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Quality monitoring of long-term care in The Netherlands
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- By Jos M. G. A. Schols, Maastricht University, The Netherlands, Dinnus H. M. Frijters, VU University Medical Center, Amsterdam, Ruud G. I. J. M. Kempen, Maastricht University, The Netherlands, JAN P. H. Hamers, Maastricht University, The Netherlands
- Edited by Vincent Mor, Brown University, Rhode Island, Tiziana Leone, London School of Economics and Political Science, Anna Maresso, London School of Economics and Political Science
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- Book:
- Regulating Long-Term Care Quality
- Published online:
- 05 February 2014
- Print publication:
- 06 February 2014, pp 211-239
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- Chapter
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Summary
Introduction
In this chapter we describe the regulatory structure and the monitoring of quality of long-term care in The Netherlands. Firstly an introduction to long-term care for older people is provided, together with some basic information on the position of the long-term care sector within the overall healthcare system, including its capacity, some basic service user characteristics, the services offered and the way the long-term care sector is financed and regulated. In addition, we highlight selected policy and political issues that have emerged over the last decade which have challenged the traditional approach to judging the quality of services. Secondly, we outline the most relevant legislation and regulations related to the rights of long-term care clients as well as those related to the long-term care sector itself, finishing with the most relevant regulatory measures on the quality of care. This is followed by a section on integral quality systems fulfilling ISO 9001 criteria (an internationally accepted standard for quality management systems and certification). Special attention is given to the Dutch Healthcare Inspectorate and its role in the external monitoring of quality of care and to the use of nationally established quality indicators for long-term care. Finally, we focus on the issue of transparency and how the performance of long-term care organizations is communicated to society in general (including service users themselves and insurance companies) through public reporting. In this context, the increasing strength of the role of service users will be addressed. Although this chapter focuses on long-term care for older people, the information provided generally holds for long-term care for young people and for people with chronic somatic, mental or psychiatric diseases as well as for people with mental health disabilities who need chronic care.
Fall determinants in older long-term care residents with dementia: a systematic review
- Tobias F. Kröpelin, Jacques C. L. Neyens, Ruud J. G. Halfens, Gertrudis I. J. M. Kempen, Jan P. H. Hamers
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- Journal:
- International Psychogeriatrics / Volume 25 / Issue 4 / April 2013
- Published online by Cambridge University Press:
- 20 December 2012, pp. 549-563
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- Article
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Background: Persons with dementia are two to three times more likely to fall compared to persons without dementia. In long-term care settings, the dementia prevalence is highest. Therefore, older long-term care residents with dementia can be considered a high-risk group for falls. Nevertheless, no systematic evaluation of fall determinants in this population was found. The purpose of this study was to identify fall determinants among older long-term care residents with dementia or cognitively impaired persons in long-term care, by conducting a systematic literature review.
Methods: We searched English, French, Dutch, and German articles listed in: CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, and Web of Science. Additionally, references of included articles were screened. Studies were included if determinants or circumstances of falls in older persons with dementia living in long-term care were assessed.
Results: Eight studies met the inclusion criteria. Three studies were excluded from detailed analysis because of insufficient quality. Use of psychotropic drugs, a “fair or poor” general health, gait impairments, and age were associated with an increased fall risk. Also trunk restraints were associated with an increased number of falls while full bedrails and wandering behavior were protective against falls.
Conclusions: Fall risk factors known from other populations, e.g. use of psychotropic drugs, physical restraints, and health conditions, are found in long-term care residents with dementia as well. Due to the limited evidence available, future studies with adequate sample sizes and prospective designs are required to determine specific fall risk factors and verify existing results in this population.