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Home care: How the Netherlands delivers good care at a good price

Written by Diane Archer

Unlike the classic home care agency that uses a range of personnel to provide care and support to homebound patients, one new model in the Netherlands relies on a cadre of nurses to deliver the full range of services homebound patients need. The Buurtzorg model has received significant attention for its seeming ability to deliver good quality care at lower cost than other models.

Started in 2007 with a single team of nurses, today Buurtzorg boasts 8,000 nurses in 700 teams caring for 65,000 patients, according to a new report from the Urban Institute.  And many countries, including Japan, the United Kingdom and the United States are following its lead and exploring ways to adapt the model to their populations.  How not? The Buurtzorg model not only gets high satisfaction ratings from patients but surprisingly high satisfaction ratings from its nurse providers. And, it provides home care in fewer hours than other organizations for comparable services.

The Buurtzorg model recognizes that patients value continuity of care from the same providers. Typically, home care agencies rely on a range of different providers to perform different services at different times. So, Buurtzorg nurses not only provide nursing services, but they help with bathing, toileting, dressing and other activities of daily living.

Buurtzorg offers a holistic approach, working within a neighborhood to improve people’s independence in the community. Ten to 12 nurses work together in a community to provide home care for 50-60 patients. Nurses train patients in self-care and help create neighborhood resources for patients. They also work with family members and primary care doctors to help ensure that patients maintain or improve their ability to function independently. Interestingly, nurse visits average 25 minutes.

The nurses are self-managing, with help from a sophisticated information technology system that does scheduling and billing as well as tracks nursing assessments. They assess patient needs, develop and execute on the care plan, and otherwise ensure patients receive needed care. One study found that Buurtzorg did a better job of meeting people’s home care needs and helping them live independently in fewer hours than other organizations; in addition, patients had fewer hospital emergency visits, shorter hospital stays and were less likely to go into nursing homes.

In the U.S., while many older adults end up in nursing homes, there is increasing focus on helping older adults to age in place.  Lots of new models are being studied, including CAPABLE, which you can read about here. And, there is much focus on helping people plan for long term care services and supports, which most of us will need.

Buurtzorg USA was launched in Stillwater, Minnesota in 2014 and is now a legally recognized non-profit organization licensed to provide home care in Minnesota. It is still in its early stages, making itself known in the community. Time will tell whether this home care model can work in the United States, where insurance payment systems for home care can be extremely complex and most people do not have the means to pay out of pocket.

Medicaid often covers the cost of home care for older adults with low incomes; Medicare only pays for limited home careIn the Netherlands, the Dutch government is the single payer and pays for home care for a range of conditions, regardless of income.

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