Geen diatitel

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Gouverneur Kremers Centrum Universiteit
Maastricht

Algemene informatie over de zorg aan mensen met
een verstandelijke handicap in Nederland. Deze
informatie gaat over het huidige beleid van VWS
en de zorgsector, gericht op het realiseren van
Community Care Deze presentatie bevat
achtergrondinformatie bij het college Mensen met
een verstandelijke handicap in het kader van
Blok 3.4 (Psychomedische problemen in de
gezondheidszorg) 05.02.2002 Informatie Wil
Buntinx (W.Buntinx_at_beoz.unimaas.nl)
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Deze presentatie is gebaseerd op een lezing
op AAMR Region IX Conference Building
Community Plenary session Wednesday, November
14, 2001 Langhorne, Pennsylvania The Long Way
to Community Care in the Netherlands Wil H.E.
BUNTINX St. Anna Foundation / University of
Maastricht Netherlands
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Intellectual Disability in the Netherlands
towards community care

• NOOT verstandelijke handicap intellectual
  disability (ID) mental retardation
• Three topics in this presentation
• 1. Policy
• 2. Present State
• 3. Proceedings

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Intellectual Disability in the Netherlands
towards community care

• 1. Policy
• Official Dutch policy Community Care!
• Policy Goals
• Quality of life for persons with intellectual
• disability.
• Enabling persons with ID to live a life of their
  
• own choice.
• Access to tailor made, flexible support in the
  local
• community.
• Participation of persons with ID in the local
• community.

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Intellectual Disability in the Netherlands
towards community care

• 1. Policy
• Official Dutch policy Community Care!
• Policy Targets
• Housing individual or small groups (4),
  normal
• housing conditions.
• Normal school, work and leisure opportunities
• and settings accessible to persons with ID.
• Generic support functions for general needs.
• Specialized support functions (medical,psychiatri
  c,
• psychological, educational) for special
  needs/groups
• available in Centers of Expertise and
  Multifunctional
• Treatment Centers.

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Intellectual Disability in the Netherlands
towards community care

• 1. Policy
• Official Dutch policy Community Care!
• Policy Conditions
• Changing regulations and legislation
• Client based budgets - budget relative to
• intensity of needs - real choice of
• provider.
• Non-discrimination laws (e.g. ADA like
• legislation).
• De-institutionalisation (shift from congregate
  care
• to functional and modular system of support
• provision).

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Intellectual Disability in the Netherlands
towards community care

• 2. Present State
• Dutch ID system characteristics in a nutshell
• High degree of residential placement (50 of all
  
• persons with ID are not living with their
  family or on
• their own 50 are in residential care).
• High degree of institutionalization (66 of all
  
• residential clients are in institutions).
• Group Home alternative to institutions used to
  be
• fairly institutionalized (e.g. groups of
  24) - (34 of
• residential clients).
• Recent implementation of client rights inspired
  
• regulations (BOPZ WGBO Complaint
  Committees..).

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Intellectual Disability in the Netherlands
towards community care

• 2. Present State
• Dutch ID system characteristics in a nutshell
• High degree of professionalization (availability
  of well
• trained and professional staff on all levels).
• Centralized system (regulations funding
  inspection)
• Fair compensation (salaries) and work
  conditions
• under national and field applicable
  arrangements
• between employers and unions (2 years CAOs).
• Categorization of individuals and services.
• Significant waiting lists (old solutions are
  easiest to
• apply).

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Intellectual Disability in the Netherlands
towards community care
2. Present State Facts and figures Population
16,000,000 Number of persons with ID
(estimate 102,100 (persons in any
kind of service program) 7 per 1000 deep and
severe intellectual disability
52,700 moderate and mild intellectual
disability 49,400
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Intellectual Disability in the Netherlands
towards community care
2. Present State Facts and figures Persons in
institutions 35,325 Persons in group
homes 16,937 Respite care homes capacity
140 Day care centers (children) 4,227 Day
care centers (adult) 11,938 Consulting and
social work services 36,195 (Social Pedagogic
Services including referral)
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Intellectual Disability in the Netherlands
towards community care
2. Present State Facts and figures (Residential
population) Age group Institutional Group
Home years 00-19
9 20 20-49 62 73 50 29 7
average 41y 44y
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Intellectual Disability in the Netherlands
towards community care
2. Present State Facts and figures Work force
in institutions 41,032 Work force in group
homes 9,635 Annual costs of institutional
facilities 1,700 Mil. Annual costs of group
homes 392 Mil
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Intellectual Disability in the Netherlands
towards community care

• 2. Present State
• Dutch ID system characteristics in a nutshell
• Relatively high degree of satsifaction with
  present
• service system (parents).
• Low sense of urgence with respect to change.
• Questioning of Community Care solutions by
  parents
• and professionals (Are they better off ? -
  Society
• and communities are not ready to including
  persons
• with ID. ).

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Intellectual Disability in the Netherlands
towards community care

• 2. Present State
• Fairly institution oriented?
• HOWEVER
• By 2001, between 25 and 30 of institutional
  capacity has been transformed into small,
  community housing arrangements (individual, 2, 4
  to 8 persons) and the numbers are growing fast!
• By 2001 most traditional Group Homes have been
  transformed into small appartment and individual
  living arrangements!

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Intellectual Disability in the Netherlands
towards community care
2. Present State Fairly institutional
oriented? If so much is changing towards smaller
facilities, more normal conditions, more
community presence what is the problem?
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Intellectual Disability in the Netherlands
towards community care
2. Present State The more recent Dutch community
oriented residential services however are still
fully part of the institutional / group home
administrative organizations and funding
system. So, there is no real
de-institutionalization but sort of
deconcentration of the institution into the
community. Advantages - Controlled change no
system revolution few extra costs -
Secure for all personnel involved Disadvantages
- Slow proces - Hard to change traditional
culture - No significant competition or
alternatives
from new services in the field
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Intellectual Disability in the Netherlands
towards community care

• 2. Present State
• In the past 10 years we witness considerable
  concentration of provider organizations through
  mergers.
• This doesnt result in downsizing of
  organizations but in growth towards bigger
  concerns.
• Mergers include also merging institutional
  services with group home and day care services.
• Advantage reshuffling traditional functions,
  capacities
• and opportunity for building new services (more
  support
• oriented).
• Disadvantage bigger organization scale leads to
  more
• (budget) control oriented culture and hampers
  client
• and quality oriented (fast) change responses.

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Intellectual Disability in the Netherlands
towards community care

• 3.Proceedings
• Emerging new funding system client based and
  intensity
• of support related budgets (experimental).
• Parents initiatives e.g. 36 houses initiated
  and run by
• parents (serving 237 clients) by Januray 2000
  and 75 more
• underway.
• Downsizing institutional campuses while
  maintaining
• residential capacities deconcentration.
• Establishing a new referral system (independant
  of service
• system).
• Reducing waiting lists (still a problem).

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Intellectual Disability in the Netherlands
towards community care

• 3.Proceedings
• Experts are now usually employed by the service
  and part
• of the service organization (residential or day
  care). This
• pattern is now changing
• Emerging regional Centers of Expertise for
  regional
• pooling of expert capacity and specialties.
• Emerging regional centers for treatment of
  persons with
• severe behavior problems.
• Enhancing Support orientation (instead of
  traditional Care
• orientation).
• Increasing opportunities for supported
  employment (still
• incompatibilities between SSI and right to
  paid work).

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Intellectual Disability in the Netherlands
towards community care

• 3.Proceedings
• Enlarging the number of persons in supported
  living
• arrangements (now predominantly persons with
  mild ID).
• Increasing participation of persons with ID in
  normal
• school system (still restricted number).
• Traditional administration, tracking and
  feedback systems
• (registration, bookkeeping, data bases) fail
  to reflect
• present changes in service delivery.

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Intellectual Disability in the Netherlands
towards community care

• 3.Proceedings
• Problems
• Aging (pushing waiting lists).
• General needs generic services (housing,
  health, income)
• Special needs special services (treatment,
  support).
• Generic services are ill-prepared to the new
  population.
• Inclusion in Work settings is slow (labor market
  is
• developping towards more knowledge oriented
  and
• technology based tasks / attitudes).
• Increase in employee turnover (towards 15 -
  20)

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Intellectual Disability in the Netherlands
towards community care

• 3.Proceedings
• Problems
• Concern about losing experts and expertise as
  the
• residential centers (institutions) are being
  replaced by
• community care settings (as has happened in
  Scandinavia).
• The new policy towards Quality of life and
  Inclusion
• requires a different culture of the service
  system and
• simply more money to attain the goals of equal
  
• opportunities, especially for persons with
  multiple and
• severe disabilities.
• Organizational and management models of
  services
• (combining flexible individual oriented
  services with large
• organizations)

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Intellectual Disability in the Netherlands
towards community care

• 3.Proceedings
• Shifts
• Positive shift towards Quality of Life.
• Positive focus on the individual and on needs of
  support.
• Public image of persons with ID is diverse but
  not
• necessarily negative.
• Studies show positive achievements of inclusion
  as well as
• problematic situations (social integration in
  the community
• is much more difficult than physical and
  functional
• integration).

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Intellectual Disability in the Netherlands
towards community care
Thank you Voor meer informatie W.Buntinx_at_beoz
.unimaas.nl