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Reablement in theNetherlands The ‘Stay Active at Home’ programme
Dr. Silke Metzelthin
Copenhagen, June 27 2019
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
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
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
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
* 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
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
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
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
Results so far…
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
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
Partners:
