1. Geriatric rehabilitation at Laurens:
Vision and ambition
Mr. Hans Stravers Msc BA
COO of the short-term care and rehabilitation business unit at Laurens

2. Contents of the presentation
● Laurens in context
● Developments in care hotel rehabilitation model in the
Netherlands
● Vision of the care rehabilitation model, Laurens-style
● Financial sustainability of short-term care
● Benefits of short term transitional care to reduce re-
hospitalization
● Care hotel, the future for Asia Pacific?
● Practice of "Business Unusual" at Laurens
● Treatment with cytostatics in home care
● COPD rehabilitation at Laurens

3. Laurens in context
● Established in Rotterdam since 1886
● Population Rotterdam area: 1.2 m
● Not for profit care organization
● Dementia care, 2600 patients. Market share 30%
● Home care, 8000 patients. Market share 40%
● Rehabilitation, 300 patients. Market share 70%, €31
million
● Laurens total turnover €300,000,000
● 35 nursing homes
● 6 residential buildings for the elderly
● 9000 employees

4. Laurens' area of work

5. Developments in the care hotel
rehabilitation model
● Arose in the Netherlands in the early 1960s.
● Post-treatment refuge for the elderly became a multifunctional
center.
● Multifunctional center became a specialized facility for specific target
groups.
● Individual facility became part of integrated care
● Hospital = curing disease
● Care hotel = rehabilitation
● Rest makes you rust!

6. Care hotel rehabilitation model l
Laurens has many years' experience in accelerating turnover of
patients from hospital to rehabilitation
● 1997, Rotterdam Stroke Service established
● www.rotterdamstrokeservice.nl
● In 2016, every stroke patient is in a rehabilitation center within 5
days
● 1500 admissions per year
● Continuing development into other disorders such as:
● COPD, heart failure, oncology, orthopedics, etc.
● Building expertise amongst practitioners/nursing by developing
care paths in cooperation with professionals from hospitals

7. Definitions,
3 types of recovery-focused care
Specialized rehabilitation: complex treatment which eliminates
or minimizes disabilities and/or participation problems
Reactivation: “getting active again”. Essential part of integrated
nursing and care; not complex, not multidisciplinary
Geriatric rehabilitation: rehabilitation focused on the frail elderly
with complex multimorbidity. multidisciplinary care
● The latter two groups of patients are Laurens' target groups
● Important distinction in connection with intensity of treatment

8. Geriatric rehabilitation
Integrated multidisciplinary care focused on
foreseeable recovery of functioning and participation
in the frail elderly after an acute disorder or functional
deterioration.
Geriatric rehabilitation

9. Laurens' vision of the care hotel
rehabilitation model
Rehabilitation care must be reinvented.
● Because of competition and new entrants
Our goal is:
Patients come to us from near and far, because Laurens offers:
● the proven best (integrated) care
● skilled professionals
● interdisciplinary cooperation
● in a welcoming environment
● care and attention for the individual are foremost

10. Laurens' vision
Reinvention means:
Adding value in use by
● renewing services
● reducing costs
For short-term care, this means:
● attracting new target groups
● focusing even more on hospitals (forward integration)
● adding quality to the entire integrated chain for the customer
● home-hospital-rehabilitation-home
● quality is more than working properly and lean
● providing facilities services on a higher plane

11. Renewing services
Survival of the fittest
It won't be the strongest care provider who survives, but the care
provider that knows best how to adapt to new circumstances
Innovation and entrepreneurship = Customer value +
Good Service is giving people a little more than they expect
Excellent service is enjoying giving people a little more than they expect

12. Learn from Schiphol, main
airport of the Netherlands
● Think about the entire ‘journey’
● Focus on behavior
● Friendly staff
● Patient profiles
● Influence of Social Media
● Perception of hygiene
● Wayfinding
● Continue to create WOW moments
● Catering concept

13. Points to consider
The quality of non-clinical services is critical to a patient’s
evaluation of a stay and can define their overall experience
B.J. Pine & J.H. Gilmore
It may be that many guests do not know the difference between an
ECG or an EEG, but all guests can tell if a bowl of soup is cold when
it's served

14. Intermezzo
160 rooms for geriatric rehabilitation ( https://youtu.be/xzXdhQNr20U )
● disorders of the central nervous system, stroke/trauma
● organ failure, heart and lung conditions
● oncology, focused on recovery
● musculoskeletal traumata
● orthopedics, total hip/knee
Staff
● nurses, nurse practitioners
● doctors/psychologists
● occupational, physio, speech therapists

15. Costs of rehabilitation in the
Netherlands
● Patient's medical insurance pays the costs.
● The patient pays €1500 (in 12x monthly instalments) and €385
excess per year.
● Hospital admission costs €1000 (non-intensive care) per day
● Rehabilitation admission costs €300 per day, all inclusive:
● food, treatment, medication, room.
● Rehabilitation admission varies in length from:
● 10 days, orthopedics.
● max. 6 months, stroke care.

16. Benefits of geriatricrehabilitation
Geriatric rehabilitation worthwhile?
● Yes, for interdisciplinary working
● Yes, for CVA rehabilitation (entire group) positive for mortality
and functioning
● Yes, for hip fracture rehabilitation for functioning and speed of
recovery
● Yes, for COPD rehabilitation (entire group) on quality of life
● Yes, for orthopedics
● Yes, for oncology rehabilitation

17. Benefits of geriatric
rehabilitation
1995-2010 stroke care in hospital, start of the RSS in 1997
Length of admission men down from 20.3 to 8.5 days
Length of admission women down from 25 to 9 days
Now fallen further to max. 5 days in hospital
Index number, men Index number, women
Clinical admissions
Average length of admission
Clinical admissions
Average length of admission
Clinical admission days Clinical admission days

18. Benefits of geriatric
rehabilitation
Length of admission down from 26 to 9 days (2012) for hip
fracture
Fully-integrated hospital and recovery
Clinical admissions
Average length of admission
Clinical admission days Clinical admissions
Average length of admission
Clinical admission days
Index number, men Index number, women

19. Evidence
● Bachman S. et al. In-patient rehabilitation specifically
designed for geriatric patients: systematic review and meta-
analysis of randomized controlled trials. BMJ 2010
hip fractures: better functioning, fewer hospital admissions, reduced
mortality. Costs not clear.
● Murray. Outcomes of rehabilitation services for nursing home
residents. Arch Phys Med Rehabil 2003.
Retrospective; n= 11500, extensive monitoring of 112 variables.
58% received rehabilitation and this was associated with more discharges
home, and reduced mortality.

20. Care hotel, the future for Asia Pacific?
For Laurens it is "Business Unusual" because there are several
destabilizing changes in the Dutch-language context
● doubling of ageing population
● new and other competitors
● new and other business models
● new and other customer requirements
● new and other attitudes and values of employees
How should we respond? Redefine our products
● How is the taxi world doing this with Uber?
● How is the hotel world doing this with Airbnb?

21. Care hotel, the future for Asia Pacific?
● Hard to say, I have insufficient knowledge about the context
● The same problems in Asia Pacific? Ageing population? Rising
costs of health care?
What can you learn from the Netherlands?
● Growth of an ageing population = growth in age-related diseases
● Hospital is the wrong place for the frail elderly
● Redefine your product and business case
● Hospital for the sickness
● Care hotel for the sick people who are focused on recovery
● Hospital costs higher than care hotel in the Netherlands

22. "Business Unusual", an example
Administration of cytostatics at home
● customer wishes = prefer treatment at home
● changing financing,
● hospital now has to pay costs of treatment, previously it was the patient
● Laurens is setting up specialist home care team, specialist nurses
● award of contract: start with 800 customers on an annual basis = interesting
market
● shape care path and quality requirements together with hospital professionals
● Use of e-health for patient to doctor contact
● benefit: costs to hospital €800/treatment at home €120 per day

23. "Business Unusual", COPD care
● An integrated care path since 2010
● Now:
● patients come via GP or hospital Emergency Department
(EHBO) direct to Laurens Intermezzo
● Before:
● often acute exacerbation and/or lung infection afterwards,
admission to hospital.
Inclusion criteria:
● Gold stage II, III and IV
● Motivation
● Consent

24. Exclusion criteria:
● Serious behavioral issues
● Not “trainable” because of cognitive or psychiatric problems
● Not willing to stop smoking.
Outcomes
● Client functions better in the home situation, COPM
● Reduces the number of hospital admissions
● Costs €800 per day in hospital
● Costs €300 per day in Intermezzo
"Business Unusual", COPD care

25. This is what we are doing it all for
Thank you for your attention