LONG-TERM CARE AROUND THE GLOBE
Nursing Home and Nursing Home Physician: The Dutch Experience

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Dutch nursing home care today includes a broad range of institutional and outreaching care functions. Medical care is an essential part of this care. Nursing home medicine in The Netherlands has developed as an officially acknowledged medical specialty. This is unique because The Netherlands is the only country in which nursing home medicine is a specific medical discipline. Because of this, a continuum in the medical care for the elderly has been developed: the family physician for medical care in the community, the nursing home physician for the institutionalized elderly, and the clinical geriatrician plus other medical specialists for elderly who require hospital care. This article describes the characteristics of Dutch nursing home care and nursing home medicine and the advantages of this system. The article also shows that the combination of the medical knowledge of family physician and nursing home physician can be expected to increase the quality of medical care for the disabled elderly in institutions and in the community.

Section snippets

The Dutch Nursing Home; its Position in the Healthcare System

Table 1 presents the most important professional disciplines and services that are used frequently by elderly people in The Netherlands.

As the table shows, the elderly population in The Netherlands (2002: 65+ n = 2,200,000) can profit from a lot of social and medical services.

The elderly are the most important clients of the services. Of the population above 65 years, more than 85% visited a family physician in 2002 (whole population 74%) and approximately 20% (n = 440,000) stayed shortly in an

Nursing Home Patient Characteristics

Approximately 44,000 new patients are admitted every year (29,000 somatic and 15,000 psychogeriatric patients).9 The patients are characterized by advanced age, on average 80 years, although also young patients can be admitted to a nursing home, for example, patients in a vegetative state. The most common causes of morbidity in somatic patients are cerebrovascular accidents (26%), other neurologic disorders (for example, Parkinsonism and multiple sclerosis; 7%), problems affecting mobility

Care Concept

The types of care offered by nursing homes include: long-term care, (long-term) rehabilitation, respite care, palliative (or hospice) care, observation and diagnosis (ie, clinical or ambulatory integral patient assessment), consultation and advice (eg, with regard to a prognostic planning of care), and crisis intervention.

Treatment is based on each patient's personal needs and wishes and on an integration of relevant cure and care. In agreement with the patient and his or her relatives, an

Nursing Home Medicine as an Official Medical Discipline; How and Why?

The professionalization of Dutch nursing home medicine has evolved in the wake of the developments in Dutch nursing homes. In 1972, the Dutch College of Nursing Home Physicians (NVVA) was founded.

The mission of this scientific organization was to promote:

  • 1

    Research to provide evidence base to nursing home medicine and care18;

  • 2

    A residency training program in nursing home medicine (ie, a course to become a registered nursing home physician);

  • 3

    Academic teaching of medical students in nursing

Outreaching Nursing Home Care

Dutch nursing homes also perform care activities for old, sick, and functionally impaired patients in the community.8 This trend has been originated by the following factors:

  • 1

    The (expected) demographic increase of (frail) elderly in the community;

  • 2

    The shortage of nursing home beds;

  • 3

    The phenomenon of hospitals that focus more and more on acute care; and

  • 4

    The wish of many frail elderly and patients with chronic diseases and disabilities to receive care as long as possible where they live—the

Developments in Outreaching Nursing Home Care

In the 1970s, “nursing home day care” was offered to somatic and psychogeriatric patients in the community. These patients visit a nursing home during 1 or more days per week to receive the ambulatory care and multidisciplinary treatment they need, complementary to the care they already receive from community health care. Furthermore, this day care relieves their family caregivers and the home care professionals, and thus can be considered as a form of respite care.35

Ambulatory day care

Future Developments

During the last 10 years, the first specialization-specific guidelines have been developed and scientific research in nursing home medicine has started.18 This research will provide further insight into the characteristics of nursing home patients, their clinical problems, their use of medication, the care they receive and the effects of this care inside or outside the institution. Further (evidence-based) research will provide a good basis for a continuous improvement of the quality of

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