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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.
Variability between nursing homes in prevalence of antipsychotic use in patients with dementia
- Bart C. Kleijer, Rob J. van Marum, Dinnus H. M. Frijters, Paul A. F. Jansen, Miel W. Ribbe, Antoine C. G. Egberts, Eibert R. Heerdink
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- Journal:
- International Psychogeriatrics / Volume 26 / Issue 3 / March 2014
- Published online by Cambridge University Press:
- 20 November 2013, pp. 363-371
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Background:
Antipsychotic drugs (APD) are widely prescribed for people with dementia residing in long term care facilities (LTCFs). Concern has been expressed that such prescribing is largely inappropriate. The objective of this study is to examine if differences in facility-level prevalence of APD use in a sample of LTCFs for patients with dementia can be explained by patient and facility-related characteristics.
Methods:A point prevalence study was conducted using data from the VU University Resident Assessment Instrument (VURAI) database from nursing homes and residential care facilities in the Netherlands. Patients were selected who had a diagnosis of dementia. LTCF and patient characteristics were extracted from the VURAI; facility-level resident satisfaction surveys were provided by the National Institute for Public Health.
Results:In total, 20 LTCFs providing care for 1,090 patients with dementia were investigated. Overall, 31% of patients used an APD. In facilities with a high prevalence of APD use behavioral symptoms were present in 62% of their patients. In facilities with medium APD use behavioral problems remained frequent (57%), and in facilities with low prevalence of APD use 54% of the patients had behavioral symptoms. Facilities with a high prevalence of APD use were often large, situated in urban communities, and scored below average on staffing, personal care, and recreational activities.
Conclusions:There was considerable variation between the participating LTCFs in the prevalence of APD use. Variability was related to LTCF characteristics and patient satisfaction. This indicates potential inappropriate prescribing because of differences in institutional prescribing culture.
Social engagement and depressive symptoms of elderly residents with dementia: a cross-sectional study of 37 long-term care units
- Adriana P. A. van Beek, Dinnus H. M. Frijters, Cordula Wagner, Peter P. Groenewegen, Miel W. Ribbe
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- Journal:
- International Psychogeriatrics / Volume 23 / Issue 4 / May 2011
- Published online by Cambridge University Press:
- 15 November 2010, pp. 625-633
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Background: Social engagement and depression are important outcomes for residents with dementia in long-term care. However, it is still largely unclear which differences in social engagement and depression exist in residents of various long-term care settings and how these differences may be explained. This study investigated the relationship between social engagement and depressive symptoms in long-term care dementia units, and studied whether differences in social engagement and depressive symptoms between units can be ascribed to the composition of the resident population or to differences in type of care setting.
Methods: Thirty-seven long-term care units for residents with dementia in nursing- and residential homes in the Netherlands participated in the study. Social engagement and depressive symptoms were measured for 502 residents with the Minimum Data Set of the Resident Assessment Instrument. Results were analyzed using multilevel analysis.
Results: Residents of psychogeriatric units in nursing homes experienced low social engagement. Depressive symptoms were most often found in residents of psychogeriatric units in residential homes. Multilevel analyses showed that social engagement and depressive symptoms correlated moderately on the level of the units. This correlation disappeared when the characteristics of residents were taken into account.
Conclusions: Social engagement and depressive symptoms are influenced not only by individual characteristics but also by the type of care setting in which residents live. However, in this study social engagement and depressive symptoms were not strongly related to each other, implying that separate interventions are needed to improve both outcomes.