LTCcovid Country Profile – Printable Version

COVID-19 and the Long-Term Care system in the Netherlands

Structural characteristics of the LTC system, impact of the pandemic, measures adopted and new reforms

This is a section of the LTCcovid International Living Report on COVID-19 Long-Term Care that brings together information on the experience of the long-term care sector (focussing on people who use and provide care) during the COVID-19 pandemic in the Netherlands, as well as description of the system and of new reforms. This report is updated and expanded over time, as experts on long-term care add new contributions.

Authors:

Lisa van Tol

To cite this document:

Please use this citation and add the date in which the document was downloaded:

van Tol L. COVID-19 and the Long-Term Care system in the Netherlands. In: Comas-Herrera A., Marczak J., Byrd W., Lorenz-Dant K., (editors) LTCcovid International Living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy and Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6

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Acknowledgement and disclaimer:

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.

Copyright: LTCCovid and Care Policy and Evaluation Centre, LSE

Update for: Netherlands   Last updated: January 7th, 2022


1.00. Brief overview of the Long-Term Care system

Since 2015, LTC is governed through three separate legal acts: the Long-term Care Act (WLZ 2014), the Social Support Act (WMO 2015) and the Health Expenses Act (Zvw 2008). As a result, there are different rules and funding streams for care-related (LTC insurance), social support related (municipalities) and health and nursing related (health insurance) services. LTC is needs assessed but not means-tested (Bruquetas-Callejo and Böcker, 2021).

References:

Bruquetas-Callejo, M., Böcker, A. (2021) Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future MC Covid 19 Working Paper 11/2021

Update for: Netherlands   Last updated: February 1st, 2022


1.01. Population size and ageing context

The population of The Netherlands is around 17.4 million (source: World Bank) and the median age is 43.3 years (source: Worldometres).

In 2021, 20.5% of the total population of The Netherlands was over age 65 and just under 5% was over 80 (source: Statista).

Update for: Netherlands   Last updated: February 5th, 2022   Contributors: Daisy Pharoah  |  


1.02. Long-Term Care system governance

The Ministry of Health, Welfare and Sport is responsible for health and all aspects of long-term care (LTC). This includes care homes, social care and nursing care. Since 2015, community care has been devolved to private insurers and municipalities. Regional care offices contract with (WLZ and ZVW) providers and have a responsibility to ensure that there are sufficient services to meet demand. These offices are run by one private care insurer who represents all care insurers active in the region. Municipalities are responsible to provide services under the WMO and have incentives to reduce costs (Bruquetas-Callejo and Böcker, 2021).

References:

Bruquetas-Callejo, M., Böcker, A. (2021) Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future MC Covid 19 Working Paper 11/2021 

Update for: Netherlands   Last updated: February 5th, 2022


1.03. Long-term care financing arrangements and coverage

Public expenditure on LTC as percentage of GDP was estimated to be 3.5% in 2016, more than twice the European Union average of 1.6% (EU Commission, 2018). Seventy five percent of spending is allocated to residential care. Private expenditure on LTC (co-payments and out of pocked payments) is relatively low. However, in residential care, residents have to contribute to their board and accommodation. Co-payments have increased considerably for those with higher incomes. Cash for care has been a recent addition for people receiving community care, but in 2016, only 4.7% of recipients of home care aged 65 and over had a personal budget. Benefits are universal but needs tested. There has been a marked shift over time from institutionalisation to community care, with substantial involvement from patient and client organisations. There has been another more recent shift from collective (state) responsibility to individual responsibility and self-reliance. Involvement of unpaid carers, especially families, is now part of the official policy. This however goes against the widespread view that the state should take responsibility for older people in need of care. It is also recognised that this shifts the burden of care back to women (Bruquetas-Callejo and Böcker, 2021).

References:

EU Commission (2018). The 2018 Ageing Report Economic & Budgetary Projections for the 28 EU Member States (2016-2070)

Bruquetas-Callejo, M., Böcker, A. (2021) Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future MC Covid 19 Working Paper 11/2021 

Update for: Netherlands   Last updated: February 1st, 2022


1.06. Care coordination

The Netherlands has been experimenting with various integrated care initiatives over the past years (source: WHO | World Health Organization).

Update for: Netherlands   Last updated: February 1st, 2022


1.08. Care home infrastructure

Care homes are distinguished by whether they have an WLZ (Wet langdurige zorg, LTC) accreditation. These mostly include nursing homes and residential care homes with a nursing department. Care homes without a WLZ accreditation do not provide nursing care or medical treatments, but are residential homes that provide small-scale elderly housing and apartments linked to nursing homes, in which additional care can be provided as needs increase. In addition, there are private care homes for more affluent residents who contribute more to the costs of housing and facilities (such as entertainment). There is also small-scale housing where people pool their WLZ cash (provided as a personal budget) and which are self-organised or provided by entrepreneurs. Nearly 114,000 people aged 65 and over live-in residential care and nursing homes (Bruquetas-Callejo and Böcker, 2021).

References:

Bruquetas-Callejo, M., Böcker, A. (2021) Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future MC Covid 19 Working Paper 11/2021 

Update for: Netherlands   Last updated: February 1st, 2022


1.10. Workforce conditions: pay, employment conditions, qualification levels, shortages

The government provides subsidies for people wishing to go into LTC training. Dual career track is available for nurses working in general care and geriatrics. The country has developed stress management/coaching programmes on healthier work environment and prevention of work-place accidents for LTC centres to help decrease absenteeism (OECD, 2020).

References:

OECD (2020) Who carers? Attracting and Retaining Care Workers for the Elderly.

Update for: Netherlands   Last updated: February 1st, 2022


1.12. Personalisation, user voice, choice and satisfaction

In the Netherlands all care homes are required, by law, to have “client councils” that have the right to participate in decisions that affect their daily lives. The members of the councils are residents or their representatives, and the councils have the right to participate in the strategic management of the care homes. They need to be consulted about organisational issues and have a right to consent to decisions that affect the residents’ daily lives. They also have the right to provide advice (Zuidgeest et al. 2011; Kruse at al. 2020).

References: 

Zuidgeest, M. et al. (2011). Legal rights of client councils and their role in policy of long-term care organisations in the Netherlands. BMC Health Service Research  doi: 10.1186/1472-6963-11-215

Kruse, F., van Tol, Vrinzen, C., van der Woerd, O., Jeurissen, P. (2020). The impact of COVID-19 on long-term care in the Netherlands: the second wave. LTCcovid report 

Update for: Netherlands   Last updated: February 1st, 2022


1.14. Pandemic preparedness of the Long-term care sector

The Netherlands had a national pandemic action plan in place as well as various obligations on hospitals and others to have disaster relief plans. However, these were seen as insufficient. It was also criticised that the government had ignored recommendations provided by experts following the 2014 Ebola outbreak and the 2018 influenza epidemic. The national plan had specific appendices for care and nursing homes (Bruquetas-Callejo and Böcker, 2021). Most Dutch Long-Term Care organisations have an Infection Prevention and Control committee (van Tol et al., 2021).

References:

Bruquetas-Callejo, M., Böcker, A. (2021) Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future MC Covid 19 Working Paper 11/2021

van Tol LS, Smaling HJA, Groothuijse JM, et al COVID-19 management in nursing homes by outbreak teams (MINUTES) — study description and data characteristics: a qualitative study 

Update for: Netherlands   Last updated: February 11th, 2022


2.01. Impact of the COVID-19 pandemic on the country (total population)

During the first wave of the pandemic, Southern regions of the Netherlands were hardest hit, with Carnival celebrations being one of the main catalysts. The second wave started in September 2020, and by November was most pronounced in the West, including in the large urban centres Amsterdam, Rotterdam, and the Hague. An overview of the first year of the pandemic is available here.

Sources: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf.

Update for: Netherlands   Last updated: January 6th, 2022


2.02. Deaths attributed to COVID-19 among people using long-term care

During the first wave, the National Institute for Public Health and the Environment (RIVM) estimated that about 40% of nursing homes had experienced outbreaks. By May 15, 2020, about 7% of residents in nursing homes had been infected and 2% had died. A report published in November 2020 noted that approximately 50% of all COVID-19 related deaths during the second wave were residents of nursing homes.

As of March 6, 2021, there had been 8,446 COVID-19 related deaths of care home residents. Accounting for 51% of the total COVID-19 deaths in the Netherlands. These numbers are an underestimation of the actual COVID-19 deaths because not all those who died due to COVID-19 will have been tested (especially at the beginning of the pandemic). Only people over 70 years of age are included in these statistics.

As of April 25, 2022, there are 10,867 COVID-19 related deaths of care home residents and 22,227 deaths in the Netherlands overall (Source:https://coronadashboard.rijksoverheid.nl/landelijk). Thus care home residents account for 48.8% of the total COVID-19 deaths. The Netherlands has approximately 125,000 care home residents, so the deaths represent 8.7% of residents.

Statistics Netherlands (CBS), a governmental organisation, provides weekly updates on observed mortality. They distinguish the mortality figures by long-term care users and age. They also provide expected figures based on the previous 5 years to estimate excess mortality. These figures show that there has been 9.9% excess mortality (observed-expected/expected) among long-term care users since the start of the pandemic to the end of January, 2022, compared to 8.5% excess mortality among the wider population (outside long-term care).

Update for: Netherlands   Last updated: May 3rd, 2022   Contributors: Adelina Comas-Herrera  |  Disha Patel  |  


2.04. Impacts of the pandemic on access to care for people who use Long-Term Care

Nursing homes (usually running waiting lists) now have empty beds because people are reluctant to move into a home, in response to the visiting ban, while other nursing homes had to implement temporary bans on new admissions (Sources: https://drive.google.com/file/d/1Ji-iDCjC-8EbBpV0dW_xlz780uvU7F–/view; https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf). However, questions have been raised about the access to health care for Covid-19 patients in nursing homes (Source: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

During the first wave, people receiving care in the community who also had family support experienced a reduction or suspension of services. This approach was changed in the second wave, where home care could only be reduced following a consultation with the person with care needs. However, there were instances, such as when there was a lack of staff when services were temporarily reduced.

Efforts have also been made to continue day care, by moving services, where possible, online. Technological interventions have received increased government subsidies. During the second wave day care activities were largely not reduced, but a number of difficulties around ensuring the safety of people with LTC needs and staff were identified (Source: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Update for: Netherlands   Last updated: August 2nd, 2021


2.05. Impacts of the pandemic on the health and wellbeing of people who use Long-Term Care

Impacts on people living with dementia

A qualitative study involving semi-structured interviews with family and professional carers of people with dementia found that, for people with dementia, social distancing measures resulted in a deterioration of physical health and that the impact on emotional state and behaviour depended on the stage of dementia. The authors were not able to establish if the observed cognitive decline was due to the usual disease progression or to under stimulation due to social distancing measures.

The study found that the negative impacts were more pronounced for people living in the community with more severe dementia, and in nursing homes for people with mild to moderate dementia, the authors attributed this to the loss of ability to carry to carry out meaningful activities that provide a sense of purpose (Smaling et al., 2022).

Another study focused on the changes in behaviour considered challenging among care home residents, as reported in a survey of 199 nursing home practitioners. It found that there were reports of both increased and decreased behaviours considered challenging by staff, with a slightly higher proportion of increase. While staff attributed both increased and decreases to the ban in visits in place at the time, the most negative effects were attributed to residents not being allowed to go outside, being made to stay in their rooms and changes in organised activities, with those with mild to moderate dementia having been most affected (Leontjevas et al., 2021). A further analysis of that data explore the views of practitioners on the effects of reductions in stimuli on behaviour. The study distinguished between targeted stimuli (such as planned recreational activities) and unplanned stimuli (for example spontaneous noise in corridors). Practitioners reported that, for residents with advanced dementia and those with psychotic and agitated behaviours reductions in untargueted stimuli were beneficial, as well as the the adjustments made to daily activities. In contrast, for people without dementia and those with depressive and apathetic behaviour the reduction in stimuli was considered to have had negative effects. The study concludes that it is important to adopt approaches more tailored to the needs of individual residents in terms of the right balance between stimuli and tranquility. Practitioners supported the the idea of creating separate environments within care homes with different levels of stimulation for residents with different needs (Knippenberg et al., 2022).

Impact of physical distancing on vulnerable people needing care

A study by de Vries et al. (2022) on the impact of physical distancing on vulnerable people (including people with learning disabilities, mental health problems, older people with care needs living in the community and in residential care, as well as carers) noted a range of experiences,  from relative calmness to loneliness and loss of perspective. For those with small social networks, the loss of  care professionals and informal carers in their daily life during the pandemic meant the loss of a vital part of their social networks. Overall, the loss of social contact for a longer time was linked to low quality of life or motivation for life.

References:

Knippenberg, I.A.H., Leontjevas, R., Nijsten, J.M.H. et al. Stimuli changes and challenging behavior in nursing homes during the COVID-19 pandemic. BMC Geriatr 22, 142 (2022). https://doi.org/10.1186/s12877-022-02824-y

Leontjevas R., Knippenberg I.A.H., Smalbrugge M., et al (2021) Challenging behavior of nursing home residents during COVID-19 measures in the Netherlands, Aging & Mental Health, 25:7, 1314-1319, DOI: 10.1080/13607863.2020.1857695

Smaling HJA, Tilburgs B, Achterberg WP, Visser M. The Impact of Social Distancing Due to the COVID-19 Pandemic on People with Dementia, Family Carers and Healthcare Professionals: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(1):519. https://doi.org/10.3390/ijerph19010519

de Vries, D., Pols, A., M’charek, A. and van Weert, J. (2022) The impact of physical distancing on socially vulnerable people needing care during the COVID-19
Pandemic in the Netherlands, 6(1-2): 123–140, International Journal of Care and Caring, DOI: 10.1332/239788221X16216113385146

Update for: Netherlands   Last updated: March 4th, 2022


2.07. Impacts of the pandemic on unpaid carers

A report from November 2020 indicates that unpaid carers in the Netherlands have experienced more pressure and stress in their caring role since the COVID-19 pandemic.

Impacts on family carers of people living with dementia

A qualitative study involving semi-structured interviews with family and professional carers of people with dementia found that family carers of people living dementia found difficult to cope with visiting restrictions, experienced anxiety regarding safety and had higher carer burden.

Relatives of people living in care homes reported that video calling and window visits were difficult as people with dementia often found it difficult to communicate in this way or use equipments, but relatives stated that this was better than no communication. They also worried that their relatives with dementia would no longer recognise them when the restrictions were lifted. Their carer burden was reduced, but they felt sidelined as they were no longer able to continue providing care.

Carers of people living in the community tried to keep the “bubble” around the person with dementia small. They worried about professional carers not adhering to safety measures and experienced higher care burden.

References:

Smaling HJA, Tilburgs B, Achterberg WP, Visser M. The Impact of Social Distancing Due to the COVID-19 Pandemic on People with Dementia, Family Carers and Healthcare Professionals: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(1):519. https://doi.org/10.3390/ijerph19010519

Update for: Netherlands   Last updated: January 6th, 2022


2.08. Impacts of the pandemic on people working in the Long-Term Care sector

A qualitative study involving semi-structured interviews with family and professional carers of people with dementia found that professional carers experienced increased workload due to:

  • Additional responsibilities and care tasks, particularly due to implementing Infection Prevention and Control measures and due to additional care demands during outbreaks (in terms of providing care to people who were quarantining and increased care needs due to COVID-19 infections)
  • Having to work extra hours due to staff shortages
  • In the community, workers also found it burdensome to have to make decisions about reducing care and having to communicate if care needed to be stopped or reduced.

The study also found that staff in care homes experienced stress as a result of relatives of people with dementia not adhering to rules and felt conflicted about having to implement measures that they perceived to be harmful and too strict. Some also expressed guilt that they had contact with residents while their relatives were not able to visit (Smaling et al., 2022).

A study analysing the minutes and other meeting documents of Outbreak Teams operating in care homes (including residential and nursing care homes) during weeks 16 to 23 of 2020 (covering the first two waves of COVID infections in the Netherlands) shows concern about the staff mental wellbeing. In particular, the Outbreak Teams were concerned about emotional exhaustion due to high workloads, fear of infection and verbal abuse by residents’ family members (van Tol et al, 2021).

Another qualitative study with care workers in care facilities highlighted a number of moral challenges faced by care professionals. These challenges were related to  to the visitor ban policy, residents’ loneliness and despair, as well as deaths. Moral challenges triggered different responses from care workers from acceptance  to deviating from protocols and ‘acts of rebellion’ as well as leading to clashes between care workers and with superiors. Overall, the paper noted that care workers experienced a degree of moral distress (van der Geugten et al., 2022).

References:

Smaling HJA, Tilburgs B, Achterberg WP, Visser M. The Impact of Social Distancing Due to the COVID-19 Pandemic on People with Dementia, Family Carers and Healthcare Professionals: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(1):519. https://doi.org/10.3390/ijerph19010519

van der Geugten, W., Jacobs, G. and Goossensen, A. (2022) The struggle for good care: moral challenges during the COVID-19 lockdown of Dutch elderly care
facilities, 6(1-2): 157–177, International Journal of Care and Caring, DOI: 10.1332/239788221X16311375958540

van Tol LS, Smaling HJA, Groothuijse JM, et al COVID-19 management in nursing homes by outbreak teams (MINUTES) — study description and data characteristics: a qualitative study 

Update for: Netherlands   Last updated: March 7th, 2022


2.09. Impact of the pandemic on workforce shortages in the Long-Term Care sector

An OECD paper and other sources indicated that the Netherlands has experienced staff shortages during the various waves of pandemic. To address these, the country provided financial help to LTC facilities to recruit unemployed or former LTC workers, and provide financial help to LTC facilities to recruit students. LTC facilities also received financial support that they could use independently; including for stafff recruitment. Moreover, a pool of volunteers for emergencies was activated to boost staff at the start of the pandemic.

However, according to a recent report (February 2022) by The Federation of European Social Employers, The Netherlands has experienced an increase of between 1 – 10% in staff shortages since 2021. The sub-sector most critically affected by staff shortages across the countries surveyed for this report were services for older persons. The job position most affected was nursing, but care assistants and homecare / social care workers also face real shortages. The most common reasons given for staff leaving the social care sector for another include low wages, and mental and physical exhaustion relating to the pandemic.

Update for: Netherlands   Last updated: February 5th, 2022   Contributors: Daisy Pharoah  |  


2.10. Financial and other impacts of the pandemic on Long-Term Care providers

The high numbers of deaths in nursing home affected the occupancy rate of homes which led to loss of income especially of those hardest hit by the pandemic. The government sought to address this through payments for providers (Source: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Update for: Netherlands   Last updated: January 6th, 2022


3.01. Brief summary of the overall pandemic response (not specific to Long-Term Care)

During the first wave of the pandemic, southern regions of the Netherlands were hardest hit, with Carnival celebrations being one of the main accelerators. The second wave started in September 2020 and by November was most pronounced in the west, including in the large urban centres Rotterdam, the Hague, and Amsterdam. The Dutch government introduced an “intelligent lockdown” during the first wave. A regional approach was attempted at the beginning of the second wave, but was abandoned by mid-October 2020, when the government introduced a second lockdown, with similar rules like the first (Source: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf). A published paper describes the economic and public health interventions during the first wave. An overview of measures to reduce community transmission, such as an overnight curfew, have been published online.

Update for: Netherlands   Last updated: September 8th, 2021


3.02. Governance of the Long-Term Care sector's pandemic response

As per the national pandemic action plan, crisis response is delegated to many organisations at all system levels. However, as the crisis deepened the National Institute for Public Health and the Environment (RIVM) was made coordinator of the response and an outbreak management team was created to advise the government (Source: https://drive.google.com/file/d/1Ji-iDCjC-8EbBpV0dW_xlz780uvU7F–/view).

Update for: Netherlands   Last updated: September 8th, 2021


3.02.02. Measures to improve coordination between Health and Social Care in response to the pandemic

People interviewed for the McCovid project reported that nursing homes and hospitals collaborated well and there was some exchange of staff (nurses, gerontologists) when needed. Nursing homes were deemed to be well equipped to provide medical care themselves and by accessing health care in the community (GPs, geriatric doctors, other specialists). It is customary to treat illness in nursing homes and only to transfer to hospitals in exceptional circumstances (source: https://drive.google.com/file). There was improved regional cooperation between nursing homes and hospitals through regional networks (RONAZ). Nursing homes also assisted hospitals in making available additional beds to increase hospital capacity (source: https://ltccovid.org/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Update for: Netherlands   Last updated: November 30th, 2021


3.02.03. Measures to support, facilitate and compensate for disruptions to access to care

GPs have been told they should closely monitor those who are homebound and frail and should act like a case-manager when they develop COVID-19 symptoms (Source: https://ltccovid.org/wp-content/uploads/2020/05/COVID19-Long-Term-Care-situation-in-the-Netherlands-25-May-2020-1.pdf). During the second wave, efforts were increased to ensure continuity of care and services for people receiving domiciliary care and for those requiring daytime services (Source: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Update for: Netherlands   Last updated: September 9th, 2021


3.03. Monitoring Covid-19 impacts in the Long-Term Care sector: data and information systems

The association of geriatric doctors, Verenso, initiated a registration system to improve data collection from nursing homes on incidence and mortality (Source: https://drive.google.com/file/d/1Ji-iDCjC-8EbBpV0dW_xlz780uvU7F–/view). Two electronic healthcare systems (i.e. Ysis and ONS) have collected the number of COVID-19 cases in nursing homes. These electronic healthcare systems cover the majority of nursing homes in the Netherlands (Source: https://ltccovid.org/wp-content/uploads/2020/05/International-measures-to-prevent-and-manage-COVID19-infections-in-care-homes-11-May-2.pdf).

Update for: Netherlands   Last updated: September 9th, 2021


3.04. Financial measures to support users and providers of Long-Term Care

Public authorities launched temporary compensation schemes to help nursing homes cover extraordinary expenses related to the pandemic (e.g. personal protective equipment) and compensate for loss of income (Source: https://drive.google.com/file/d/1Ji-iDCjC-8EbBpV0dW_xlz780uvU7F–/view).

Care professionals received a bonus of €1000 in 2020. In 2021 there will also be a bonus provided (Source: https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf).

Update for: Netherlands   Last updated: September 10th, 2021


3.06. Support for care sector staff and measures to ensure workforce availability 

On March 16, 2020, the Dutch Youth and Health Care Inspectorate allowed nursing home managers to recruit personnel beyond their traditional pool of employees, enabling them to hire personnel such as medical students (Source: https://ltccovid.org/wp-content/uploads/2020/05/International-measures-to-prevent-and-manage-COVID19-infections-in-care-homes-11-May-2.pdf). Several initiatives have been set up to increase the number of staff working in stretched LTC settings, including an IT platform “Extra Hands for Healthcare” to match existing healthcare staff with employers. This included a campaign to recruit healthcare personnel that had left the sector or retired (called “Duty calls”), and a rapid training scheme for those with no previous healthcare training (Source: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Update for: Netherlands   Last updated: January 26th, 2022   Contributors: Joanna Marczak  |  


3.06.01. Surge staffing and other measures to support care homes with outbreaks or critical staff shortages

A study analysing the minutes and other meeting documents of Outbreak Teams operating in care homes (including residential and nursing care homes) during weeks 16 to 23 of 2020 (covering the first two waves of COVID infections in the Netherlands) shows that at times of high levels of staff absences due to COVID-19 infections and need to isolate, additional staff was brought in. These additional staff included  temporary workers, non-healthcare staff members and army medical staff. In some situations staff who needed to self-isolate were also provided with equipment to be able to work from home. (van Tol et al, 2021).

References:

van Tol LS, Smaling HJA, Groothuijse JM, et al COVID-19 management in nursing homes by outbreak teams (MINUTES) — study description and data characteristics: a qualitative study 

Update for: Netherlands   Last updated: February 8th, 2022


3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, support and implementation

On 20 March 2020 the National Institute for Health and the Environment (RIVM) issued their first Covid-19 guidelines to the LTC sector. These guidelines were regularly updated and new guidance was added. Some guidelines were difficult to follow, especially where there were shortages of Personal Protection Equipment and staff absent due to illness (https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Experiences of Outbreak Teams in care homes

Long-Term Care organisations installed multidisciplinary Outbreak Teams, building on existing Infection Prevention and Control committees previously acting as focal points to lead and coordinate IPC activities. The Outbreak Teams also include management representatives, unlike the previous IPC committees.

Analysis of the minutes of and other meeting documents of Outbreak Teams operating in care homes (including residential and nursing care homes) during weeks 16 to 23 of 2020 (covering the first two waves of COVID infections in the Netherlands). The data shows that most Outbreak Teams included management, medical staff, support services staff, policy advisors and communication specialists. Only in a few teams there was representation of nursing staff and residents.

The meetings mostly covered: crisis management, isolation of residents, PPE and hygiene, staff, residents’ well-being, visitor policies, testing and vaccination. The minutes reveal key challenges and dilemmas around testing, isolation of residents, PPE and staff and residents’ wellbeing.

References:

van Tol LS, Smaling HJA, Groothuijse JM, et al COVID-19 management in nursing homes by outbreak teams (MINUTES) — study description and data characteristics: a qualitative study 

Update for: Netherlands   Last updated: January 6th, 2022   Contributors: Lisa van Tol  |  


3.07.01. Measures in relation to transfers to and from hospital, from community to care homes and between settings

Many people died in nursing homes and were not transferred to hospitals, therefore it was seen that nursing homes reduced pressure on hospital Intensive Care Units. It is customary to treat older people when they fall ill in the nursing home, perhaps explaining why few were referred to hospital (source: https://drive.google.com/file).

Update for: Netherlands   Last updated: November 30th, 2021


3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes

The association of geriatricians has issued guidelines for infection control in care homes (Verenso). The ability to control infection has increased substantially between the first and second wave. The publicly financed programme “Dignity and Pride on Location” has developed a “roadmap” to help providers to prepare for a new pandemic (https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Update for: Netherlands   Last updated: September 9th, 2021


3.07.03. Visiting and unpaid carer policies in care homes

The Netherlands was one of the first countries where, under strict conditions set by the Dutch government, the visiting ban in care homes was lifted and its impact was assessed scientifically (Verbeek et al., 2020). In October 2020, the Dutch Parliament accepted the Corona Act, a temporary legislation prohibiting complete lockdowns in care homes (Koopmans et al., 2021). The Act guarantees that each resident has the right to welcome at least one visitor in the case of COVID-19 outbreaks.

In October 2020, five months after the visiting ban in Dutch nursing homes had been lifted, there were still found to be consequences for residents, family members and staff. Although complete visiting bans are indeed prevented, not all nursing homes felt prepared for welcoming visitors in case of new COVID-19 infections (Backhaus et al., 2021).

Data collected in March and April 2021 showed that a high proportion of care homes had adjusted their visitor policies after vaccinations. Nevertheless, many restrictive rules were still often in place. For example, residents were not allowed to hug visitors, or visitors were not allowed to stay for dinner. Most nursing homes did not have concrete plans or protocols on how to further ease the protective measures and policies (Hamers, Koopmans, Gerritsen, & Verbeek, 2021).

References:

Backhaus, R., Verbeek, H., De Boer, B., Urlings, J. H. J., Gerritsen, D. L., Koopmans, R. T. C. M., & Hamers, J. P. H. (2021). From wave to wave: a Dutch national study on the long-term impact of COVID-19 on well-being and family visitation in nursing homes. BMC Geriatrics, 21(1). doi:10.1186/s12877-021-02530-1

Hamers, J., Koopmans, R., Gerritsen, D., & Verbeek, H. (2021). Gevaccineerd, en nu?

Koopmans, R. T. C. M., Verbeek, H., Bielderman, A., Janssen, M. M., Persoon, A., Lesman-Leegte, I., . . . Gerritsen, D. L. (2021). Reopening the doors of Dutch nursing homes during the COVID-19 crisis: results of an in-depth monitoring. International Psychogeriatrics, 1-8. doi:10.1017/s1041610221000296

Verbeek, H., Gerritsen, D. L., Backhaus, R., De Boer, B. S., Koopmans, R. T. C. M., & Hamers, J. P. H. (2020). Allowing Visitors Back in the Nursing Home During the COVID-19 Crisis: A Dutch National Study Into First Experiences and Impact on Well-Being. Journal of the American Medical Directors Association, 21(7), 900-904. doi:10.1016/j.jamda.2020.06.020

Update for: Netherlands   Last updated: November 29th, 2021


3.08. Access to testing and contact tracing for people who use and provide Long-Term Care

Access to testing was limited in the beginning of the pandemic and restrictive policies prevented access to testing for care homes. Testing capacity was limited and restrictions lasted until June. 2020. A new testing policy announced on 6th April 2020 allowed all healthcare workers (including LTC staff) to get tested when they developed symptoms (https://ltccovid.org/wp-content/uploads/2020/05/International-measures-to-prevent-and-manage-COVID19-infections-in-care-homes-11-May-2.pdf).

Criteria for testing have been broadened over time but testing capacity remained a challenge (https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Update for: Netherlands   Last updated: September 8th, 2021


3.09. Access to Personal Protection Equipment (PPE) in the Long-Term Care sector

PPE was scarce in the early months of the pandemic and hospitals were given priority in government efforts to alleviate the problem. This was reinforced by regional networks of emergency care (ROAZ) being given responsibly for distributing PPE, which disadvantaged LTC. During the first wave, 90% of masks went to hospitals and only 10% to nursing homes. Care homes were asked to make their equipment available to hospitals (https://drive.google.com/file/d/1Ji-iDCjC-8EbBpV0dW_xlz780uvU7F–/view).

During the first wave it was reported that the use of PPE was strictly regulated due to shortage, could only be used under specific circumstances. Only those LTC personnel that were at risk received PPE. The Dutch Health and Youth Inspectorate inquired whether the LTC providers have sufficient PPE (24th April 2020) (https://ltccovid.org/wp-content/uploads/2020/05/International-measures-to-prevent-and-manage-COVID19-infections-in-care-homes-11-May-2.pdf).

A study analysing the minutes and other meeting documents of Outbreak Teams operating in care homes (including residential and nursing care homes) during weeks 16 to 23 of 2020 (covering the first two waves of COVID infections in the Netherlands) shows that there were still PPE shortages at that stage and costs were high. This resulted in Outbreak Teams considering the sterilisation and reuse of PPE (van Tol et al, 2021).

References:

van Tol LS, Smaling HJA, Groothuijse JM, et al COVID-19 management in nursing homes by outbreak teams (MINUTES) — study description and data characteristics: a qualitative study 

Update for: Netherlands   Last updated: January 6th, 2022


3.10. Use of technology to compensate for difficulties accessing in-person care and support

In the Netherlands the SARA robot, developed as part of EIT Digital, was offered to care homes to support the residents in communicating with their family and friends. The company offered care homes to have the robot for one month.

A survey of 175 nursing home staff found that practitioners thought there was value in continuing to use telecommunication between residents and their loved ones, in addition to the preferred face to face contact. However there were challenges in using telecommunication with residents with advanced dementia, with reports of negative emotional responses. With regards telehealth, some practitioners (particularly psychologists, physicians and nurse practitioners) would like to continue working partly remotely after the pandemic, whereas more than half activity coordinators reported that this would not be possible for their tasks (Leontjevas et al., 2021).

References:

Leontjevas, R., Knippenberg, I., Bakker, C., Koopmans, R., & Gerritsen, D. (2021). Telehealth and telecommunication in nursing homes during COVID-19 antiepidemic measures in the Netherlands. International Psychogeriatrics, 33(8), 835-836. https://doi.org/10.1017/S1041610221000685

 

Update for: Netherlands   Last updated: February 24th, 2022


3.11. Vaccination policies for people using and providing Long-Term Care

National COVID-19 vaccination coverage and booster rollout

As of 2nd January 2022, 86.0% of people over the age of 18 have completed the basic vaccination for COVID-19 in the Netherlands, while 89.1% have had at least one dose. With regard to people over the age of 12, 87.4% have had at least one dose, while 84.4% are fully vaccinated. With regards boosters/third doses, according to the RIVM (national institute for public health and environment), Dutch inhabitants are invited by the Municipal Health Service (in dutch ‘GGD’) for their booster vaccine in order of birth year (oldest first). By the 2nd January 2022, 32.0% of all over 18 y/o have received a booster dose.

The website of national organisation for 25 national Municipal health services (GGD’s) and Medical Aid Organizations (GHOR’s) in the regions announces that by the 4th of January 2022, all 18y/o or older, who have been vaccinated or got COVID-19 at least 3 months ago, can now plan an appointment to receive a booster vaccine within the coming weeks.

Vaccination among people living in care homes and staff

In the Netherlands, as in many other countries, care home residents and staff were among the first to be vaccinated against COVID-19. The first residents were vaccinated on 18 January 2021. After residents had been fully vaccinated, COVID-outbreaks and deaths in care homes declined.

According to the website of professional association for carers and nurses ‘V&VN’, the booster vaccination for healthcare workers was to start on the 19th November 2021. This had been planned for December but, due to high rates of COVID-19 related absences for nurses and carers, the Ministry of Health, Welfare and Sports decided to start earlier.

Hospitals vaccinate their own employes, ambulance staff, employees of rehabilitation institutions and categorical institutions (such as asthma clincs, orthopedic clinics), general practitioners and their employees.

Employees in the other care sectors, after invitation from RIVM, can visit the GGD (municipal health service) locations to receive their booster vaccine. Healthcare institutions can also choose to provide the booster to their employees themselves.

Measures to increase vaccination uptake among staff working in the long-term care sector

Vaccinations are voluntary, according to guidelines of the ministry of Health Welfare and Sports. This statement is supported by all professional associations in the long-term care sector. In accordance with the General Data Protection Regulation (GDPR) by the European Union (EU), it is not mandatory for employees to inform their employer of their vaccination status. Among politicians and within the media, debate about making vaccinations for long-term care staff compulsory has been limited. There has been some discussion about the legal grounds on which an employer could change the terms of employment for employees who work with vulnerable people and refuse to be vaccinated.

In December 2020, before the vaccination program was rolled out, some polls found that vaccine hesitancy among healthcare personnel (in long-term care and other healthcare sub-sectors) was about 30%. Currently this hesitancy has decreased over time. However, there are no hard figures for vaccination coverage in healthcare, because the standards for privacy protection applicable in the Netherlands also apply to nurses and carers.

This factsheet (in Dutch) provides an overview of the strategies that long-term care organisations have used to improve the willingness of staff to take up COVID-19 vaccinations.

Update for: Netherlands   Last updated: January 6th, 2022   Contributors: Lisa van Tol  |  


3.12. Measures to support unpaid carers

The Dutch government issued guidelines for informal carers. These guidelines include advice on hygiene standards and guidelines on how a caregiver should act if the person they provide care to develops symptoms of COVID-19 (https://ltccovid.org/wp-content/uploads/2020/05/COVID19-Long-Term-Care-situation-in-the-Netherlands-25-May-2020-1.pdf).

All family care caregivers that experience symptoms of COVID-19 have been able to get tested since 18 May 2020. In addition, family carers could access free PPE from 19 May 2020 if they support vulnerable people (70 years and older, with chronic conditions) who experience symptoms of COVID-19 and where personal care (with less than 1.5 metres distance) is required (https://ltccovid.org/wp-content/uploads/2020/05/COVID19-Long-Term-Care-situation-in-the-Netherlands-25-May-2020-1.pdf).

Municipalities have set up support desks to help distressed informal carers and the role of the General Practitioner (GP) to support has been emphasised (https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Guidelines advise that GPs play an important role in supporting unpaid carers.

Update for: Netherlands   Last updated: September 7th, 2021


4.04. Reforms to improve care coordination

An EU report noted that several programmes were set up in 2017 with an aim to improve integrated delivery of care and the matching of care to needs.

Update for: Netherlands   Last updated: November 24th, 2021


4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions

An EU report (2021) noted that the Netherlands implemented numerous measures in 2017, including: improved working conditions; better protected contracts (e.g. open-ended contracts, flexible working time, leave); better matching of supply and demand. The government programmes also focus on improving the attractiveness of the sector via image campaigns as well as other measures improving working conditions and training.

Update for: Netherlands   Last updated: December 2nd, 2021


4.11. Reforms to improve the pandemic and emergency preparedness of the Long-Term Care sector

The country aims to focus research on pandemic-related issues (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

Update for: Netherlands   Last updated: November 9th, 2021