Going Dutch.





“It is the fastest growing organisation in the Netherlands and for three years running has been named the country’s top employer. Not-for-profit organisation Buurtzorg Nederland, founded and developed by community nurses, is transforming home care in the Netherlands and is quickly garnering attention worldwide, including in Australia.

Since its development in 2006, the Buurtzorg or “neighbourhood care” model has attracted the interest of more than 25 countries including the National Health Service in England. Sweden, Japan and the US state of Minnesota have already begun introducing Buurtzorg nurse-led teams in their jurisdictions.

Speaking to Australian Ageing Agenda ahead of his keynote address to the Leading Age Services Australia (LASA) National Congress in October, founder and director Jos de Blok said his home care model has been shown to deliver higher quality care at a reduced cost. A 2010 Ernst and Young report said costs per patient were approximately 40 per cent less than comparable home care organisations and surveys have shown that patient satisfaction is the highest in the country.

At the heart of the nurse-led model is client empowerment by making the most of the clients’ existing capabilities, resources and environment and emphasising self management.

“The model is much more focused on self-support and working with high qualified nurses that have skills in coaching and supporting patients to do the things that they are able to do themselves,” Mr de Blok told AAA.

While the costs per hour are higher from employing registered nurses, savings are made through lower overhead costs and a reduction in the overall number of care hours required per client.

Notably, the Dutch approach represents a challenge to the wisdom of low-skill, low cost staffing models which have tended to dominate health and aged care systems in Australia and overseas by demonstrating how a high-skill professional model can deliver greater efficiency.

The model also demonstrates the benefits of handing control over to the nurses that run the service.

Under the model, Buurtzorg nurses form self-organising or autonomous teams that provide a complete range of home care services supported by technology and with minimal administrative oversight. “The nurses organise all the work themselves, so there is no management structure and no hierarchy,” said Mr de Blok. The small teams of up to 12 nurses work in close collaboration with patients, doctors, allied health professionals and informal community networks to support the patient.

The emphasis on continuity of care and patient-centred care strengthens the quality of client-staff relationships and has been shown to improve both patient satisfaction and nursing staff morale.

“We have received a lot of attention from all sides – from politicians, from insurance companies but mostly from nurses themselves. In every region in the country groups of nurses came to ask us if they could start a team themselves in the neighbourhood they worked in, so they resigned at the other organisation and they have come to work for Buurtzorg,” he said.

Since its development Buurtzorg has experienced rapid growth and currently employs more than 8,000 nurses in the Netherlands, working in 700 neighbourhoods caring for palliative care clients, people with dementia and older people with chronic disease.

Mr de Blok said the model is based on World Health Organisation principles on integrated community-based care and is universal in its application. “In the last three to four years we have had interest from people in 25 countries. We have already started an organisation in Asia for Japan, China and Korea and in the US we have a team in Minnesota and a few years ago we started in Sweden.”

Mr de Blok will deliver a keynote address on the Buurtzorg model at the LASA National Congress, which runs 20-22 October at Adelaide Convention Cen”

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20 Responses to “Going Dutch.”

  1. auntyuta Says:

    Let’s hope they can start in Australia too!

    Liked by 2 people

    • gerard oosterman Says:

      “The (Dutch) model is much more focused on self-support and working with high qualified nurses that have skills in coaching and supporting patients to do the things that they are able to do themselves,”

      Not for profit aged-care already exists in Australia but is still working with untrained or badly trained staff without the clients or patients and nurses having much say in how it should work. It is from the top down.

      Liked by 1 person

  2. rangewriter Says:

    This appears to be a perfectly sensible model. Thanks for passing along the information. I hadn’t heard of it.

    Liked by 2 people

    • gerard oosterman Says:

      Much of the retirement industry also runs along community/privately owned retirement villas within retirement villages that are run by large corporations such as Lend-Lease, Stockland and others. The retiree buys the villa and on vacating it, pays back a percentage to the Corporation of the re-sale price.
      They are mainly geared towards the well-off.


  3. auntyuta Says:

    This is a video about Aged Care Crisis in Australia

    Leading Age Services Australia LASA
    Published on Feb 12, 2018

    Liked by 1 person

  4. shoreacres Says:

    This is a really interesting model. Quite apart from the advantages in terms of patient care, I can see how nurses, too, would be happy with quite a different structure than many (most?) of them work under today — at least, in this country. Beyond that, trained nurses often are as skilled at diagnosis as doctors, and the ones I know have been keen observers — sometimes allowing them to spot changes others miss.

    I’ve absolutely nothing against nurses’ aides or physicians, but nurses (and in some cultures, midwives) have important roles to play, and expanding that role makes sense to me.

    Liked by 2 people

    • gerard oosterman Says:

      Expenditure on health in Holland is one of the highest in the world. Private operators are only given a license provided they remain profit free. As far as I can glean from the Internet. The Dutch system of health seems to be the envy of the world as is their system of everyone entitled to a pension, poor or rich.
      I don’t understand how it is done or how it is paid for, but it seems to work. Social democracies seem to out perform most other forms of democracies, especially in the long run.
      Whenever we visited our mother in Holland after their return from Australia we were struck how well the retirement village worked for her. It was most inclusive of the staff, the other residents and above all the local community with many volunteers being included.

      Liked by 1 person

  5. doesitevenmatter3 Says:

    What a good model! I’ve never heard of this before. Thank you for sharing this, Gerard!
    I hope the information spreads throughout the world. Something HAS to be done.

    Liked by 2 people

  6. bkpyett Says:

    How refreshing to hear that such a positive movement exists. I hope our politicians are amenable and DO something to improve the lot of the elderly! Thanks Gerard for some positive news!

    Liked by 2 people

    • gerard oosterman Says:

      The Royal commission into aged-care will no doubt turn up anomalies and rorting. I would also not be surprised if it will also turn the spotlight on the Government, whereby it will show that the spending on aged-care is woefully inadequate. But, giving tax cuts all the time means less money on health, education etc.
      For the elderly we might do well to start hoarding incontinence nappies, band-aids, commodes etc, toilet paper, just in case things will get even worse.


  7. kaytisweetlandrasmussen83 Says:

    This sounds like a great plan. Maybe something of the sort will get over here some day. As most honest doctors would say “the nurses run the hospitals.”

    Liked by 1 person

    • gerard oosterman Says:

      I hope to stay home and become my own nurse and the same for Helvi. It can’t be that difficult to keep going to and feed oneself, change clothes. There is an organisation called ‘meals on wheels’, whereby the local council drives around providing hot meals to those that can’t be trusted with cooking own meals.
      We shall wait and see!

      Liked by 1 person

  8. freefall852 Says:

    This is from a much longer article I posted on The AIMN back a while..but this part is important to the subject at hand, I think.

    [ Death by a Thousand Cuts, Living by a simple philosophy.

    Or : “Old Ideas, New Australians.”

    Quote :

    “ 1983…Business ………..of Survival.

    With the Death of Richard, I must now manage alone, on one pension.
    The house seems in good condition. No large account, only the small loan I had taken out, which finishes in June 1985. Must try not to take out anymore loans, to(sic) much drain on my low income.

    I must try to live on produce from garden, with eggs to help out.

    Try to cut down on weekly food bills, most of all on meat.

    The animals take quite a lot (money) for food, reg, etc.

    As the fowls are all getting old, must breed up some new hens. “

    That was from a aged pensioner’s diary…sure, we know she was not going to die of hunger or homelessness..or do we?…She certainly was afraid of some vague uncertainty…and therein lies the simple truth..: “A lifetime of habit, creates a certainty of belief ..A moment of uncertainty doubts a lifetime of belief ”. For that lady, her entire life was constructed around hard work…the old-age pension that Labor and the Unions put in place gave her a measure of security so she could live out her final years in dignity…that is a word well worth praising…; Dignity…..Let’s put that up there at the top of the page of Labor Party principles.]

    Liked by 1 person

    • gerard oosterman Says:

      Dignity should be at the very front of aged-care. A reward for having lived a good life. I did not detect much of that during the showing of the ABC Broadcast’s exposure of aged-care.

      It is of little consolation to have featured at the end of the program phone numbers for those that feel they need help with depression or suffer suicidal thoughts. This is another blight on our sunny and cheerful image that we hold so dear about Australia.

      Liked by 1 person

  9. Curt Mekemson Says:

    I like the concept, Gerard. It’s obvious that what we are doing in the US isn’t working. The cost of medical care keeps going up with little, if any, improvement in the quality of the care. –Curt

    Liked by 1 person

    • gerard oosterman Says:

      The costs are going up but if the healthcare goes down it just means the money is siphoned off into the pockets of shareholders. This is what seems to be happening in Australia.
      Profit driven healthcare does not work for better health! It makes for bigger and juicier profits.


      • Curt Mekemson Says:

        Absolutely, Gerard. It is one of capitalisms uglier stories. Sort of like turning the cost of education over to financial institutions. Now we have a whole generation faced with college debts they may have to take years to pay off. It borders on criminal and is the direct result of huge chunks of cash flowing from financial institutions into the coffers of politicians. –Curt

        Liked by 1 person

  10. Big M Says:

    We caught up with a dear friend on Thursday night. She has been trying to organise her parent’s care for the last few years. She initially had the idea that her parents would stay in their own home, with support from community nurses, just to give them their medications and check that they have eaten properly. “No bloody way.” Said Dad.” No outsiders in our home!” It turned out, that when unattended, nearly blind Dad would ride the mobility scooter down the road (not the footpath) to buy icecreams and chips for mum. Demented mum would eat said icecreams and chips for morning tea and afternoon tea, then was too full to be bothered cooking lunch or dinner. A fight would ensue because he was too blind to make a sandwich.

    They are now in a nursing home after paying a deposit of $950000. With an extra $14000 for mum to have direct access to a secure garden. They are of course in adjacent apartments, but she still sneaks in and eats all of his chocolates. Interestingly, this nursing home was featured in the newspapers for various minor breaches of the rules, yet the papers never seem to be able to name and shame the homes where the elderly are slapped around and left lying in their own feculence.

    Liked by 1 person

    • gerard oosterman Says:

      Yes, Big M. There are many ways to skin a cat or the elderly. Of course a stability of the mind is needed to steer oneself steadfastly to the Pearly Gate.

      The body does give up, and in most cases before the mind. It must be awful not to have the presence of mind to be able to keep doing the minimum in feeding oneself together with partner, pay the bills and remain reasonably hygienic.

      Helvi just told me that walking a lot is the best way to prevent Dementia or Alzheimer. It is working as I have yet to find my pyjamas in the fridge or a pancake underneath my pillow. But, one just never knows what lies behind the corner.


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