Author: leydenacademy

“Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally, in the service of self-understanding and wisdom.” – Jon Kabat-Zinn

Mindfulness have been shown benificial in a lot of cases, amongst other:

• reduces pain
• lowers blood pressure
• increases self-awareness and focus
• improves your ability to solve problems
• decreases feelings of loneliness
• generally increase well-being

Visit the free public introduction to Mindfulness on July 26, 13.00 till 14.30 hours. By Berit Lewis, author of the book Ageing Upwards. Berit is an experienced and accredited Mindfulness Teacher, who has carried out research on mindfulness and ageing in cooperation with Leiden University Medical Centre (LUMC) and Leyden Academy.

Location at Leyden Academy on Vitality and Ageing, Poortgebouw, entrance Zuid, room 0.15. Rijnsburgerweg 10, 2333 AA Leiden. Also accessible online.

For whom and registration?
Everybody is welcome. After all, the earlier we start with mindfulness, the more years we will benefit from it. You can register by mailing your name to info@leydenacademy.nl. Please indicate if you would like to join live on location or prefer to follow the lecture online (Zoom link will follow after registration).

TOWARDS AGE-FRIENDLY POLICIES

The governmental COVID-19 policies worldwide reflect the national levels of economic and political development, and the cultural contexts for implementation. Furthermore, they are closely linked to the national policies on aging and long-term care. As a result, the COVID-19 policies lead to highly varied results worldwide. In the Netherlands the measures that were introduced, were accompanied by public discourses that were questioned with regard to their ageism, including so-called compassionate ageism. This type of ageism, implicit and difficult to detect, is based on the perception of older people as warm and likable but nonetheless incompetent and helpless. Literature points out that many policy measures that were intended to be age-friendly and to protect older people, turned out to be inherently ‘ageist,’ demonstrating a paternalistic behaviour toward older people by labelling them collectively as vulnerable. These findings underline the necessity to assess the age-friendliness of policy measures in times of crisis.

WHO framework
Protective measures that were taken during the COVID-19 pandemic, targeted older people as an at-risk group. How did older people in the Netherlands experienced the COVID-19 measures and policies introduced by the Dutch government? In our study we used the framework for age-friendliness of the World Health Organization (WHO), who define age-friendliness as ‘encouraging active aging by optimizing opportunities for health, participation and security in order to enhance quality of life as people age’. The framework allows for a broad assessment of the COVID-19 policies, as it incorporates eight areas: outdoor spaces, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community and health services. We focused on the experiences of 74 older Dutch adults in the first and the second wave of the pandemic, to find out the impact in the earlier mentioned areas, and the lessons which can be learnt to better respond to a similar situation in the future.

Age-friendliness
The term ‘age-friendly’ is well-known in the Netherlands, among local policy makers, academic researchers, social- and care professionals and older people themselves who take part in the participatory research projects. Several Dutch cities already joined the WHO’s network, and by now several areas of age-friendliness have been incorporated in local policies. This study helps to understand whether age-friendliness has been incorporated in the Dutch governmental policy during the COVID-19 pandemic. The Dutch COVID-19 policies were predominantly developed on the basis of information provided by (bio)medical experts. The response of the government took time, which generated public critique, given the high death rate among older people, increased loneliness and limited freedom due to the lockdown.

Key points
The results of our analysis indicate that older people feel negatively affected in the areas of social participation, respect and social inclusion. Furthermore, the measures concerning communication and the health services were experienced as age-unfriendly. An important underlying issue of the COVID-19 measures is limitation of individual autonomy. The following key points can thus be made:

• A crisis such as a pandemic requires policies, based on interdisciplinary and experiential knowledge.
• Policies directed at older people can be experienced as ageist if the heterogeneity of that group is not considered.
• Policies directed at older people will benefit from examination within the WHO conceptual framework of age-friendliness ex ante and ex post.

From: Toward Age-Friendly Policies: Using the Framework of Age-Friendliness to Evaluate the COVID-19 Measures from the Perspectives of Older People in the Netherlands. Journal of Ageing & Social Policies, March 2023. Elena Bendien, Miriam Verhage, Jolanda Lindenberg, Tineke Abma.

In a transition from paternalistic to democratic care, Dutch nursing homes are expected to concentrate on the well-being of their residents and to align care with residents’ signifcant others. Although this way of working is affrmed in nursing home policies, care staff experiences diffculties with providing democratic care in practice. In co-creation with care staff (n = 110) throughout 11 nursing homes in the Netherlands, we therefore developed the enjoying life approach, plan, and training program. A responsive evaluation was completed including observations, conversations during and outside training sessions, and semi-structured interviews with care staff, residents, and signifcant others (n = 81). The enjoying life approach values the participation of all people involved in the care process and strives for person-centered care by learning from each other through sharing narratives and building personal relationships. This is in line with democratic care’s notion that good care starts in the lifeworld of care receivers and is the result of an intersubjective dialogue between care receivers and their caregivers. In this chapter we present our learning experiences with the enjoying life project and discuss implications for the democratic potential of organizations. We show that the participation of residents and signifcant others within the care process can lead to a mutual understanding of what is deemed “good” in a specifc situation. However, this requires the cultivation of an organization culture wherein different and sometimes conficting perspectives on what good care entails are acknowledged and a space is created to engage in dialogues about good care.

This is an abstract of chapter 3: ‘Democratic Care in Nursing Homes: Responsive Evaluation to Mutually Learn About Good Care’ by Marleen Dohmen, Josanne Huijg, Susan Woelders en Tineke Abma, which was publicshed in the book ‘Institutions and Organizations as Learning Environments for Participation and Democracy’, University of Innsbruck, Springer, January 2023.

Older women play an important role in providing care in our society, and there is a growing group of older women who are demonstrating leadership and being active in their local communities. Elena Bendien and Tineke Abma argue that traditional images of older women as caretakers limit women’s opportunities to give meaning to their own lifes. Even if women are given equal rights, the persistent image can limit women. We need to stop thinking of older women as grandmothers, informal caregivers, or nannies for the grandchildren. We need alternative roles and images to inspire new generations and create a much richer range of roles to suit the talents, creativity and aspirations of older women.

“We’re not just old women volunteering invisibly. I want people to see what we’re doing and what we can still do. I want people to understand the kind of power we represent.” Susan, age 67

Bendien and Abma wrote a chapter about it for the book Older Women in Europe – A Human Rights-Based Approach by Isabella Paoletti, about the strength, freedom, tenacity, determination, resilience, independence, social and political involvement of older women. The authors who contributed to this publication ask that space be made for the elderly and elderly women in particular. How will society tackle discrimination based on age and gender? How should work situations change to support older workers and older women in particular? How should the pension system change? The book takes a human rights-based approach and provides valuable insights for a wide range of human rights activists, professionals, policymakers and social scientists.

Today Leyden Academy welcomed a small delegation pre-medical students from Union College in New York. The students are currently touring the US, Canada, the UK and the Netherlands for an impression of how health care is structured in the various countries. In our country, the tour included amongst others visits to hospitals, a health centre, a centre specialising in physical and mental disabilities and an interview with a general practitioner. The goal is to provide students with an exposure to the different types of systems alongside an emphasis on teaching them how to compare and analyse the strengths and weaknesses of each model. Some issues are looked into in depth, such as how each system deals with decisions about allocating resources, regulating and managing costs, dealing with end of life issues, and supporting programs to improve public health.

At Leyden Academy, some of these topics were discussed. PhD candidate Miriam Verhage provided the students with an introduction to the mission and research projects of Leyden Academy as well as on the structure and financing of health care in the Netherlands. Miriam also gave a brief insight on the future of the Dutch method of care, on the impact of COVID-19 and on the care for vulnerable older populations.
The topic of the presentation of Lucia Thielman, researcher at Leyden Academy, was ‘Care for older people in a transitioning society’. In recent years the Netherlands has transitioned from a welfare state to a participation state. Within this transition care for older adults has changed from care provided in nursing homes to care provided at home. In addition, care is now more often being provided by informal providers in collaboration with formal care provides such as the primary care doctor.
Furthermore, the students got to experience what it feels like to be old, by wearing the ‘ageing suit’. Including shaky hands, unsteady feet and limited eyesight due to glaucoma or diabetic retinopathy, depending on the glasses you choose. A true eye-opener…

On May 10, 2022, the conference ‘Enjoying Life Approach on location’ took place in Arnhem (in the Netherlands), as a completion of the eponymous project. Marieke Braks, director of long-term care at VGZ and host of the conference, said that the first steps in the project started with a cup of coffee and that she is proud of what has been achieved since then, with all those involved. Tineke Abma, director of Leyden Academy and professor of Elderly Participation at the Leiden University Medical Center, then discussed good care and care ethics: 1) it is very personal, 2) it is a reciprocity, in coordination with residents and relatives, and 3) it starts with attention and insight into wishes and desires.
In addition to ‘attention’, according to Theo van Uum, director of Long-term Care at the Ministry of Health, Welfare and Sport, ‘trust’ is also a key word. He finds the Enjoying Life Approach an inspiration that puts the elderly in control, and he believes the scalability of the approach is promising. However he indicated, we must be aware of, on the one hand, the growing number of people with dementia (from 300,000 to approximately 500,000 in 2040 in the Netherlands) and, on the other hand, the shortage on the labour market.
After the plenary part, the participants discussed in various workshops subjects related to person-oriented care.

“Two years ago I mainly focused on carrying out the care tasks. Everything has changed since we focus on person-oriented care. That has done a lot to my job satisfaction. Even though we have a route, it no longer feels like a list I have to work through. I just enjoy doing it now.” – Employee

Book about person-oriented care
As a result of the project, a book (in the Dutch language) has been made, packed with striking photos, experiences, stories and practical tips. Tineke indicated that she is pleased with the fact that the project has been anchored in practice. She handed over the first copies to elderly care employees Wendy van der Ven and Gwendolyn Graven and asked them for a reflection on their experiences with the Enjoying Life Approach. Wendy: “You ‘see’ each other and share with each other. You need each other and everyone is valuable; residents, relatives, and employees.” Gwendolyn: “It is a process, it is never finished. You have to get to know each other and give each other space, even when you face dilemmas.”

“Last summer it was my birthday. The nurses bought a present, which they let my mother give to me. I thought that was so wonderful. My mother really feels at home at the care facility. The care employees and the residents have really become family to her. I’m not the most important person to her anymore. And I don’t mind at all.” – Relative

A film with love
What we can’t express in words, needs to be experienced. That’s why we made a short film ‘With love’ (also in Dutch), which premiered at the conference. ‘With love’ follows Piet and Annemarie and her Bernard, and shows the person behind the resident: attention gives recognition. In the film you can see that employees provided a hook-up bed, so that Bernard can stay with his wife every now and then. And Piet gets emotional by a Doodle board that a care worker made for him after a pleasant conversation and a dance.

“I think it’s important that have good contact with the nursing staff. That you can rely on them and that they keep to their promise.” – Resident

Action research
Implementing the Enjoying Life Approach in practice is not easy: there are sometimes (practical) objections between dream and deed. From 2019 to 2021, the action research focused on the training and coaching of employees as well as the redesign of the electronic client file, work processes and accountability frameworks at two elderly care organisations.
The research was supervised by Leyden Academy and supported by the care offices of Menzis and VGZ, the Ministry of Health, Welfare and Sport, the Dutch Healthcare Authority, the Health Care and Youth Inspectorate, and the KIK-V program of the National Health Care Institute.

“We had a lady who absolutely did not want to be showered. Every time it was a fight. The family could hardly believe it. The son was invited to attend once. It turned out that Mrs. did not want a stranger to help her in the shower, but that she enjoyed it when her children did it. From then on the children helped her shower. For them it was a nice way to make contact, for the staff it was a relief.” – Manager

The Netherlands Scientific Council for Government Policy (WRR) recently put a magnifying glass on elderly care in four countries: Japan, England, Germany and Denmark. One of the researchers is Tineke Abma, professor of Participation of Older People at the Leiden Medical University Centre and Executive-Director of Leyden Academy on Vitality and Ageing. What lessons can be learned from this research?

Why research in these four countries?
Tineke Abma: “These are countries with a similar demographic structure as in the Netherlands: an increasing group of older people and a shrinking younger working population that can take care of older people. In addition, these are countries that differ in the way in which they have organized healthcare. England is market oriented. Denmark is an egalitarian society where mainly local governments direct long-term care. Germany has a hybrid model just like us. Here, both the government as well as the market determine care, and the civil society plays an important role. Japan is interesting because it is a ‘super-aged society’ like no other country. No fewer than 86,000 people of 100 years and older live there. The respect with which older people are traditionally treated also makes that country interesting.”

Three dimensions of sustainability
The issues facing us as an ageing society in the field of elderly care are complex and difficult to solve, Abma emphasizes. One of the most important conclusions that she and her fellow researchers draw is: when you develop policy, you have to keep an eye on the balance between three dimensions that play a role. These concern:

• Financial sustainability: will healthcare remain affordable for society and for individual citizens?
• Personnel sustainability and quality of care: is there sufficient care personnel, and is the staff qualified to take care of the well-being of older people?
• Societal sustainability: is there support and trust for health care policy?

England
Abma: “There should not be one of those three dimensions dominating the policy for long-term care. Then things can go wrong, as in England where the financial dimension has come to dominate. This leads to a disbalance compared to the other countries. In England there is no broad societal support for the long-term care policy, on the contrary we saw a lot of social outrage and discontent regarding the long-term care policy. For regular and acute healthcare, the English people are insured through taxes and the National Health Service. That is well arranged. But long-term and social care, has for a large part being been privatized. People have to take out additional insurance for this, but a majority of the population doesn’t know that. This leads to a situation wherein older people out of necessity stay longer at home to save costs, resulting in a situation where they do not receive the care needed, or end up in hospital when a crisis occurs. Another consequence is that if they have to be admitted to a nursing home, many of them have to sell their house. Kings Fund College referred to the situation as ‘The road to nowhere,’ because the problem has been known for more over than thirty years. Politicians have promised to resolve the issue but nothing has happened yet..”

Denmark
England is therefore not a shining example for the Netherlands. Denmark is, says Abma. This brings her to a second important conclusion: the importance of developing a global long-term vision for long-term care for the older population. “Denmark has had a law since 1891 stipulating that care is provided locally in the community. Community care is grounded in the notion of ‘ageing in place’, and community care includes physical care as well as prevention, domestic care and social care. This long-term vision ensures stability and societal sustainability, because for over a decade Denmark followed the principles of community care. New policies are always in line with the underlying vision of ageing in place, such as the home visits and reablement program, and therefore recognizable for the general population. Moreover, the values on which the community care policy is based are in line with the values of the egalitarian and democratic culture of the Danish country. One of their remarkable features for working women is the good childcare and professional support for the older population which is provided. Informal care is therefore kept to the minimum.”

The Netherlands
Abma disapproves of the situation in the Netherlands, compared to the Scandinavian country. She recalls the great transition of 2015. The Exceptional Medical Expenses Act (AWBZ) disappeared from one moment to another, without a careful and proper preparation and information and communication to the general population. The Long-term Care Act came into being, as well as the Health Insurance Act and the Social Support Act. Abma: “It was a shame, of course, to phase out all those nursing and care homes, without at the same time investing in care and support in the local community. That is happening now, but we are very late with that. The challenge we face right now is how to facilitate the local collaboration between healthcare providers and social care and support services in order to attend well to the needs of the older population.”

Supermarket
“It is therefore extremely important to invest massively in local care and support networks to foster ageing in place. This should be in joint collaboration with the local communities, mobilizing their sources of resilience. Also, we should acknowledge that healthcare alone cannot resolve the challenges we face. This is a societal issue, and we need everyone in our society to develop a sustainable future, such as social workers, housing corporations, and all kinds of services older people need in order to thrive.” Abma also emphasizes the importance of unexpected coalitions in this regard, for example the collaboration between care, welfare and business companies. “The local supermarket for example can be of importance by keeping an eye on older people and jointly building up local communities. One may also think of social designers and artists who want to contribute and develop a sense of belonging in a community.”

Men and cars
The point is that our society is not designed for older people, according to the professor. “It is mainly geared to dynamic, young and fit people, and productive work. Just look at the infrastructure. It’s based on the husband taking the car going to work. Why are the sidewalks so narrow everywhere? That is residual space in this view. While wide sidewalks are important for older people, but also for children and people with disabilities. Everyone thrives in an inclusive age-friendly society.” Looking through the lens of age-friendliness may help to re-envision our society as a place for human flourishing.

Step by step
The future of care for the older population and of policy making is a complex and wicked issue, as Abma stated earlier. It is wicked, because many stakeholders are involved, with different interests and visions; the multiple dimensions, including ethical, political, economic and cultural dimensions; the entanglement with other issues like the emancipation of women, economic crises, political destabilization, migration; and because much is uncertain, hard to predict and out of control. That is not to say that it should paralyze us; that we no longer know where to start. In a complex society like ours we should not want to make master plans as if everything can be predicted and controlled. Such a strategy simply does not fit the nature of our postmodern situation. This does not mean that we can do nothing at all, or follow a laissez faire strategy. “It is much more wise and sensible to give up the high ambitions and notions of full control, and start with relatively small actions, with small wins. Starting by building relationships of trust with community partners, mobilizing their sources of strengths, and by learning-by-doing, building in feedback loops. In this way we learn step by step how we can shape an inclusive society.”

Community
The point is that our society is also similar to the one in England where the emphasis is on the individual, Abma adds. “We still think too much in terms of: ‘there is an individual client who has a problem, a solution has to be found.’ It is much wiser to learn to think in terms of relationships, networks and communities, and to stimulate social cohesion. There are so many sources of resilience in the community, and people who are willing to contribute to society, just because it makes them feel being meaningful.”

The Dutch version of this interview was published in the magazine ‘MOVISIES’ in March 2022.

In Amsterdam, the number of seniors who need care is increasing rapidly. A large part of this growth is taking place among older people with a migration background. This group of seniors is not only getting older and more in need of care, but is also increasingly diverse. This demographic development brings important questions: How great will the demand for care be in the near future? And how can we meet the diverse care wishes and needs of older people with a migration background?

Large diversity
At the moment there are many (culture) specific facilities aimed at different target groups; think, for example, of small-scale living for seniors with a Surinamese background or daytime activities for seniors with Turkish or Moroccan descent. There are good reasons (such as language and religion) that make culture-specific care desirable. However, research and mirror discussions show that all kinds of bottlenecks are experienced in meeting expectations, needs and wishes in this culture-specific care. Moreover, the wishes and needs of older people with a migrant background are just as different as those of older people born in the Netherlands. There is also great diversity within equal migrant groups, in which other characteristics (such as education and income) can play a more decisive role.

Quantitative and qualitative research
We investigated the (future) demand for care with the help of register data from Statistics Netherlands. This shows that the demand for long-term care among older people with a migration background will increase in the future. The strongest increase is expected in the demand for long-term care that falls within a mix of personal budget, full package at home and modular package at home.

We also talked to 66 people with a migration background about their ideas about care, now and in the future. They indicate that they consider it important that the quality of care is good, for example when it comes to care-technical actions, cleaning and hygiene and the supply of (diverse) food. They find it essential that care is person-oriented and relational. Language must be taken into account and there must be room for religion. In the future, they want to live independently at home as long as possible. If that is no longer possible, the wishes are diverse: ranging from (paid) informal care to home care to a stay in a nursing home.

Intervention and knowledge dissemination
After this first phase (research), we will develop a concept intervention (phase 2) and test it in five locations of the participating healthcare organizations (phase 3). Finally, in phase 4, we will permanently place the information and skills obtained in care and support, and make them accessible to everyone. We hope that this will improve care provision in situations in which cultural differences play a role, and that the quality of care and satisfaction will increase.

Would you like to know more about this research project? Please contact Nina Conkova at conkova@leydenacademy.nl.

The Healthcare Clowning International Meeting (HCIM) brings together all the people who are part of the life-changing picture of healthcare clowning, who connect worlds, connect people and change spaces.

20-22 April 2022,  the Fokker Terminal in The Hague
​
We find ourselves in an extraordinary moment in time. We are more aware than ever how important human contact and connection are to our wellbeing. This meeting aims to nurture and strengthen this vital work.
Experts from all over the world look into the world of healthcare clowning. HCIM will approach the field from different angles including: impact and our role in  society, the art of clowning, innovation and online opportunities and fundraising.

From Leyden Academy, professor Tineke Abma is a keynote speaker and Barbara Groot en Lieke de Kock are panelists.

Below a short interview of moderator Laura Koppenberg with keynote speaker Christopher Bailey (Lead of Arts & Health at the World Health Organization). He explains how clowns create a magic space where connection is possible. How they see people where they emotionally are and take them on an amazing journey, wherever it might lead.

 

More information or registration? Go to www.hcim2021.com.

“I was emotionally very affected by the despair of a resident who had to be isolated in his room. I found it difficult to be confronted with such visible suffering. Especially since there wasn’t much I could do besides lend an ear and be physically present. I sat in the office and cried for a while afterwards.”

Due to its major impact on Dutch care homes for older people, the COVID-19 pandemic has presented care staff with unprecedented challenges. Studies investigating the experiences of care staff during the pandemic have shown its negative impact on their wellbeing. We aimed to supplement this knowledge by taking a narrative approach. We drew upon 424 personal narratives written by care staff during their work in a Dutch care home during the first year of the COVID-19 pandemic (March 2020-Januari 2021). We published our findings on 13 February 2022 in the article ‘Good Care during COVID-19: A Narrative Approach to Care Home Staff’s Experiences of the Pandemic’ in the International Journal of Environmental Research and Public Health.

Obstructions to relational-moral good care
Firstly, our results show that care staff have a relational-moral approach to good care. Residents’ wellbeing is their main focus, which they try to achieve through personal relationships within the triad of care staff–resident–significant others (SOs). Secondly, our results indicate that caregivers experience the COVID-19 mitigation measures as obstructions to relational-moral good care, as they limit residents’ wellbeing, damage the triadic care staff–residents–SOs relationship and leave no room for dialogue about good care. Thirdly, the results show that care staff experiences internal conflict when enforcing the mitigation measures, as the measures contrast with their relational-moral approach to care.

“A resident is standing at the window. Her husband has come to wave to her from outside. As a result of the corona restrictions, no visitors are allowed. The resident gestures to her husband: ‘come upstairs.’ I explain to her that that’s not possible. ‘Then I’ll go to him.’ I tell her that’s not possible either. ‘You are so mean’, she tells me.”

Recommendation
We conclude that decisions about mitigation measures should be the result of a dialogic process on multiple levels so that a desired balance between practical good care and relational-moral good care can be determined.

The article ‘Good Care during COVID-19: A Narrative Approach to Care Home Staff’s Experiences of the Pandemic’ by Marleen Dohmen, Charlotte van den Eijnde, Lucia Thielman, Jolanda Lindenberg, Josanne Huijg, and Tineke Abma was published on 13 February 2022 in the International Journal of Environmental Research and Public Health, Special Issue Nursing and COVID-19.