Table 1 Differences between the Prevention and Reactivation Care Program and current geriatric Care in The Netherlands
| Â | Prevention and Reactivation Care Program | Hospital care with follow-up care | Hospital care without follow-up care |
|---|---|---|---|
Hospital care | Identification of vulnerable elderly patient within 48 h Assessment of risk factors for functional decline Start reactivation treatment within 48 h Clinical geriatrician Geriatric nurses | Start reactivation treatment after discharge No specific identification instrument | Start reactivation path after discharge |
Hospital replacement care | Prevention and Reactivation Centre Part of treatment plan Continuation of (in hospital started) treatment focused on six domains of functional status Availability of (para)medical disciplines | Hospital replacement care Admission is patient's choice Care facility with option for treatment No structured treatment plan, but separate elements Limited number of (para)medical disciplines | Hospital replacement care not available |
Home care | Geriatric care chain agreements with general practitioner and home care Case management with geriatric expertise | Follow-up care by home care organizations (not specialized in geriatrics) | Follow-up care by home care organizations (not specialized in geriatrics) |
Multidisciplinary approach | Weekly multidisciplinary team meeting Treatment and care focused on medical condition and functioning in six domains (i.e. physical, mental, social, financial, home, and care) Goal-oriented approach | Key professional is responsible for treatment and interdisciplinary consults Discussion and collaboration focused on medical condition | Key professional is responsible for treatment and consults Discussion and collaboration focused on medical condition |
Patient | Patient oriented integrated treatment plan Discussion treatment with patient during entire treatment path Problem solving | Separate treatment plans Treatment coherence determined by patient | Separate treatment plans Treatment coherence determined by patient |
Informal caregiver | Part of treatment plan | Individual choice | Individual choice |