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Activity centre for people with dementia helps avoid the nursing home

Published on: 25-08-2023

Tackling the nursing home waiting list. This was one of the driving forces behind Dutch care provider TanteLouise in setting up the neighbourhood initiative ‘VanThuisUit’. Literally translated, ‘Away from Home’, the venue is an activity-based day care centre for people with dementia. ‘Most of the people who come to VanThuisUit will never go to the nursing home at all,’ says director Jan-Kees van Wijnen.

At first, it’s like walking into a standard day care centre. In a 1970s nursing home in Steenbergen, a group of ten people are doing exercises under the guidance of an occupational therapist. But soon the differences with regular day care for people with dementia begin to stand out. For example, in the kitchen a man helps peel potatoes, while in the art room someone else is putting together a miniature ship. Each visitor walks briskly from room to room. There is a lively, active atmosphere that you don’t associate with traditional dementia care.

A special day care

Launched in 2022, the care initiative is a collaboration between TanteLouise and the care department of health insurer, CZ. It is geared towards helping people live independently at home for as long as possible. In the past ten months, sixty clients have received care at VanThuisUit. The care provided differs from the norm because it starts at ten in the morning and continues until eight in the evening, after which anyone who needs it can have their support stockings put on and be taken safely home. And it happens every day, including weekends. During a tour, director Van Wijnen explains the concept. One of the rooms he shows is set up as a kind of hair plus beauty salon. ‘In this room we help people learn to take back independent control of their personal care. For example, brushing their teeth and combing their hair by themselves.’

Community care with therapy

Re-training people with dementia to perform activities is the key to VanThuisUit. This approach is very similar to reablement, which is currently popular in the care sector, but Van Wijnen does not want to call it that. ‘Reablement is primarily intended for people with somatic complaints. Our target group consists of people with advanced dementia. That is why we speak of a multi-intervention in which we combine social cohesion with activation and working on personal goals. It is community care, but with the treatment component added. This is precisely the component that is missing in other community care projects. By consistently repeating the same actions, we condition people and tap into their cognitive reserves. This enables people to once again, perform actions themselves that they could no longer do without this training.’

TanteLouise leads the way in dementia care

This method has a scientific basis. TanteLouise’s nursing home approach is now taught at the Fontys University of Applied Sciences in the Netherlands under the label Active Ageing, and the organisation is a member of the International Federation of Ageing (IFA). This is not surprising when you know that in nursing home care, TanteLouise has been a decade ahead in dementia care.Ab

We have been working on this in our nursing homes for a long time. We began by first phasing out psychopharmaceuticaesidels and antidepressants in our nursing home residents, opening all doors and no longer providing night care. That resulted in a noticeably less accelerated deterioration among clients. When you reactivate people they don’t end up in the foetal position in bed.

Van Wijnen: ‘Our residents are shopping independently again and family members are seeing glimpses of their father, mother or partner again.’ In those ten years, just about every VVT organisation (nursing homes, care institutions and home care organisations) in the Netherlands came to see our nursing homes. Some really thought we were cheating and were not really providing caring for people with severe healthcare packages (category 5 and 6), but people with a much lower level of need.’

Does it work outside the nursing home?

But the big question is whether this approach also works outside of the controlled environment of the nursing home. ‘That, of course, is the exciting question,’ says Van Wijnen. ‘People hear that we are reducing psychopharmaceuticals and letting people do their own grocery shopping again. That our goal is not for the family to visit the client, but for the client to visit family again. And even now they often have to be convinced to believe it. But the results show that it can be done. Of the sixty people who receive care from VanThuisUit, only three now end up in the nursing home. The rest just live at home and never see the inside of a nursing home. The end is then, for example, pneumonia.’

Cheaper than nursing home care

The goal of VanThuisUit is not only to reduce the number of people on the nursing home waiting list, but also to have lower costs than a nursing home facility. ‘Initially, the comprehensive treatment and opening hours until evenings and weekends sound quite costly. But you also have to remember that the occupational therapist and the life coach are brought in and are not here all day. We are open until eight o’clock so only at that particular time we have to bring in care to help with support stockings. That saves quite a bit compared to the cost of a car from one of the home care agencies driving from house to house to do this. It’s very efficient in that respect.

Still, there are risks

Despite the efficiency, there are challenges to the project. ‘For now, this is a separate project that is difficult to replicate outside the project framework. That has to do with the different forms of care financing that must be separated by law, particularly the Health Insurance Act and the Long-Term Care Act,’ says Van Wijnen. ‘A new payscheme for cross-domain care has recently been announced by the Netherlands Healthcare Authority (NZa), and that may provide some comfort. But otherwise we can’t step outside the project framework with this. However, we trust that CZ wants to continue with this initiative for a long time to come.

Family, caregivers and volunteers enjoy being here

After touring the short-stay guest rooms, we enter the garden room which is full of plant pots and flower vases. A group of family and informal caregivers sit around chatting with clients. ‘Informal caregivers and volunteers are also important to this project,’ says Van Wijnen. ‘Because of the open atmosphere here, we notice that people like to stay and be active, also to learn from the treatment. An extra benefit for us.’

With that remark we end the tour and leave VanThuisUit, where it will certainly remain pleasantly busy until eight o’clock.

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