Dementia - Nursing Homes in the Netherlands

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Guest: Dr. Anne Margriet Pot - Clinical Psychologist

Host: Dr. Sally Smith

Dr. Sally Smith: Welcome to Age to Age. I am Sally Smith. Let’s talk. Today, we are fortunate to have Dr. Anne Margriet Pot from The Netherlands with us. Dr. Anne Margriet is a Clinical Psychologist and Head of the Program on Aging and as such knows a great deal about what homes are like and how they are provided for and what they offer citizens of The Netherlands. So Dr. Anne Margriet, I would love to ask you what are these like size wise, how many people, how bigger the buildings are there in every town and tell us a little bit about those homes?

Dr. Anne Margriet Pot: Nursing homes in The Netherlands are different in size, so it depends on the nursing home, but they can have roughly from 60 people to 600, I mean to say they can very big -- big organizations and in the last year, there were many organizations put together to one big organization, but what you also see in The Netherlands at a moment and that's very interesting development I think is that small group living homes are build and so in those homes, only six or eight people live together and get their nursing homecare, but it’s more like a home and not like an institute like they are large scale nursing homes, so that’s a difference and what we see in 2005, there were already 4500?places in those small group homes and it’s planned in 2010 that there will be almost 11,000 places, so there is a big transition going around in the field. What we don't know at the moment is how effective it is. Everybody in The Netherlands is talking about that it is better and that we have to do this and that's very important, but in fact, we don't know the effect, so what we do at VU 2.02 University, that’s a university in Amsterdam in collaboration with the institute and the Head of the Program on Ageing that we do research and look at the effect. Small group living has on the residence, the family caregivers, but also on the nursing staff and we just had a very big conference in The Netherlands on this topic and for The Netherlands, it was very big. There were almost 800 people or so. So, that's really big for The Netherlands, may be not for here, but...

Dr. Sally Smith: So, it’s big enough for anywhere.

Dr. Anne Margriet Pot: Yeah, but what was really nice that there was a very good discussion on the positive and may be also the negative sides of those homes and we presented there our first results, it is not published yet. So, that was very exciting.

Dr. Sally Smith: Wow, well it sounds like you are studying a lot of options. It does sound just as you say that the smaller home, I can see the intimacy, they are really knowing the patient, the caregiver, and the family atmosphere.

Dr. Anne Margriet Pot: Yeah.

Dr. Sally Smith: It sounds like it would be profitable, it would be something I think would be a better personal choice for me, but I understand what you are saying, you need to measure it and have the criteria that proves it.

Dr. Anne Margriet Pot: Yeah, you can also imagine that it may have some negative influence because if somebody has serious behavior problems for instance and you are in a small group, then it’s very difficult; other people may be interrupted more by...

Dr. Sally Smith: Yes, yes I see. They don't have the capacity to really take the more serious cases without impacting everybody else that’s in that house.

Dr. Anne Margriet Pot: Yeah that may be the case, so we don't know yet and it may also be a problem that you have to have a personal contact with the nursing staff, so the residence with also the family caregivers and that may not always be nice, I mean it’s like everywhere else.

Dr. Sally Smith: Personalities.

Dr. Anne Margriet Pot: Yeah.

Dr. Sally Smith: Yes, well you know that leads me to a question that I had thinking of the disruptive more serious case having up may be a unit for people like that in these larger homes in the States. There are certain criteria to get into certain homes. If you are able to walk, you are not combative, your continent or you can be in a certain level of care once you are disruptive, once you are combative; all these things, you can’t remain in that level of care anymore. My question is there is a criteria like this for the smaller homes and that everybody is much closure together, can anybody after certain age go to one of these or do you need to have some form of dementia, do you need to have some form of physical problems with some other part of your body, what’s the criterion to get it?

Dr. Anne Margriet Pot: Well, first it’s meant for people with dementia at a moment. Can you imagine that they also build these homes for other people, but we looked especially at small group living homes for people with dementia and the small group living homes in The Netherlands are meant to be the same as the nursing homes, so for instance in Sweden, it is meant as a facility between homecare and nursing homecare, but in The Netherlands, we claim that it is for the same persons; however in our study, we found that it was not the case and we will have to look at a data again to see if it may be is the case for some of the houses, but not for others.

Dr. Sally Smith: I see.Dr. Anne Margriet Pot:So, I think that's the point.

Dr. Sally Smith: You made a point often when we were speaking earlier about the fact that insurance and the government together make it possible to care of all the financial needs of an elderly person who would need to go to these homes. You also said that sometimes they had changed some of the programs and gotten rid of some of the psychologists because the cost became too great. How much is cost a factor in the smaller homes as opposed to the conglomerate home where there are 600 people, is it more expensive to have a smaller home?

Dr. Anne Margriet Pot: Well, that's a good question because there is still a lot of debate on it in The Netherlands. If it’s more expensive or if it’s cheaper, I just visited one of the homes and actually it’s one of the first small group living in The Netherlands and they claim that it’s cheaper, so -- but there are others who say it will be more expensive and well, it all depends on how you organized the care, I mean?

Dr. Sally Smith: Let me ask you this, if you have to go to one, what do you want it to be like, what's your perfect idea of a nursing home, if you have to pick one today, what would it be like?

Dr. Anne Margriet Pot: Well, like a small group living home. It’s so nice if you are there, then it’s like you are in just a home with a family and of course there are nasty sites. Hey, you have not -- your family members are also not always in a way you want them to be and that’s the same in those homes, I mean -- but it’s so nice to share some sort of a family atmosphere and I think it is much nicer to be there and that the care that is provided there. Well, I cannot say it is better because there also very good nursing homes and it’s just different, I mean the nursing staff is not only doing care tasks, but also for instance cooking and doing the shopping and all that kind of things.

Dr. Sally Smith: Much more of a family feeling.

Dr. Anne Margriet Pot: Yeah.

Dr. Sally Smith: One last question, is a home like that, is it built like a family house that you and I would know or is it built more like what we would think a nursing home like a little mini hotel with rooms for each individual person of a long hall, but with common rooms or is it really run like house with a kitchen with everybody coming in and out and...

Dr. Anne Margriet Pot: Yeah, there is a kitchen and that's the place where people will cook and there is a living room and everybody has his own room, but sometimes there are not very big because it depends on the home and there is a shower.

Dr. Sally Smith: Well, it’s amazing to see how the numbers of people that need to be in places like this or care for at home with dementia is exploding as you mentioned it, it’s to double, thank you sir, and certainly that's true with the statistics we have here in the States and it’s just so encouraging to see someone of your caliber choosing to go into this field, choosing to try to make a difference to something that is really a huge time bomb that we are all looking at and that serve you people have really realized we are going have to pull together to have the resources to deal with and I thank you for using your talents in this way because we are all be the benefactor of that and we thank you so much for coming.

Dr. Anne Margriet Pot: Thank you.

Dr. Sally Smith: It was very nice to have you.

Dr. Anne Margriet Pot:Yeah.

Dr. Sally Smith: Thank you also to my Producer, Betsy Reves and Web Administrator. Thanks to all of our listeners for joining us. We welcome your suggestions and comments on our website. This is Sally Smith with Age To Age saying goodbye and wishing you courage and joy on your journey. We are all connected.

Announcer: If you have any questions about the services or programs offered at the Medical University of the South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC health connection at (843)792-1414.

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