geriatrics in Belgium

Hospital care in Belgium

  • 03-1945: first regulation for diagnostic and treatment centres.
  • Many units filled with “older people staying for the winter”: no reimbursement after 6 weeks;
  • 1959: expert commission (Dr.Cleerens, Dr. Verbeke….)
  • New discipline is urgently needed: geriatric medicine and units “G”
  • Discussion “geriatric hospitals” or “Geriatric departments in General Hospitals”

Min. Decision 03.10.1963

  • Prof. De Schouwer and Dr. Simon
  • Departments of Geriatrics and Rehabilitation “R”
    • “G” =/= “C”
  • 0,5 beds “R” / 1.000 inhabitants (!!) = 5.000 beds
  • Norm 24 beds per unit (instead of 30)
  • 9.000 V-beds (long stay)

Min. Decision 03.10.1963
AND HOW EVERYTHING GOES WRONG……..

  • Negative attitude against older persons..
  • Planned 5.000 beds never reached…
  • Rehabilitation of hip fractures….
  • Rehabilitation after myocardial infarction..
  • Reserve beds for amygdalectomie, polypectomie in children….

1976: advice from National Commission programmation of hospitals
Based on:

  • Opportunity reasons
  • Performance reasons
  • Medical Manpower supply

“R-Departments” have to be reconverted in Departments for rehabilitation by Med.physiotherapists, orthopedics, etc.

1980 - Reaction of Minister D’Hoore
“The R-departments have a geriatric destination...”

1981

  • R-departments: low profile of nursing, no social workers, no psychologists, no rehabilitation for the ADL, meals in bed, rarely back to home, 33% of patients younger than 60 years..
  • V-departments: most younger patients, 33% stays less tha 30 days; a lot of activity of laboratory and X-ray; 40% needs no nursing care…
  • No nursing homes, only residential houses, with very little staff, but many heavy patients

Memorandum BSGG 27-02-1982

  • Full attention for the 80-85 ++
  • With multiple pathology
  • Central place of the GP in the care of the older persons (need for better education)
  • Diagnostic nihilisme in the elder patients: too much care and not enough diagnosis and therapy and rehabilitation; too much unnecessary placements
  • Specialised geriatric units: 40 to 50 % patients can go back to home (if admitted directly and acute in the unit)
  • Multidisciplinairy working
  • An unit integrated in the general hospital, with all possibilities of it;
  • Internist with special competence in geriatric medicine
  • Internist with special competence in geriatric medicine:
    • 1.knowledge of presentation of diseases in the leder persons and their therapy
    • 2.knowledge in the therapeutic possibilities of nurses and paramedics
    • 3.knowledge of psycho-social aspects
    • 4.knowledge in the organisation of a geriatric unit
    • 5.knowledge in the theoretical bases of gerontology
  • Necessity to develop geriatric medicine at the universities
  • Needs for special education of paramedics
  • Financial improvement of this medical activity
  • Necessity to create nursing homes

Evolution after this memorandum

  • 1982: creation of nursing homes
  • 1984: creation of G-Departments (suppression of R-depts)
  • 1985: creation of the internist with special competence in Geriatrics

Geriatric Department
General:

  • Unit in a general hospital for diagnosis, treatment and rehabilitation
  • Direct admissions or sec. from other units (be aware of the possible invalidating effect)
  • acute and subacute spec. care,
  • Mean age > 75 years
  • Active treatment for quick release with optimal restored physical, psychological and social potentialities;
  • Mean length of stay less than 3 months;
  • The Unit needs to dispose ON SITE of all what is needed to fulfil these goals

Architectonic requirements

  • Fitted for wheelchairs,
  • Possibilities for rest in the corridors
  • Min. 24 beds per unit
  • Restaurant, room for group exercises, living, etc.
  • Home-like furnishment

Functional norms

  • Nusing: high-low-beds, anti-decubitus, nightcommodities, wheelchairs, ambulators, etc.
  • Kine: bicycle for exercise, exercise stairs, parallel bars,
  • Ergo, logo,
  • On the admission day: notation in the records of all relevant medical, social, paramedical and nursing figures
  • Evaluation of chances going back to home or to a home-like situation
  • Treatment scheme
  • Correction of this plan according the evolution of the patient
  • Weakly team conferences with notes in the patients record

Organisation requirements

  • Head: an Internist with special competence in geriatrics
  • Can ask in consultation the other specialists when needed
  • One certified nurse has to assure the continuity of care
  • Physiotherapist, OT, Speech therapist, social worker, etc
  • A positive psychological climate
  • Eating as much as possible in the restaurant of the unit,
  • Physio and OT in group
  • Socio-cultural activities

Actual situation

  • Geriatric department in every general hospital (120)
  • 260 internists with special competence in Geriatrics (5 + 1 year)
  • 30 training places for geriatrics
  • 50.000 places in Nursing homes
  • Residential houses
  • Service flats
  • Short stay places
  • Geriatric Day centres

Geriatric Care Program
Future

  • Optional
  • For a patient with geriatric profile
  • Elements:
    • Geriatric unit
    • Geriatric outpatients
    • Geriatric day hospitals
    • Intern liaison
    • Extern liaison

Medical organisation

  • At least 1 FTE internist-geriatrician
  • Directed by internist-geriatrician

Nursing organisation

  • At least 16 FTE / 24 beds
  • GDH 2,10 FTE / 6 places
  • Reference Nurse/hospital unit

Others

  • Social worker
  • Physiotherapy
  • OT
  • Speech therapy
  • Psychology (gerontology)
  • 5 functions - 4FTE / 24 beds

Internal Liaison:

  • Has to be available: all functions, with 1 FTE for each geriatric admission, calculated with the formula: N = N70-74*0,45 + N75-79*0,65 + N80-84*0,75 + N>84*0,95

Intern liaison

  • Reference nurse try to give a signal for every patient with geriatric profile
  • Full attention to find the geriatric patients at the emergency departments.

Extern liaison:

  • Integrated services for home care and with Circles of GP
  • Nursing homes, residential houses, etc
  • Day Care Centres

Quality norms

  • Register of agreements
  • Weekly multidisciplinary team
  • Directed by a geriatrician
  • Follow up of Quality: College of Geriatrics

Actual Situation

  • 120 general hospitals (only a few exception without a geriatric department)
  • 250 geriatricians in these hospitals
  • In nursing homes: each patient keeps his own G.P.; one of these GP is a coordinator for the general policy.


In nursing homes: each patient keeps his own G.P.; one of these GP is a coordinator for the general policy.

Developments in Geriatric Medicine

  • October 2003: agreement by the High Council for an independent speciality “Geriatric Medicine”: with training:
    • 3 years internal medicine
    • 3 years geriatric medicine

PUBLISHED IN THE OFFICIAL JOURNAL: on 19-08-2005.      
 

Contacts in Belgium

Prof.

Didier Schoevaerdts

didier.schoevaerdts@uclouvain.be
Dr.

Margareta (Greet) Lambert

Margareta.Lambert@azsinjan.be
+32 504 531 60