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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 CALLShort-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
11 The King's Fund Integrated Care Summit
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
102,961euro
54,540euro
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
l.m.glimmerveen@vu.nl
15 The King's Fund Integrated Care Summit

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Ludo Glimmerveen: integrated care for people with dementia in the Netherlands

  • 1. 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
  • 2. Faculty of Social Sciences GERIANT - FOUNDING HISTORY 2 Independent organization (2004) Joint program (2000) The King's Fund Integrated Care Summit Before 2000…
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. 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 CALLShort-stay Clinic The King's Fund Integrated Care Summit
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. Faculty of Social Sciences ORGANIZATIONAL CONTEXT 11 The King's Fund Integrated Care Summit
  • 12. Faculty of Social Sciences MEASURING RESULTS Routine Outcome Measuring 12 The King's Fund Integrated Care Summit Satisfaction surveys: + + +
  • 13. Faculty of Social Sciences EVIDENCE FOR COST SAVING SUBSTITUTION 13 The King's Fund Integrated Care Summit 102,961euro 54,540euro REGULAR LTC REGULAR LTC + GERIANT (a.o.) 47% less • 8 Euro / client / day
  • 14. 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
  • 15. Faculty of Social Sciences CORRESPONDENCE Ludo Glimmerveen Department of Organization Sciences l.m.glimmerveen@vu.nl 15 The King's Fund Integrated Care Summit