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Reopening the doors of Dutch nursing homes during the COVID-19 crisis: results of an in-depth monitoring
- Raymond T. C. M. Koopmans, Hilde Verbeek, Annemiek Bielderman, Meriam M. Janssen, Anke Persoon, Ivonne Lesman-Leegte, Eefje M. Sizoo, Jan P. H. Hamers, Debby L. Gerritsen
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- Journal:
- International Psychogeriatrics / Volume 34 / Issue 4 / April 2022
- Published online by Cambridge University Press:
- 05 April 2021, pp. 391-398
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Objectives:
On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff.
Design:Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes.
Participants:Visitors and healthcare professionals.
Intervention:Allowing visitors using local regulations based on national guidelines.
Measurements:Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations.
Results:National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects.
Conclusion:The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are sometimes still struggling to find the right balance between infection control and well-being.
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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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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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.
Small, homelike care environments for older people with dementia: a literature review
- Hilde Verbeek, Erik van Rossum, Sandra M. G. Zwakhalen, Gertrudis I. J. M. Kempen, Jan P. H. Hamers
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- Journal:
- International Psychogeriatrics / Volume 21 / Issue 2 / April 2009
- Published online by Cambridge University Press:
- 23 December 2008, pp. 252-264
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Background: There is large cross-national variation in the characteristics of small, domestic-style care settings which emphasize normalized living. However, a systematic overview of existing types is lacking. This study provides an international comparison of the care concepts which have adopted a homelike philosophy in a small-scale context. Insight into their characteristics is vital for theory, planning and implementation of such dementia care settings.
Method: A literature search was performed using various electronic databases, including PubMed, Medline, CINAHL and PsycINFO. In addition, “gray” literature was identified on the internet. Concepts were analyzed according to five main characteristics: physical setting, number of residents, residents' characteristics, domestic characteristics and care concept.
Results: 75 papers were included covering 11 different concept types in various countries. Similarities among concepts reflected a focus on meaningful activities centered around the daily household. Staff have integrated tasks and are part of the household, and archetypical home-style features, such as kitchens, are incorporated in the buildings. Differences among concepts were found mainly in the physical settings, numbers of residents and residents' characteristics. Some concepts have become regular dementia care settings, while others are smaller initiatives.
Conclusion: The care concepts are implemented in various ways with a changing staff role. However, many aspects of these small, homelike facilities remain unclear. Future research is needed, focusing on residents' characteristics, family, staff and costs.