[The upper-limits of deinstitutionalization not yet reached]. / De grens van extramuralisering is nog niet bereikt.

The government aims at decreasing the number of elderly with disabilities in institutional care, and supplying them with homecare instead. This article provides starting points to identify the elderly for whom homecare is a realistic alternative to institutionalized care. Data from two Dutch surveys are used: the Amenities and Services Utilization Survey (AVO'07) and Elderly in Institutions (OII'08). We use a regression model that explains the use of care from several characteristics, and predict the probability to use a certain type of care for each individual. One ninth to a fifth of the elderly receiving institutional care have similar characteristics to homecare users. They are generally younger than other users of institutional care, attained higher educational levels, have higher incomes and have fewer disabilities. The prevalence of dementia is noticeably lower in this group. Domestic help, often in combination with personal care and nursing, is the most likely alternative for institutional care. Personal assistance may also prove to be an alternative, but could not be included in this research. However, there will always be a group of elderly that are more suitably and more efficiently cared for in an institutional setting. It is important that institutionalized care remains an option for this group.

Positieve ervaringen door mantelzorg: constructie van een schaal.

POSITIVE EXPERIENCE THROUGH INFORMAL CARE: CONSTRUCTION OF A SCALE: An 8-item scale has been developed to measure positive experiences by informal caregivers, the Positive Experiences Scale (PES). The PES is a unidimensional hierarchical Mokkenscale which varies from intrinsic satisfaction and relational enhancement to improvement of competence and social enhancement. The scale has a satisfactory Loevinger's H-value (0.37) and reliability (0.74). Furthermore, satisfying H-values are found for large groups of informal caregivers, such as carers for the elderly, the chronically ill, partners, parents and people who live in a care facility. For informal caregivers of people with dementia or mental impairments, two items do not uphold ('I received appreciation for the care I've been giving' and 'the help brought me and my family and friends closer together'. For these groups a 6-item scale is advised. Solely for informal caregivers of people with psychological impairments, the scale as a whole does not uphold. Further research will have to determine how these caregivers derive positive experiences from caregiving. The PES is recommended because of its psychometric qualities and its usefulness in different populations of informal caregivers.

[Positive experience through informal care: construction of a scale]. / Positieve ervaringen door mantelzorg: constructie van een schaal.

An 8-item scale has been developed to measure positive experiences by informal caregivers, the Positive Experiences Scale (PES). The PES is a unidimensional hierarchical Mokkenscale which varies from intrinsic satisfaction and relational enhancement to improvement of competence and social enhancement. The scale has a satisfactory Loevinger's H-value (0.37) and reliability (0.74). Furthermore, satisfying H-values are found for large groups of informal caregivers, such as carers for the elderly, the chronically ill, partners, parents and people who live in a care facility. For informal caregivers of people with dementia or mental impairments, two items do not uphold ('I received appreciation for the care I've been giving' and 'the help brought me and my family and friends closer together'. For these groups a 6-item scale is advised. Solely for informal caregivers of people with psychological impairments, the scale as a whole does not uphold. Further research will have to determine how these caregivers derive positive experiences from caregiving. The PES is recommended because of its psychometric qualities and its usefulness in different populations of informal caregivers.

[Self perceived burden from informal care: construction of the EDIZ-plus]. / Ervaren belasting door mantelzorg; constructie van de EDIZ-plus.

To measure the experienced burden by informal carers (N = 2.444), a 15-item Mokken scale has been developed. This concerns an extended version of the EDIZ ("Ervaren druk door Informele zorg"); several items refer to the pressure of time brought by the combination of labour and care and the consequences for the health of the informal carers are added to the EDIZ. We call this new scale the EDIZ-plus; it concerns a reliable one-dimensional and hierarchical scale which extends from o (no burden) to maximum 15 (severe burden). First, the burden manifests itself in feelings of responsibility of the carer, followed by having difficulty with combining work and family tasks and ultimately exceeding all limits due to too many obligations. In most cases this last group does not only deal with conflicts at home or at work and a decline in their own health, they also experience all other problems in the scale. The presumed limit for overburdening is enclosed by the proposition 'caring put too much pressure on me'. This is a score on the EDIZ-plus of nine or higher. Furthermore, the scale has proved to be usable for several population groups, such as carers of partners and children, parents/parents-in-law and carers of different patient populations (people with dementia, mental disability or a chronic disease). The EDIZ-plus is not only suitable because of its reasonable psychometric qualities, but also because of the usability in different populations.