Care for the elderly faces the biggest change it has ever seen. Not only because of concerns about the quality and affordability of care, but also because our view of ageing is gradually changing. And that view ultimately determines what we expect of elderly people themselves, their networks and of the care and support available.
In this respect, the National Care for the Elderly Programme (NPO) was well ahead of its time. In 2007 the Dutch Ministry of Health, Welfare and Sport decided to launch the programme in order to improve care for frail elderly people. At the time, not everyone saw the need for radical change to care for the elderly. And no one could have foreseen what those changes would mean for the care sector and for elderly people themselves.
For ten years, elderly people, professionals, researchers and policymakers working in the programme have made a steady contribution to this voyage of discovery. This not only produced a lot of knowledge concerning care and support for the elderly, it also – and more especially – revealed new ways of doing things differently, and of setting our expectations. ‘The bridge to better care still needed to be built, but we were already crossing it’, one of the elderly participants said.
First, the programme focused on medical conditions and treatments. Later, the emphasis shifted to ways of ageing better, in order to take more account of what elderly people want and need in terms of their care, welfare and housing. And to allow them to take responsibility for these things. This might be the programme’s main benefit to society: the growth in ideas about ageing. About what is good about it, what better ageing will require, from us, from each other, from the care sector, from those funding care and from the authorities. Ageing is a new phase of life with new possibilities and challenges, but also with setbacks and bereavement.
Ten years seems like a long time, but it is not long to bring about the reforms that are so urgently needed. Things have been set in motion. Now it is a matter of securing the benefits and building on them.
ZonMw administered the €88.6 million National Care for the Elderly Programme (NPO) on behalf of the Ministry of Health, Welfare and Sport from 2008-2016. The programme aimed to improve care and support for frail elderly people, elderly people in vulnerable positions with complex requests.
It was implemented in three stages:
Since 2016, the Ageing Better (‘BeterOud’) consortium and platform (www.BeterOud.nl) has continued to implement the results.
ZonMw collaborated closely on NPO with the Netherlands Federation of University Medical Centres, the eight UMCs in the country, and with elderly people themselves, through organisations like the CSO, the umbrella association of organisations for the elderly. Elderly people could participate both in the networks and in the NPO organisation itself.
During the programme, the focus shifted from mainly empirical research to care innovation based to some extent on what elderly people regard as important. Steadily more emphasis came to be focused on the welfare of and support for elderly people in a continuum of welfare and care. Besides support for participation, the establishment and use of a national database and improvements to training were also funded, and a vision for the future and change agenda were developed.
NPO yielded benefits for both science and society. Eight regional networks coordinated by the UMCs were for example created, in which over 650 parties and organisations from the field worked together. 218 projects were carried out, involving 43,000 elderly people, and 200 of them played an active role in the networks. All projects were subjected to expert evaluation.
Most of the results can be accessed online at www.BeterOud.nl. The name of this website translates to 'Ageing Better'. It concerns getting older as new phase of life, the logical continuation of your life in which you still play the main role. BeterOud / Ageing better will support and inspire everyone, in person and online, so we succeed to assign value to this new phase.
The projects produced some 300 specific tips for practitioners. The regional networks published 439 scientific papers and 45 doctoral theses. A database (TOPICS-MDS) is now available for further research and evaluation. It contains research data on 43,000 elderly people and 9000 informal carers.
More than 45 dissertations and 400 articles were published.
Data from the elderly participants were gathered in 53 projects using a questionnaire and delivered to the TOPICS-MDS database (The Older Persons and Informal Caregivers Survey – Minimum Dataset). The database therefore contains information on 43,000 elderly people and 9000 informal carers. In recent years, 13 international publications have been based on TOPICS-MDS data.
For more information, see: http://topics-mds.eu/
Elderly people participated in both the executive programme committee and in the networks. Their participation in the projects was a formal requirement for grant eligibility. The elderly people who actively participated received support from the national ‘Strong Client Perspective’ project. Input from the elderly meant there was more focus on welfare and prevention in NPO. The collaboration between elderly people, professionals and academics turned out to be one of the most important learning experiences of the programme. The elderly participants ensured that attention remained focused on the substance of the issue and that other interests featured less prominently.
Thoughts about ageing
From 2012 onwards, NPO attempted to stimulate debate on the future of care for frail elderly people, drafting the ‘Ageing Better Vision for the Future and Change Agenda’ for the purpose. The agenda is based on five core values that define how people will grow older and how frail elderly people will be treated: control, human dignity, reciprocity, meaning and quality & efficiency. The Vision also revealed five keys to success (core themes), which together comprise the Ageing Better change agenda. These themes are client resourcefulness, early detection, customisation, coherence and innovation. Since the agenda was published, it has been further rolled out under the name ‘Ageing Better platform’ (platform BeterOud). The Ageing Better consortium and platform was established on the basis of the partnership with the knowledge institutes.There is a focus on growing older as a new stage of life, in which the elderly increasingly take the lead and retain control.
From the outset, the programme focused strongly on implementation. Some experiments were implemented successfully in other regions. In these cases the experiment was successfully adapted to local circumstances. But the fact that there is still no structural funding for these innovative projects is hampering implementation.
It was found that both local authorities and health insurance companies need to be given the right information, and that their needs and wishes need to be catered for as well as possible. Scientific publications are not the way to do this. It is better to inform them about the added value of an innovation by compiling a concise business case that includes all the relevant information (effects, requirements, costs and benefits).
Further implementation took place in close collaboration with knowledge institutes Vilans, Movisie and the former CBO. A website containing all the results, plus collaborative centres and learning communities were set up in collaboration with the eight regional networks. At collaborative centres, promising results can be translated into practical implementation tools. In learning communities, the practical application and implementation of the results is supported on the basis of three themes: local care, early detection and transmural collaboration.
Ambassadors from all sections of society have committed to work together to achieve the objectives in the agenda. The key thing is to achieve a positive experience of ageing as a new stage of life with new opportunities and, of course, setbacks. A broad social movement is expected to emerge. The ‘Ageing Better’ consortium is intended to ensure the continuity of this infrastructure, and will thus make a direct contribution towards achieving the change agenda.
Thoughts about ageing (2)
Researchers, elderly people, professionals and policymakers all underline the fact that NPO was very important for care for the elderly in both scientific and societal terms. At the same time, elderly people and professionals say that further improvements are needed in the care and welfare services available to frail elderly people.
ZonMw funds health research and stimulates use of the knowledge developed to help improve healthe and healthcare.
ZonMw’s main commissioning organisations are the Ministry of Health, Welfare and Sport and the Netherlands Organisation for Scientific Research
Colofon Editors Cecile Vossen, Marc van Bijsterveldt, Translation Sue Mc Donnell Photography Ringel Goslinga