Lessons learned from an integrated care project in Arnhem

The RIVM (National Institute for Health and Environment) and Vilans have published a country report in August to share the lessons learned with other countries on two applied integrated care initiatives. Vilans researcher, Lian Stouthard was involved in the integrated care site in Arnhem. ‘Caregivers and care users (clients) experience uncertainty with transitions. For example, when elderly people go from hospital to their home.’

The country report was published for SUSTAIN, a European research project on sustainable integrated care for the elderly living at home in Europe. For the initiative ‘Good in one Go!’ in the Arnhem region, two interventions involving temporary stays in nursing homes were examined. The first intervention involved working together with an elderly care professional providing services to a care user, 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.

Unnecessary referrals

Investigating these interventions was necessary because the first aid and the general practitioner often lack knowledge about elderly care. As a result, elderly people are sometimes referred to a temporary stay in a nursing home. From then on, they often end up living there permanently. This leads to unnecessary displacement. Another problem is that temporary beds in nursing homes, that are meant for other purposes, are being occupied.’

Two interventions

For the country report, Stouthard mainly focused on the experiences with the two interventions. What are the active elements? And what are the experiences of care users, informal caregivers, managers and healthcare professionals? Stouthard: ‘What struck me is that the users were very satisfied with the care they received. Especially the personal attention was appreciated, and the fact that care workers visited them; for example, to see how they could live at home longer.’

Communication at transition

The experiences of informal caregivers were different. Stouthard: ‘Informal caregivers are prone to the role of planning and arranging, and therefore mentioned that the coordination between care organisations could do better. When there is a transfer between organisations, informal caregivers feel that they must stay on top of it. Often, hospitals do not know exactly what is needed; for example, a caregiver is told: “Your partner can go home tomorrow.” Then he thinks: “Help, what shall we do now?”. More guidance could therefore be offered in this type of transition, so that people know to whom they can go with questions. It is mainly about better communication during such a transition.’

Leadership is important

‘In addition, collaboration between organisations is essential for the transition, say, from the hospital to home. Good leadership is indispensable in this. Our interventions included an independent project leader who was well-known in the region, and because of that, organisations trusted her. Leadership is important, because if you leave it up to the organisations, collaboration will soon be second or third priority.’

Collaboration at case level

‘Finally, the collaboration at a case level was regarded as positive for these interventions by care managers. This way, the perspective of the care user is automatically considered, and his or her individual wishes are the central point of view. Normally, collaboration is done at a policy level, and the information shared during the transfer of a care user is more general.’

Also of international importance

Will other countries benefit from with this information? Stouthard thinks they will: ‘The problem in the Netherlands also involves different types of legislation and corresponding financing streams. But there are also more general factors that apply internationally, such as the importance of mutual trust between organisations. When there is trust, organisations are working towards the same goal, and understand that they cannot capture and define everything.  Not only is the aforementioned leadership a factor, you must also commit all layers of an organisation when you try out such interventions.’

Read more

Earlier, researcher Monique Spierenburg told about her findings with ‘Good in one Go!’. In her research, she focused on why integral care is so necessary, and how the two interventions can contribute to this. The country report highlights the experiences with the interventions.

Link to the country reports

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