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Netherlands

2013: National policies covering the care and support of people with dementia and their carers

Background information

Where people with dementia receive care and support

The following table provides estimates of the number of people with dementia living at home, in various types of residential care and in hospitals or psychiatric institutions.

Place of residence

 

YES or NO

Estimated number/

Additional information

At home (alone)

Yes

70% (alone, with relatives or close friends, with other people with dementia)

At home (with relatives or close friends)

Yes

See above

At home (with other people with dementia)

Yes

See above

In general/non-specialised residential homes

No

 

In specialised residential homes for people with dementia

Yes

30% (in specialised residential homes for people with dementia, in general/non-specialised nursing homes, in specialised nursing homes for people with dementia, in hospital, special wards or medical units, in psychiatric establishments, and others

In general/non-specialised nursing homes

 Yes

See above

In specialised nursing homes for people with dementia

 Yes

See above

In hospitals, special wards or medical units

 Yes

See above

In psychiatric establishments

 Yes

See above

The organisation of care and support for people with dementia

Overall organisation of care

Standards of care and support

Since July 2013 a national standard on dementia (de Zorgstandaard Dementie) was developed (http://www.alzheimer-nederland.nl/actueel/nieuws/2013/juli/zorgstandaard-dementie-en-publieksversie-gereed.aspx). These are guidelines for the provision of integrated care to people with dementia. They span the whole spectrum of disease development: from the first concerns such as forgetting things, to the terminal stage of the disease.  The guidelines are broadly accepted and now implemented by the most prominent and important professionals working in dementia healthcare.

Organisation of care

  • At national level: the ‘Delta Plan Dementia’ (http://www.alzheimer-nederland.nl/extra/deltaplan-dementie.aspx)

In the summer of 2011, Alzheimer Nederland, VUmc Alzheimer Centre and the national umbrella organisation of medical university hospitals (NFU) took the initiative for a new national plan. In May 2013, the organisation launched the ‘Delta Plan Dementia’ alongside insurers, business partners and other parties. The main goal of this plan is scientific research for future patients and better care for patients today. It also takes the carers into account.

The plan includes the setting up of a national register, for instance.

The government donated a financial incentive of EUR 32,000,000 for this purpose.

The name “Delta Plan” was chosen, as it reflects the increase in the number of people with dementia in a similar way to the expected flood of 1953. After the flood, a national strategy was formed to fight a possible new flood. Embankments along the coast and dikes in river areas were built and great pieces of land were reclaimed.

  • At regional level: insurers stimulate regions to form networks on dementia care. Alzheimer Nederland participates in every region. At the moment there are 90 dementia regions involving different stakeholders who work together for better dementia care in their region. Alzheimer Nederland encourages the regions to use the national standard on dementia.
  • At local level: Municipalities are also responsible for their citizens, providing them with good information to be able to participate in social networks for instance.

The Social Support Act (Wet maatschappelijke ondersteuning, WMO), which came into force in the Netherlands on 1 January 2007 covers the care and support of people with prolonged illness, invalidity or age-related diseases.

Under WMO, municipalities are responsible for providing social support to those in need regardless of the level of support they may have from friends, family or acquaintances. The Ministry of Health, Welfare and Sport (MHWS) defines the framework within which municipalities can develop policies in keeping with the composition and demands of their inhabitants (MHWS, 2007b).

The municipalities are legally obliged to provide care services to the elderly and disabled (MHWS, 2007a). People in need of care can apply to a special municipal agency for care services. If assessed as needing domestic care, personal care, nursing, supportive guidance, activity guidance or temporary residential care, the agency decides which services and how much of each service the person is entitled to. The person can then decide whether to have the services in kind, a cash payment or a combination of the two. The cash payment is known as a personal budget or “pgb”.

The municipalities are responsible for the provision of assistance with housework, as well as for aids, mobility and wellbeing. They can also offer a personal budget. This means that people may end up with two different personal budgets (MHWS, 2007c).

People with dementia and their carers do not make much use of the personal budget. They prefer to seek assistance from the service providers.

When writing this report, the Netherlands was preparing a national transition. Governmental budgets for care were going to be decentralised to the municipalities. The budgets for day care for people with dementia are concerned by this change. This implies that municipalities must understand what people with dementia and their carers need. Alzheimer Nederland encourages municipalities to become dementia friendly. Therefore, the organisation introduced a service page on its website (www.alzheimer-nederland.nl/gemeenten). It gives information about figures, facts and leaflets about dementia.

The overall funding of social support for people with dementia and carers

Since 2006, there has been a new private health insurance, with social conditions. The system is operated by private health insurance companies and the insurers are obliged to accept every resident in their area of activity. A system of risk-equalisation enables the acceptance obligation and prevents direct or indirect risk selection.

The insured pays a nominal premium to the health insurer. Everyone with the same policy pays the same insurance premium. The remainder of the cost is paid by the insured through income-related contributions. Employers contribute by making a compulsory payment towards the income-related insurance contribution of their employees.

In the Netherlands, everyone who pays health insurance premiums is now entitled to a small rebate if no claim is made during the preceding year. This scheme, known as the ‘no-claim rebate rule’, was introduced in 2005. The costs of GP consultations are not included in the calculation for rebate entitlement. The no-claim rebate rule applies only to the standard insurance cover, and not to any supplementary policies. Moreover, the rule does not apply to people under the age of 18 (since they do not pay premiums).

The personal budget mentioned in the previous sub-section is not dependent on income but the co-payment for it is.

The legal framework surrounding the provision of social support

As of January 2006, a new insurance system for curative healthcare came into force in the Netherlands. Under the new Health Insurance Act (Zorgverzekeringswet), all residents of the Netherlands are obliged to take out a health insurance.

Social support to people with dementia and carers is provided in the framework of this new Health Insurance Act (Zorgverzekeringswet) and the Social Support Act (Wet Maatschappelijke Ondersteuning), known as the WMO, which came into force on 1 January 2007. The WMO encompasses three other laws, namely, the Services for the Disabled Act (WVG), the Social Welfare Act and some parts of the Exceptional Medical Expenses Act (AWBZ) (MHWS, 2007b).

The suitability of social support for people with dementia and carers

  • Adequacy and accessibility in general

There is a large national programme currently running which is targeted at improving the quality and quantity of care provided. This National Dementia Programme aims to stimulate the regions to create better, more and different care arrangements. At the moment, services are inadequate and availability is poor due to huge regional differences in care arrangements and the existence of waiting lists for certain services such as nursing homes, small-scale housing and day care.

  • People living in rural areas

People living in rural areas do not have particular problems accessing services although transportation is sometimes problematic. However, it is important to note that the greying of the population is particularly noticeable in rural areas so this may result in a shortage of services.

  • People with different types of dementia

In the Dutch system, there is no differentiation between types of dementia. Social support is provided for all types of dementia although it is possible that people with fronto-temporal dementia may be considered unsuitable for small-scale housing.

  • People from ethnic minorities

There is a whole range of services targeted at people with dementia and carers from ethnic minorities but they are not used much and funding varies.

  • Younger people with dementia

There are specialised nursing homes, day care programmes, group-based interventions and mental health services specifically for younger people with dementia. There are no other differences in the provision of care for this group.

How specific aspects of care and support are addressed

Services and support for people with dementia and their carers

  • Respite care

Respite care in the home is available but insufficient. It is partly funded by local municipalities and partly by service users. This service is also provided by volunteers and Alzheimer associations.

Short and long-term residential respite care is available but is insufficient. In the future, more long-term residential respite care will be needed. Short-term respite care is partly funded by the State and partly by service users, whereas long-term respite care is completely funded by the State.

  • Day care

Day care exists and is completely funded by the State but it is insufficient. Potential service users must fulfil certain criteria in order to be eligible for day care.

  • Long-term residential care

Most long-term residential care is financed by the so-called Algemene Wet Bijzondere Ziektekosten. This is a non-means-tested social insurance programme financed by premiums. In most of the institutional settings, residence and care are integral parts of the services provided. The government has started a process to separate residence from care and intends to separate the costs for care and rent, or residence, in institutional settings. Furthermore, care recipients will be allowed to organise housing on a private basis (e.g. to rent it from a real estate company) and to receive care on a separate basis from another party (van Waarde, 2007).

  • Palliative care

Palliative care at home is available and sufficient. It is partly funded by the State and partly by service users. Palliative care in a centre is completely funded by the State but this service is considered insufficient.

  • Monitoring in the home via alarm systems

Tele-alarm systems exist and are partly funded by the State (by municipalities). This service is not considered sufficient.

Personal assistance and home help

  • Personal assistance

The following services are available and partly funded by the State (the municipalities). They are considered insufficient:

• Assistance with personal hygiene

• Supervision/assistance taking medication

• Assistance with eating and drinking (not the preparation of food)

• Assistance with mobility e.g. lifting, moving and walking

Assistance with incontinence is covered by healthcare insurance. It is completely funded by the State. Assistance with skin care, on the other hand, must be completely funded by service users. Neither of these services is considered sufficient.

Municipalities partly fund companionship/social activities and occupational therapy but these services are insufficient.

Assistive devices and home adaptations are available but are insufficient. Home adaptations are partly financed by the State but service users must pay for assistive devices themselves. The State does not contribute towards the costs.

  • Home help

The following services are partly funded by the State but they are considered insufficient.

•Assistance with housework

•Assistance with the preparation of meals (including meals-on-wheels)

•Transportation

Assistance with shopping and laundry is also available but insufficient. Service users must pay the full cost for these services.

Psychosocial support and training for people with dementia and carers

Numerous organisations provide general information on the availability of services. They are not funded by the State. People with a personal budget have set up their own organisation to protect their interests. It is called Per Saldo. It provides legal support, a telephone helpline, information, meetings and courses, as well as an electronic marketplace for people seeking services and service providers (MHWS, 2007c).

Counselling services are available for people with dementia and carers but the services for people with dementia are only available in a few places. When available, counselling is partly funded by the State.

Holidays for people with dementia are sometimes organised by voluntary organisations and Alzheimer Nederland. However, service users have to cover the full cost themselves. There are no provisions to enable carers to have a holiday, e.g. substitute carers.

Training

Which social and healthcare professionals provide care and support

The following social and healthcare professionals are involved in the provision of care and support to people with dementia in residential care or living at home.

Social or healthcare professional

Involved in the provision of care and support to people with dementia in residential care or at home

Nursing staff

Yes

Auxiliary staff

Yes

Allied health professionals

Yes

Specialists (e.g. psychiatrists, gerontologists, neurologists)*

Yes

General practitioners*

Yes

Other

Yes

Support for informal carers

There is no national policy regarding informal carers of patients with dementia, but there is a national policy for informal carers in general. Besides that, the local authorities are obliged by law to support informal carers in their community.

Every two years Alzheimer Nederland carries out a broad survey on the perceived impact of caring on caregivers. The results are used to identify solutions to improve the situation.

Respite

The local authorities are obliged by law (Vmo) to support informal carers in their community, e.g. by providing respite care. 

Training

Training is available for carers. It is partly funded by the State and partly by the service users.

Counselling/support

The local authorities (municipalities) are obliged by law to support informal carers in their community, for example by giving information, respite care, advice, emotional support, practical help and financial support.

Work/tax related support for carers and carer allowances

  • Paid leave

Employees can take paid time off work to sort out emergency situations such as a death in the family, a burst water pipe or to care for a sick relative. The leave should be reasonable and in keeping with the emergency situation. However, if a person’s partner (with whom he or she lives) suddenly becomes ill and needs instant care, the first day off can count as emergency leave but subsequent days cannot. They count as a different kind of leave (Ministry of Social Affairs and Employment, 2007).

Ten days’ leave can be taken per year to care for a sick child, partner or parent if it is necessary that the employee provides such care. In such cases, the employer must pay at least 70% of the employee’s wage. The employer receives compensation for this (Pijl, 2003).

Employees do not have a legal right to time off work to care for a dying person but employers may agree to grant such leave. It can be granted to people who are close to the dying person even if the latter is in an institution. The leave consists of at least one third of the employee’s working hours. The leave can be from one to six months but can be extended to a maximum of 18 months. During this time, the employee receives a monthly payment from public funds (Pijl, 2003).

  • Unpaid leave

Long-term compassionate leave can be taken by employees who need to take care of a seriously ill child, parent or partner whose life is at serious risk. For a maximum of twelve weeks per year, the employee can take up to half of his/her working hours as compassionate leave. These hours are not paid but the remaining working hours are. They can be spread out over a period of up to 18 weeks subject to agreement with the employer. A request for long-term compassionate leave must be made in writing at least 2 weeks before the requested start of leave. With regard to payment, certain collective labour agreements or other agreements with employers may result in part-payment of the hours taken as compassionate leave (Ministry of Social Affairs and Employment, 2007).

  • Flexible working time

The Working Hours (Adjustment) Act 2000 (wet aanpassing arbeidsduur) gives employees the right to increase or decrease their working hours. This right applies to employees in the public and private sector who have been employed by a particular company for at least one year. The request, which can be made once every two years, must be made 4 months in advance and must contain details of the starting date for the change, the magnitude of the adaptation of working time and how the working hours would be divided over the week (International Labour Organisation, 2002).

  • Tax rebates

People who are caring for an elderly dependent parent, brother or sister (who lives in the same household) are entitled to a tax rebate for expenses incurred if these expenses exceed 11.2% of their income (National Alliance for Caregivers, 2003).

National Alzheimer Association

Alzheimer Nederland provides the following services and support: 

Helpline

x

Information activities (newsletters, publications)

x

Website

x

Awareness campaigns

x

Legal advice

x

Care coordination/Case management

 

Home help (cleaning, cooking, shopping)

 

Home care (personal hygiene, medication)

 

Incontinence help

 

Assistive technologies / ICT solutions

 

Tele Alarm

 

Adaptations to the home

 

Meals on wheels

 

Counselling

 

Support groups for people with dementia

 

Alzheimer cafes

x

Respite care at home (Sitting service etc)

 

Holidays for carers

 

Training for carers*

x

Support groups for carers

x

Day care

 

Residential/Nursing home care

 

Palliative care

 

*Web-based/help training for carers (Alzheimer experience is a web-based film for those who wish to become an Alzheimer assistant).

References

Ministry of Health, Welfare and Sport (2007c), Summary and overview of care allowances in 7 countries. http://www.minvws.nl/en/reports/lz/2007/summary-and-overview-of-care-allowances-in-seven-countries.asp

Ministry of Health, Welfare and Sport (2007b), Social Support Act. http://www.minvws.nl/en/themes/social-support-act/default.asp

Ministry of Social Affairs and Employment (2007), Emergency leave and other short absence breaks. http://internationalezaken.szw.nl/index.cfm?fuseaction=dsp_rubriek&rubriek_id=391638&lijstm=0,310_6057,334_13212

International Labour Organisation (2002). Working Hours (adjustment) Act – Netherlands. http://www.ilo.org/public/english/employment/gems/eeo/law/nether/l_wa.htm

National Alliance for Caregivers (2003). International caregiving legislation. http://www.caregiving.org/intcaregiving/netherlands/netherlands.htm

Pijl, M. (2003). Developments in the support of carers – In Finland, England and the Netherlands, 1998-2002. National Board of Health and Welfare (Socialstyrelsen): http://www.caregiving.org/intcaregiving/documents/2003-123-5.pdf

Van Waarde, H. (2007), Email communication regarding long-term residential care, 15 August 2007

Acknowledgements

Julie Meerveld, Manager Advocacy, Alzheimer Nederland

Anne-marie Bruijs, Employee Advocacy, Alzheimer Nederland

 

 
 

Last Updated: Tuesday 25 February 2014

 

 
  • Acknowledgements

    The above information was published in the 2013 Dementia in Europe Yearbook as part of Alzheimer Europe's 2013 Work Plan which received funding from the European Union in the framework of the Health Programme.
  • European Union
 
 

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