Consent

Exclusion criteria:

● Serious behavioral issues

● Not “trainable” because of cognitive or psychiatric problems

● Not willing to stop smoking.

Outcomes

● Client functions better in the home situation, COPM

● Reduces the number of hospital admissions

● Costs €800 per day in hospital

● Costs €300 per day in Intermezzo

"Business Unusual", COPD care

This is what we are doing it all for

Thank you for your attention