The University Network of Carehomes

Transcription

1 The University Network of Carehomes Nijmegen An infrastructure for academic long-term care Prof. Raymond TCM Koopmans Professor of Elderly Care Medicine, especially long-term care 1

2 Radboud Alzheimer Centre, Nijmegen 2

3 Radboud Alzheimer Centre, Nijmegen Contents Dutch Nursing Home Medicine: unique in the world From nursing home network tot knowledge network in long-term care Educational activities Research projects Activities to develop best-practices Future developments The Dutch nursing home physician: Unique in the world 1989: start training program for NHP in A dam (2 years) 1990: Nursing Home Medicine officially certified as a speciality 1995: start training program in Nijmegen 1997: start traning program in Leiden 2007: start 3-year curriculum 2009: new name of the specialty 3

4 Koopmans, et al: Journal of the American Geriatrics Society, 2010 Nursing Home Physician Community Geriatrician Elderly Care Physician 4

5 Competencies for the three year training program are based on CANMEDS Roles Framework Structure (practical course) Year 1 Year 2 Year 3 DSCU PDP Hosp COM Choice COM DSCU PDP DSCU Care Home: dementia special care unit PDP Care Home: unit for physically disabled patients Hosp Hospital: geriatrics, internal medicine, neurology, surgery, orthopedics COM: Community part: Institute for Mental Health Care, day care center, outpatient clinic, outreaching care Choice: Rehab centre, hospice, GP practice, research project Structure (theoretical course) One day a week on the University in small groups of 12 trainees Two teachers: an elderly care physician and a behavioral scientist Exchange of practical experiences One or two issues a day with preparation task, literature stuy 5

6 Curriculum based on six major themes Acute care Long-term care for people with physical impairments Geriatric rehabilitation Palliative care Care for people with dementia Community (mental health) care Dutch elderly care physicians have an important impact on end of life decisions for instance in dementia patients Hospitalization rates for Nursing Home patients with Pneumonia Hospital transfer Treatment in intensive care unit Mildly to Moderately Demented U.S. (n=421) Netherlands (n=223) Severely Demented U.S. (n=280) Netherlands (n=328) 28.5% 0.9% 22.1% 0.3% 2.0% 0 4.0% 0 Van der Steen et al. JAGS

7 Annals of Family Med 2006;4: Physician Care Role USA: Passive knowledge Typical US physician spends less than 3 hours per week at nursing home The Netherlands: First-hand knowledge of the patient Appreciation of patient s quality of life and functional status Place of Death of Older Persons with Dementia Houttekier et al. JAGS 2010;58:

8 Elderly Care Medicine as an academic specialty Academic departments at Maastricht, Nijmegen, Groningen, Amsterdam, and Leiden University (Utrecht) Three ECP specialist training sites: Amsterdam, Leiden, Nijmegen Eight ECP s have a chair (three Emeritus) Main tasks: education in medical school, research, academic networks of long-term care facilities From nursing home network tot knowledge network in long-term elderly care Start in 2003 with 5 care-organisations Grown from 5 to 13 in 2012 Comprising: 60 care-homes, 110 residential homes and several home-care organisations Renaming in 2009 to University Nijmegen Knowledge Network in Long-Term Elderly Care (UKON; www. ukonnetwerk.nl,website in Dutch) Collaborating partners 8

9 Network Groningen i.o. Dia 3 Dia 4 Department of Primary & Community Care Teaching Unit Specialist Training Unit Academic Networks Unit Research Unit The network is a full academic workplace and as such part of the Department of Primary and Community Care Organisational structure Steering committee Directors of careorganisations Network coordinators researcher secretary Local committee Local committee Local committee Local committee 9

10 local committee Multiprofessional committee Elderly Care Physician Member of Nursing Staff Psychologist Physiotherapist Sometimes a manager Sometimes a member on behalf of a teaching unit within a care-organisation Goals of the Network The development of an infrastructure for teaching and postgraduate specialist training program (Elderly Care Medicine) The development of an infrastructure for research projects in long-term care in order to improve quality of care Development of best-practices in long-term care Diagram Research questions Practice Best Practice Researchprojects Education 10

11 Agreements, meetings and funding Contract in which care-organisations agree with the goals Care-organisations pay for the network We make 3-year plans Local committee meet at least 6 times a year Steering committee meets 4 times a year Meeting with the directors once a year Teaching/educational activities Nursing attachment in first year of medical school Orientation on Elderly Care Medicine in second year of medical school Internship on Elderly Care Medicine (4 week) Extended internship on Elderly Care Medicine (12 week) Internship on choice on Elderly Care Medicine (4 week) Theoretical courses on quality of care, death and suffering Specialist Training Program 11

12 Yearly symposium for professionals in LTC (mostly nursing staff) contents April 16-th, 2013 Dementia in movies How to deal with agressive behavior Psychosocial interventions in dementia Liverpool care-pathway in palliative care Non Wakefulness Syndrome Apathy And many more Research projects Paratonia in dementia 12

13 The Waal Behavior studies in Dementia (WAALBED) 1 and 2 13

14 Safe or sorry? Palliative sedation in Dutch nursing homes 14

15 Geriatric Rehabilitation in Amputation and Stroke (GRAMPS)-study The NEEDS in Young onset Dementia (NEEDYD)-study 15

16 MAPPING-study Ongoing PhD projects Dementia BEYOND NEEDYD-2 Dementia care mapping GRIP on problem behavior PROPER CONCERN Pneumonitor TENSE-studie Life and care-plan 16

17 Ongoing PhD-projects Mental Health MAPPING Palliative care SIN Polyfarmacy in palliative care Ongoing PhD projects Complex care and non-aquired brain damaga Huntington NWS Parkinson Locked-in MCS Ethics in NWS NAH Organisation of primary care for elderly CareWell in primary care Act in Case of depression as an example on the way to best practices UKON psychologist reached consensus on screening and diagnosis Research project (cost-effectiveness-study) New grant on e-learning modules E-learning site of UKON Offer the program to Dutch care-home organisations Publication in LANCET!! 17

18 Depression Assessment Detection by nursing staff, repeat every 4 months (NORD) Screening indicated, NORD>1 Depressive symptoms in dementia, CSDD>7 Screening not indicated Screening by psychologist (CSDD, GDS-8) Depressive symptoms in non-dementia, GDS-8>2 No depressive symptoms Diagnosing in dementia Diagnosing in non-dementia by by physician & physician & psychologist psychologist Depression in Depressive symptoms Minor Major dementia but no depression depression depression Module 1, Basic interventions by nursing staff & recreational Day structure & therapist Pleasant Activities Plan Module 2, Psychotherapy by psychologist Mediative therapy in severe Life Review therapy or cognitive problems other psychotherapy Evaluation with screening instruments Monitoring and evaluation Module 3, Medication considered by physician Stepped care: 1) citalopram; 2) nortriptiline; 3) consulting psychiatrist Treatment modules 18

19 Future developments Development of more care programs Further development of e-learning site Focus on implementation We need the best professionals for our most frail people! 19