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Avoid unnecessary displacement of vulnerable elderly

Often, elderly persons who are initially admitted to a temporary stay in a nursing home, go on to stay there permanently. The percentage of people who return home is relatively low. This is the conclusion found in a research project entitled ‘Good in one Go!’ which Vilans carried out for the international project SUSTAIN.

Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN) is an international research project aimed at improving integrated care for the elderly living at home. On their behalf, Vilans conducted an experimental project entitled ‘Good in one Go!’, which examined two interventions concerning primary care and first aid. The research included a data analysis of clients in need of intensive care, who were admitted to a temporary stay in a nursing home. The inflow, throughput and outflow of 115 clients were analysed from November 2016 to December 2017. Interviews with care managers; program managers and specialists in geriatric medicine were also conducted.

Unnecessary change

Vilans Researcher, Monique Spierenburg: ‘Many elderly people receive care from the first aid station or the general practitioner, but there is too little knowledge of elderly care available. As a result, these people are sometimes referred to a temporary stay in a nursing home. From there, they often end up living there permanently. This leads to unnecessary displacement with the risk of delirium or other complications. Another problem is that temporary beds in nursing homes are being occupied that are meant for other purposes.’

Inflow temporary stay in nursing homes

The study shows that most people are admitted from their home situation (46%) or the hospital (40%). The largest group goes to nursing homes (43%), while far fewer people go home (34%). This shows that a temporary stay in a nursing home is mainly used as an unnecessary intermediate station because of an incorrect diagnosis.

Underlying problems

Spierenburg: ‘This wrong-bed policy is caused by a number of problems. For example, due to a lack of knowledge of how to care for the elderly at home, the possibilities for home care are not being adequately considered by referrers. This applies not only to medical problems, but social and mental health problems as well. The question of what is the right care is for a specific client is not the primary focus because we are dealing with different indication counters for the different forms of care in the Netherlands. Various forms of financing also work against each other. ‘

Two interventions

For the research study, Vilans investigated two interventions. The first intervention involved working together with an elderly care professional providing services to a client who has been registered for a temporary stay in a nursing home by a general practitioner. The second involved having an elderly care professional observe an older person receiving care in an emergency situation.

Specialist geriatric medicine has added value

Spierenburg: ‘For the group of frail elderly persons living at home, good cooperation between general practitioner and specialist in geriatric medicine has proved to be of great added value. The general practitioner can request a consultation from a specialist in geriatric medicine when he sees that the complexity of care, and the vulnerability of the client and his system are increasing. This prevents unnecessary admissions and referrals.’

Clinical geriatrics as a bridge function

Spierenburg adds, ‘It is more complex with the intervention at the emergency department. When it is necessary for people to be admitted to a nursing home, there is a need for trust from the emergency department that this person receives the right care in the nursing home. In addition, it is important that they know which medical care can be supplied there. Good mutual coordination helps, and clinical geriatrics may possibly be a bridge function in this. ‘

From research to policy

‘The good news is that results from this research will soon be discussed by the Dutch government. Policymakers underpin the problems we must tackle. With ‘Good in one Go!’ we zoomed in on a small part, but there are more factors related. We will therefore take a wider scope in the next research.’

About SUSTAIN

SUSTAIN is a European research project on sustainable integrated care for the elderly living at home in Europe. In the SUSTAIN consortium, researchers, policy advisors, and other partners in the field of care systems and care for the elderly in Europe all work together. Their work involves nine different countries, including the Netherlands, Estonia and Spain. The consortium analyses fourteen initiatives in the field of integrated care.

Contact for this project:
Monique
Spierenburg