By Florien Kruse & Toine Remers, Radboud University Medical Center.
The first Dutch COVID-19 case was detected on 27th February in Noord-Brabant (a province of the Netherlands). This region soon became the epicenter of the virus within the Netherlands. The nursing home sector could not be shielded from these developments and soon the first deaths in the Dutch nursing homes followed.
At the time of writing, 25th March, the Netherlands has 6412 people who have tested positive for COVID-19 and 356 patients who died as a result of the virus. (The National Public Health institution regularly updates the information on their website.) Only recently, the Association of Geriatric Specialists launched a system to collect the number of COVID-19 cases in nursing homes via an electronic healthcare system. Data provided in the few days after the launch indicates that 0.2% – 0.5% of all residents show COVID-19 symptoms (Ysis data 162/73000 and GeriCall data 77/15000). Since both registers combined do not represent the total population of nursing home residents and provision of data is voluntary, these numbers provide a rough estimate (most likely an underestimate).
Dutch policy responses
The Dutch response is primarily focused on slowing the spread of the virus. The main aim is to avoid a demand peak that will significantly strain the resources of the healthcare system. Another aim spelled out by the government is to protect older people and those with poor health. The governmental response that follows from this can be described as, on the one hand, imposing strict regulatory measures and, on the other hand, relaxing traditional rules and standards to give long-term care professionals discretionary power to make certain decisions.
Noord-Brabant was the first province to advise nursing homes on limiting visitors on 16th March. Not much later, on 19th March, strict visiting rules were imposed nationally: visitors are not allowed at nursing homes at least until the 6th April. This decision was supported by stakeholders in the long-term care sector. However, in contrast to some other countries, the Dutch government does allow nursing home staff to make rare exceptions for close friends and relatives to visit clients when they receive end-of-life care. In addition, the government is strictly regulating personal protective equipment; nursing homes are only allowed to use these under specific circumstances.
Several rules and standards have been loosened. Firstly, the regional long-term care offices and the Youth and Healthcare Inspectorate announced that they will relax their supervisory role. Secondly, the Central Administration Office (CAK), which normally conducts house visits to determine whether people are eligible for nursing home care (need-testing), has relaxed its rules, so the needs-testing can be done remotely wherever the respective healthcare professional (e.g. case-managers) deems fit. Thirdly, the Dutch Youth and Health Care Inspectorate (IGJ) allowed nursing home managers to recruit personnel beyond their traditional pool of employees, allowing them to hire personnel such as medical students.
COVID-19 has, and will have in the future, a significant financial impact on nursing homes. They have to invest in additional measures to combat COVID-19. For instance, measures to isolate clients, provide protective clothing for nurses and possibly employing additional staff. It has therefore been agreed that regional Dutch long-term care offices, who purchase long-term care from nursing homes, can provide financial support to those long-term care providers that are confronted with additional costs due to the outbreak.
Kruse F and Remers T (2020) Report: Nursing homes and COVID-19, policy responses in the Netherlands. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE. Available at https://ltccovid.org/2020/03/26/report-nursing-homes-and-covid-19-policy-responses-in-the-netherlands/