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INTEGRATED COMMUNITY CARE FOR PEOPLE WITH DEMENTIA IN THE NETHERLANDS
LUDO GLIMMERVEEN - VU UNIVERSITY AMSTERDAM
The King’s Fund Integrated Care Summit Making integrated care happen at scale and pace Wednesday, 8 May 2013
Faculty of Social Sciences
GERIANT - FOUNDING HISTORY
2
Independent organization (2004)
Joint program (2000)
The King's Fund Integrated Care Summit
Before 2000…
Faculty of Social Sciences
GERIANT - CARE MODEL
3
GP referral
• Diagnosis • Treatment • Case management
CARE HOME CLIENT DECEASES
SERVICES FOR CLIENTS & INFORMAL CARERS
The King's Fund Integrated Care Summit
Faculty of Social Sciences
Social Geriatrician
Psychiatrist
Clinical Psychologist
Specialized home care nurse
GERIANT - CARE MODEL
4
Clinical case manager
Case management
&
providing treatment…
…as part of multidisciplinary team
Short-stay Clinic
The King's Fund Integrated Care Summit
Faculty of Social Sciences
Social Geriatrician
Psychiatrist
Clinical Psychologist
Specialized home care nurse
CARE NETWORK
5
Clinical case manager
NETWORK PARTNERS
Home care – Welfare – GP – Hospital – Nursing Homes
Short-stay Clinic
The King's Fund Integrated Care Summit
Faculty of Social Sciences
Social Geriatrician
Psychiatrist
Clinical Psychologist
Specialized home care nurse
VARIOUS FORMS OF INTEGRATION
6
Clinical case manager
NETWORK PARTNERS
Home care – Welfare – GP – Hospital – Nursing Homes
6-MONTHLY PHONE CALL Short-stay Clinic
The King's Fund Integrated Care Summit
Faculty of Social Sciences
Social Geriatrician
Psychiatrist
Clinical Psychologist
Specialized home care nurse
VARIOUS FORMS OF INTEGRATION
7
Clinical case manager
NETWORK PARTNERS
Home care – Welfare – GP – Hospital – Nursing Homes
MULTIDISCIPLINARY MEETINGS / JOINT VISITS
Short-stay Clinic
The King's Fund Integrated Care Summit
Faculty of Social Sciences
Social Geriatrician
Psychiatrist
Clinical Psychologist
Specialized home care nurse
VARIOUS FORMS OF INTEGRATION
8
Clinical case manager
NETWORK PARTNERS
Home care – Welfare – GP – Hospital – Nursing Homes
ARRANGE / INSTRUCT / ALIGN CARE WITH
NETWORK PARNERS
Short-stay Clinic
The King's Fund Integrated Care Summit
Faculty of Social Sciences
Social Geriatrician
Psychiatrist
Clinical Psychologist
Specialized home care nurse
VARIOUS FORMS OF INTEGRATION
9
Clinical case manager
NETWORK PARTNERS
Home care – Welfare – GP – Hospital – Nursing Homes
INTERORGANIZATIONAL PLATFORMS FOR
INDIVIDUAL CLIENTS
Short-stay Clinic
‘DEMENTIA HOME TEAM’
The King's Fund Integrated Care Summit
Faculty of Social Sciences
Social Geriatrician
Psychiatrist
Clinical Psychologist
Specialized home care nurse
VARIOUS FORMS OF INTEGRATION
10
Clinical case manager
NETWORK PARTNERS
Home care – Welfare – GP – Hospital – Nursing Homes
Short-stay Clinic
The King's Fund Integrated Care Summit
Faculty of Social Sciences
ORGANIZATIONAL CONTEXT
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Faculty of Social Sciences
MEASURING RESULTS
Routine Outcome Measuring
12 The King's Fund Integrated Care Summit
Satisfaction surveys: + + +
Faculty of Social Sciences
EVIDENCE FOR COST SAVING SUBSTITUTION
13 The King's Fund Integrated Care Summit
102,
961
euro
54,5
40 e
uro
REGULAR LTC
REGULAR LTC +
GERIANT (a.o.)
47% less • 8 Euro / client / day
Faculty of Social Sciences
RECAP MAIN FEATURES
14 The King's Fund Integrated Care Summit
•Various mechanisms of integration can be present… …acting at various levels in the care model • Fluid structures for integration follow the client’s condition… …instead of the client following the structures • Flat organizational structure and small teams… ... facilitating collaboration and creative search for solutions
Faculty of Social Sciences
CORRESPONDENCE
Ludo Glimmerveen Department of Organization Sciences [email protected]
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