‘Digitalisation makes the care more personal’

‘It was a difficult period for our clients’. Speaking is Monique van Doorn. She’s managing director of Zeeuwse Zorgschakels [Zeelandic carechains]. This organization is responsible for support of people with dementia. With more than 40 case managers specialized in dementia, they support more than 200 clients in Zeeland.

Casemanagement dementia

Monique van Doorn
Monique van Doorn

These clients live at home and deal with the challenges of organizing a life with dementia. Things that used to take no effort become increasingly difficult and their environment does not understand what the condition entails. Generally, a need for care develops. These factors make that there is a lot to be dealt with and create the need for information and support. The casemanagers at Zeeuwse Zorgschakels help in this. They regularly get in touch with the clients and their caregivers, and guide them through available care. This contact, often in the form of house visitation, is the core-business of Zeeuwse Zorgschakels.

People that benefit so much from regular contact and are searching for new connections must be strongly affected by the lockdown? ‘Indeed’, van Doorn says. ‘The crisis had, and still has, a large impact on the visitations’.

‘The case managers immediately started using video calls, often with clients but also with caregivers’. The use of video calls with the people surrounding the clients was very effective: ‘You saw the connections with caregivers and family grow more intense. It became easier to get in touch with the children [of the clients], also when they are living abroad. The same goes for contact within the chain, such as with general practitioners, district nursing, welfare work and daycare centres.

The contact with clients was more challenging. ‘When connecting with them, we mostly used conventional telephones.’ These phone calls helped people to maintain structure and rhythm, which was highly needed. ‘Not just our visits were cancelled, but also the daycare for a lot of our clients. In a sense they were isolated from society to protect them, to not get ill. In the meantime a lot of them got more ill because they lost their routine and structure.’ During the first two months people seemed to be carrying on, but after that more crisis situations developed. We saw the rate in which dementia developed in people increase. fortunately by that time we were almost ready to get back to doing visitations.

Learning networks

Aside from case management dementia, Zeeuwse Zorgschakels facilitates three learning networks. It supports organizations and professionals in sharing and generating knowledge around dementia, palliative care and traumatic brain injury (TBI). Building connections is their core activity, and encounters play a key role. What was the impact of the lockdown on this ambition?

‘The impact here was less drastic, because we work with professionals who are equipped with digital conferencing means. Of course it took some getting used to, and it still does; meeting is more than talking online. But the needs of the crisis gave an enormous boost to opportunities to meet online. Employees also saw the benefits: some meetings are easier now, and that saves time.

When it comes to sharing information, digital platforms present great opportunities. Within the Zorgschakels, Breinlijn [brainline] might be the best example thereof. For treatment complex cases of TBI professionals depended on the knowledge of the network of the coordinator and a few exports. There is a digital platform for collaboration of brain injury experts now. Answers to questions that were tackled earlier are available for both professionals and clients. ‘In the palliative care network, there’s a consultancy team for professionals. The opportunity of using a knowledge base like Breinlijn to spread knowledge can also be explored here.

‘There are long-term challenges here, and Zeeuwse Zorgschakels monitors national developments and joins in where possible. We part of the forefront in the development of Breinlijn. Learning networks depend on the creativity that mainly develops through encounters. Van Doorn sees how this slightly decays when video calling: ‘we need to develop skills for online meetings, for example by alternating video calls with in-person activities.

An example thereof is the Zeeuwse Zorgschakeldag: ‘This was an event, adjusted to meet the requirements set by RIVM. We chose for a hybrid form with a webinar that a lot of people could attend, and four smaller events throughout Zeeland. In the end we unfortunately had to switch to a completely online event. Because of a professional setup and competent technical support we managed to keep almost 300 attendees engaged. These kinds of events are helpful in determining what is and isn’t possible online. We need to ask ourselves those questions again and again.’

DigiVitaal Zeeland

Monique van Doorn and her colleagues have been working according to the Social Approach Dementia for a while already. ‘It’s about meeting the people for as long as that is possible. Besides the medical story, dementia is mainly a social story.’

The crisis emphasized the need for digital care. This led to the start of Social Approach Digital. In this programme people with dementia were given an easy to use tablet. The available apps are developed for people that have difficulty switching between tasks, and have difficulty dealing with a lot of stimuli. People can look at pictures, video call, or watch television. ‘It’s about strengthening encounters through digital means’. That way, people stay more involved for longer with normal life. 

This was started in spring 202 with a first group of 15 people on walcheren, and it will be extended to other parts of the province as part of the bigger program Digivitaal Zeeland. This program also contains other instruments, for example to guide caretakers. In Terneuzen and the OosterSchelde region, they already started with the project Partner in Balance.

‘Until recently we regularly organized “classes”. Caregivers meet up five to six evenings or afternoons to talk about their experiences and to learn how to give substance to a life with dementia. In Partner in Balans, developed by Maastricht University, professionals are trained to coach caregivers and to teach caregivers the skills they need. The original class content can be lined up with individual needs, and provided services are adjusted to the situation. Caregivers don’t need to wait until a class starts in their neighborhood,, but can immediately use the website and choose the modules they need together with their coach. Modules cover dealing with dementia, symptoms and a range of practicalities. This makes the offer more personal, and it can be used at a time that suits the caregiver.

Future

The first steps towards implementing digital tools have been taken. How does Van Doorn see the future? ‘I think there are opportunities to use the new tools to increase the autonomy of the client.’ The visitations are currently used to determine how people are doing, and help them to organise the right support. Digital tools can help with that. If we provide tools to tell stories about what people have eaten, or about the people that visited, this creates an activity for the people on the one hand, while on the other hand providing insight in how people spend their time. 

‘We have gotten used to saying that the client should be the point of focus. This puts me on my guard. It shouldn’t be the customer first, but the perspective of the customer should determine the full guidance and care. This demands a culture change: To go along with the customer. At their, and their surroundings’ pace. This is a big challenge, because it means that standardization requires adjustment. If you have a hundred clients, can you walk with a hundred people and guard everything? No, that’s impossible. 

‘Digital tools can help the people and the professionals to walk together at the same pace. With the Social Approach Digital and Partners in Balance, we take the first steps.

‘Digitale instrumenten kunnen de mensen en de professionals helpen om wel meer op maat mee te lopen. Met de Sociale Benadering Digitaal en Partner in Balans zetten we eerste belangrijke stappen.’

More information (in Dutch): 

Zeeuwse Zorgschakels

Zorgschakeldag (conversation with Anne-Mei Thé)

Breinlijn