P3 - Care Innovation: a coordinated and comprehensive care package
Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.
Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?
Solidariteit voor het Gezin
Social enterprise (partly economically self-sustained through market products and services, primary mission is to solve a social problem)
, VOV, Ghent
More than 5 years
'Solidariteit voor het Gezin' is an independent (non profit) service for welfare and health care that offers a versatile range of services starting from home care, but depending on the needs of its clients, is also committed to organizing and coordinating additional services. Assistance is offered by knowledgeable and motivated staff, starting from a humanist vision and dynamic client centered attitude.
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Huisartsenvereniging Gent (Ghent General Practitioners' Association)
Network
The General Practitioners' Association's first task is making the project known to general practitioners in Ghent. Moreover, general practitioners will also participate in team consultation meetings for selected patients.
UZ Gent (Ghent University Hospital)
Public body
The Ghent University Hospital delivers expertise in care for older people and release management. They are in charge of screening and referral of possible patients. The continuity of care and an optimum reintegration in patients' home environment is ensured together with the care coach.
OCMW Destelbergen & Gent (Ghent & Destelbergen Social Service Centres)
Public body
The Ghent & Destelbergen social service centres employ occupational therapists who screen patients' homes and make adaptations in order to prevent patients from falling. Furthermore, they teach patients to use simple tools enabling them to live in their homes longer with a few minor interventions.
Liever Thuis LM (mantelzorg)
Network
Liever Thuis LM is a volunteer care association that organizes about 5 information sessions every year on relevant topics for individuals in need of care and carers: subsidies in home care, how to prevent falls … During these sessions both parties meet others who are in similar situations.
Health literacy and patient empowerment, Personalized health management, Integrated care for chronic conditions, Independent living solutions.
Our various partners have been active in first-line care for many years. Based on their experience they have a clear view of the problems experienced by older people in need of care and of the gaps in the offer of care services leading to early admission to a nursing home for many older people in need of care. Our partners have been involved in the preparation of the project at different levels: defining the target group, defining and developing care services… Carers were also consulted during the elaboration of the project, because without them home care would be impossible.
No, our care services were not tested in advance since elaborating and testing a tailor-made range of services was part of the National Health Insurance Institute (RIZIV) call for projects.
for 1‐5 years
complementary (your solution is complementing existing solutions and compensating their weaknesses while not intending to substitute them)
Flemish and federal rules and regulations are not entirely harmonised and make it difficult to optimise care services. The various types of care providers and their professional status are often defined by different regulations, which sometimes prevents flexible employment of these professionals. A concrete example: professional carers subject to Flemish regulations who provide assistance at the weekend cannot be replaced in case of illness… As a result, carers will have to be appealed to. However, some individuals in need of care do not have carers or they are unavailable (they are abroad…), which compromises the continuity of care provision.
36
16
5
Our team consists of:
- nurses (verpleegkundigen)
- professional carers (verzorgenden)
- nursing assistants (zorgkundigen)
- carers (mantelzorgers)
- occupational therapists
- social workers
- general practitioners
- geriatricians
- volunteers
who, each from their own training, background and experience contribute to the project objective: keeping older people in need of care at home longer with the necessary support.
Project progress is monitored by a steering committee consisting of representatives of our various partners. Furthermore, a project report must be submitted to the National Health Insurance Institute (RIZIV) every six months. Within Solidariteit voor het Gezin the project is monitored by an administrative coordinator who is also in charge of contacts with the National Health Insurance Institute (RIZIV). Our care coaches ensure care coordination.
455.000
97%
%
1,5%
%
%
%
%
%
1,5% (overhead costs of the organisation that are not subsidised through public funding)
People aged 60 or older who need complex or long-term care after hospitalization or who suffer from serious health complaints, with an inevitable admission to a nursing home on the short term. The patient needs to meet one of the following conditions: FFA/FFB/FFC Katz-scale, FFB/FFC/FFCd Residential Katz-scale, suffering from dementia, 6 or 6+ on the Edmonton-scale.
We also target carers who need professional support to continue to deal with these challenging tasks and to avoid admission in a residential setting.
110 (yearly basis)
Ghent
Many older people (in need of care) are keen to stay at home, in a familiar environment, for as long as possible. In practice, however, a lot of older people live in their homes in awkward and unsafe circumstances because care services are not adapted to the concrete needs of this target group.
With this project we would like to enable older people in need of care to stay at home longer, in worthy and safe conditions, and to postpone and even avoid admission to a nursing home.
As our population grows older, society faces an enormous challenge. Health care costs are already a considerable part of the budget that can be spent. To keep health care and the impact of an ageing population payable, it is necessary to introduce innovative forms of care aimed at caring for older people at home longer and at providing residential care to older people who are in great need of care but for whom quality care at home is no longer possible. Since there already is a shortage of residential settings, the introduction of 24/7 support at home can remedy this situation.
Since the start of the project, older people in need of care have been able to postpone admission to a residential setting with an average of 240 days. Thanks to different types of care (day and night), they have been able to stay in their homes, which would have been impossible without this project. Support by carers and close monitoring by our care coaches makes older people in need of care feel more supported at home, and their specific care needs are met. If attention is paid to quality and safety as well as affordability, older people could/can stay in their familiar environment longer.
Experience-based self-assessment (you assessed the impacts based on your experiences with the target group), Self-evaluation (you used qualitative and/or quantitative methods to assess impacts), External evaluation of impacts based on quantitative methods (quantitative measurement of impact indicators).
Mission and strategy, Organisational structure, Information on team members.
We would like to continue to improve the range of care services in this project based on the experience we have acquired in the past three years. Both the input of individuals in need of care and professional care providers is very valuable in this respect.
We intend to submit the modified project for a 4-year prolongation in the same region. Additionally, we will submit the improved project for a second region.