Rethinking Dementia Support at Home: Bridging Gaps Between Healthcare and the Social Domain

Rethinking Dementia Support at Home: Bridging Gaps Between Healthcare and the Social Domain | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Rethinking Dementia Support at Home: Bridging Gaps Between Healthcare and the Social Domain Frank Antonissen, Eveline Wouters, Rens Brankaert, Carolien van der Linden This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8214306/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Dementia poses a rapidly increasing global and national challenge, with growing demands on home-based care systems, families, and communities. Although policies encourage people with dementia to remain at home, current support structures remain fragmented, reactive, and overly medicalized. As a result, opportunities to promote autonomy, social participation, and well-being are often missed. This study examines how professionals in healthcare and the social domain experience the organization, collaboration, and quality of home-based dementia support, and identifies ways to improve coordination and awareness of innovative social initiatives. Methods A qualitative study design grounded in Interpretative Phenomenological Analysis (IPA) was used. Data were collected through seven focus groups and nine individual interviews with 31 professionals from healthcare, social care, community services, and municipal organizations across the Netherlands. Interviews and focus groups were transcribed and analyzed following Graneheim and Lundman’s six-step qualitative content analysis. Results Professionals described dementia support as a “landscape of isolated islands,” marked by minimal interprofessional communication, inconsistent collaboration, and unclear responsibilities. Support often starts too late, focuses predominantly on medical needs, and insufficiently addresses everyday routines, autonomy, and social participation. Limited dementia-specific knowledge across sectors contributes to patronizing communication and reduced involvement of people with dementia in decision-making. Resource constraints—including staff shortages, time pressure, and bureaucratic barriers—further hinder continuity and person-centred support. Participants highlighted the effectiveness of simple, familiar, and inclusive social activities embedded in daily life, and emphasized the need for proactive promotion and a recognizable coordinating professional, such as a practice nurse, case manager, or occupational therapist. Conclusion Improving home-based dementia support requires stronger cross-sector collaboration, earlier and more proactive interventions, and enhanced coordination across health, social, and municipal systems. Embedding simple, meaningful, and community-based activities within everyday life, supported by knowledgeable and trusted professionals, is essential to fostering autonomy, participation, and quality of life for people living with dementia at home. Home-based dementia care Interprofessional collaboration Social participation Person-centred support Care coordination Introduction Dementia is an umbrella term for conditions that impair memory, cognitive functioning, and the ability to carry out daily activities (WHO, 2021). In the Netherlands, approximately 290,000 people are currently diagnosed with dementia—a number expected to rise to over 500,000 by 2050 (Alzheimer Nederland, 2022). Worldwide, more than 55 million people suffer from dementia, including about 8 million in Western Europe (WHO, 2021; OECD, 2023; Eurostat, 2023). Dementia is also one of the leading causes of disability and dependency among older people worldwide (GBD, 2019). The global economic cost of dementia is estimated to exceed USD 1.3 trillion annually and is expected to rise sharply in the coming decades (ADI, 2022). These figures likely underestimate the true scale of the challenge. Dementia remains significantly underdiagnosed, particularly in the early stages, when symptoms may be subtle or misinterpreted (Lang et al., 2017). As a result, many individuals miss the opportunity for early intervention and appropriate support. Being diagnosed with dementia profoundly alters an individual’s daily life, as it is a progressive condition that gradually affects memory, independence, and social participation. However, the impact of dementia extends far beyond the individual diagnosis: it affects families, communities, and national health and social systems. As cognitive and functional decline progresses, quality of life decreases not only for people with dementia but also for their informal caregivers, who often experience emotional distress, physical exhaustion, and social isolation (Graff et al., 2010; Brodaty & Donkin, 2009). In most Western countries, policy encourages people with dementia to remain at home for as long as possible, placing substantial responsibility on informal caregivers, who are frequently older adults themselves (Zwaanswijk et al., 2009; Schulz & Eden, 2016). Although professional care services are available—ranging from nurses and case managers to occupational therapists and social workers—these services are primarily focused on immediate or medical needs. The current landscape of formal and informal support tends to address deficits rather than strengths, with services largely reactive and aimed at managing symptoms instead of promoting the personal well-being, identity, and remaining abilities of the individual (Berkovic et al., 2023).Even valuable offerings, such as day programs, are often rigid in design, medically oriented, and inaccessible without a formal diagnosis or referral (Ramaker & Alderliesten, 2021). Consequently, they frequently lack the flexibility and person-centered focus needed to respond to the evolving nature of dementia. This misalignment underscores a broader issue: despite the increasing prevalence of dementia, both people living with the condition and professionals in the field often remain unaware of the full range of support and activities available (Swaffer, 2014; Innes et al., 2012). Current support structures are often limited by bureaucratic barriers, insufficient interdisciplinary collaboration, and a lack of shared understanding regarding the possibilities for non-medical interventions that promote autonomy and social participation (Vernooij-Dassen & Jeon, 2016). It is therefore crucial to explore how the social domain can better support people living with dementia, particularly those living at home. In addition, communication between professionals from different care services remains inconsistent, often hindered by institutional silos, differences in language and priorities, and a lack of shared digital infrastructure (Iliffe et al., 2013). These communication and knowledge gaps create barriers to integrated, proactive support and contribute to missed opportunities for enhancing well-being and quality of life, particularly in home-based settings (WHO, 2021). In this study, we aim to understand how professionals experience collaboration across healthcare and social sectors, identify where communication and knowledge-sharing break down, and explore how awareness of (innovative) support options can be increased (Popham & Orrell, 2010; WHO, 2021). Central Research Questions How do professionals in healthcare and the social domain experience the current organization, collaboration, and quality of home-based support for people living with dementia? What improvements do these professionals identify as necessary to enhance the coordination, communication, and awareness of innovative social initiatives that promote quality of life? To answer these research questions, we took a qualitative approach and examined in depth the perspectives of professionals across healthcare, social care, and community services. This study aims to uncover systemic shortcomings and identify actionable strategies for improving the coordination, accessibility, and overall quality of support for people living with dementia. Method This study is part of a broader project titled Moving Towards a New Practice for People Living with Dementia and Professionals, a professional doctorate trajectory funded by the Taskforce for Applied Research SIA (part of the Netherlands Organisation for Scientific Research, NWO). The overarching aim of this project is to transform and innovate professional practices related to the care and support of people living with dementia in home settings. Research Design This study adopted a qualitative approach grounded in Interpretative Phenomenological Analysis (IPA) as described by Smith, Flowers, and Larkin (2021). IPA is well-suited for exploring individuals’ lived experiences across diverse populations and research questions, enabling a nuanced understanding of personal perspectives, including those of professionals in care and support contexts. To explore these experiences, we engaged both professionals directly and indirectly involved in supporting people with dementia at home. Focus groups were organized to capture a range of perspectives and stimulate dynamic discussion (Krueger & Casey, 2015). Individual interviews were conducted to fill gaps in the data and allow deeper exploration of personal experiences and reflections. In total, seven focus groups and nine individual interviews were conducted. Participants and Recruitment To involve a broad range of professional groups, a preparatory field study was conducted prior to recruitment. This exploratory phase included accompanying and observing professionals during home visits, as well as visiting care homes, social organizations, and community services to understand how people with dementia are supported across different settings. Directly involved professionals included case managers and general practitioners who provide day-to-day care and support for people living with dementia at home. Indirectly involved professionals included those whose engagement in home-based dementia care is less official but still relevant, such as religious or cultural social workers, museum-based wellbeing facilitators, nursing home staff, municipal policy officers, and educational or training coordinators. These professionals influence how dementia support is envisioned and organized, for example through policy-making or the development of educational frameworks. Including both direct and indirect perspectives allowed for a comprehensive understanding of the professional ecosystem surrounding home-based dementia care. The Dutch College of General Practitioners (Nederlands Huisartsen Genootschap NHG) Dementia Guideline (M21) (Dieleman-Bij de Vaate et al., 2020) was used as a supplementary reference to guide the identification of relevant care providers. This evidence-based guideline (NHG), provides a structured framework for recognizing, diagnosing, managing, and treating people with dementia in primary care. It also outlines the key professional groups involved in home-based dementia care, including general practitioners, practice nurses, community nurses, elderly care physicians, physiotherapists, occupational therapists, social workers, and case managers. This helped determine which professional groups were essential for inclusion in the study. Following the identification of relevant disciplines, recruitment was carried out through professional networks, [removed for review]. Additional connections were established through national social initiatives such as Switch2Move (Switch2Move, n.d.) and DemenTalent (DemenTalent, n.d.), both of which actively involve people with dementia and focus on their talents and abilities rather than their care needs. Initial contact with potential participants was made by phone, email, or through intermediaries from these organizations. Focus Group Topic List and Translation to Interviews To collect qualitative data, a semi-structured approach was employed, combining focus group sessions with in-depth interviews guided by an interview protocol. This approach was chosen for practical reasons, as some participants could not attend focus groups but were essential to include for their perspectives on supporting people with dementia at home. The development of the topic list was informed by two key theoretical frameworks. First, the Person-centred Nursing Framework (McCance & McCormack, 2025) provided a foundation for exploring professionals’ experiences and reflections across domains such as care prerequisites, the care environment, person-centred processes, and expected outcomes. Second, the Social Health and Dementia framework (Dröes et al., 2017) guided the inclusion of themes related to autonomy, participation, and the ability of people with dementia to live meaningfully and independently within their social environment. The topic list was further refined through iterative discussions among the co-authors to ensure its relevance, clarity, and grounding in practice. Accordingly, the topic list comprised three central domains: (1) Perceptions of Organization, Collaboration, and Quality of Home-Based Support – professionals’ reflections on how dementia care and support at home are currently organized and experienced, including interprofessional collaboration; (2) Identified Needs and Opportunities for Improvement – perspectives on what is needed to strengthen coordination, communication, and overall quality of life for people with dementia; and (3) Awareness and Applicability of Innovative Social Initiatives – experiences with and assessments of well-being initiatives designed to support home-based dementia care. An overview of the topic list and sample questions used during the focus group sessions is provided in the supplementary material. To ensure the clarity and practical feasibility of the questions, a pilot focus group was conducted within a long-term care facility in Amsterdam. Feedback from this pilot informed minor refinements to the phrasing and sequencing of questions. Based on the finalized topic list, the structure and content were translated into individual in-depth interviews to allow for deeper exploration of the same core themes from a personal perspective. Analysis The anonymized transcripts of the focus group sessions and in-depth interviews were analyzed using qualitative content analysis, following a six-step procedure based on the methodology of Graneheim and Lundman (2004). In the first phase, all textual material was carefully reviewed to gain a holistic understanding of the data and to identify the three predefined main topics that served as the foundation for further analysis. In the second phase, meaningful units of text relevant to the research questions were selected. In the third phase, these units were condensed into succinct formulations that closely reflected the original content. Subsequently, in the fourth phase, the condensed units were coded, with each code assigned a conceptual label. During the fifth phase, the codes were analyzed for similarities and differences and grouped into subcategories. In the sixth and final phase, these subcategories were further abstracted into broader overarching categories. These main categories formed the basis for reflection on the underlying level of meaning, ultimately leading to the formulation of an overarching latent theme that captured the essence of the findings (Graneheim & Lundman, 2004). To enhance reliability and intersubjective validation, a second student researcher was involved in the coding process. This student researcher contributed to the project as part of her graduation research. She was present as an observer during data collection and was closely involved in both the coding and thematic interpretation of the material. Data collection and quality assurance To ensure the accuracy, credibility, and reliability of the research findings, multiple quality strategies were used. Interviews and focus group discussions were audio-recorded using a secure mobile application. Transcriptions were generated using Microsoft OneNote and were manually verified for completeness and accuracy. Furthermore, data collection continued until thematic saturation was reached—meaning that no new topics or insights emerged during subsequent interviews or focus groups. This criterion ensured that the thematic scope was sufficiently comprehensive and representative of participants' experiences. Finally, the principle of thick description was applied. Rather than presenting the experiences of care and welfare professionals as isolated accounts, findings were embedded within the broader social, organizational, and normative contexts in which they occurred. Quotations are presented alongside contextual information to provide a rich and nuanced understanding of everyday professional practices in supporting people living with dementia. Ethical Considerations Ethical integrity in this study was maintained through adherence to established guidelines on research involving human participants. Informed consent was obtained from all participants following the distribution of an information letter that clearly described the study’s objectives, procedures, potential risks, and the voluntary nature of participation. Participants were assured of their right to withdraw at any time without consequence. Data security was rigorously upheld; all personal data were pseudonymized to protect participant identities, and securely stored within the Fontys research drive environment, with access strictly limited to the research team. Data handling and storage practices conformed to the General Data Protection Regulation (GDPR; Regulation (EU) 2016/679), as implemented in Dutch law through the Algemene Verordening Gegevensbescherming (AVG). Institutional data retention policies were followed, stipulating a maximum storage period of fifteen years. Furthermore, the study was reviewed by the Fontys Committee on Ethics in Research (FCEO), which concluded that the research did not fall under the scope of the Dutch Medical Research Involving Human Subjects Act (FCEO Advice Number 156a Antonissen, 2024; Wet medisch-wetenschappelijk onderzoek met mensen, WMO). Results In total, 31 professionals from 17 different professional practices participated in the study. They represented a diverse range of disciplines within the health and social care sectors, spread across multiple provinces in the Netherlands (Table 1). Analysis of the interviews and focus groups yielded four main themes in response to the first research question, which explored how professionals in healthcare and the social domain experience the current organization, collaboration, and quality of home-based support for people living with dementia: (1) Care support as a landscape of isolated islands , (2) Timing and focus of support , (3) Specific knowledge about dementia , and (4) Resource constraints . For the second research question, which focused on identifying suggested improvements to enhance coordination, communication, and awareness of social initiatives, two themes emerged: (1) Centralized Control and (2) Keep it Simple . These themes build directly on the barriers identified in the first research question, suggesting ways to overcome fragmentation and complexity by providing a clear coordinating role and promoting accessible, user-friendly social initiatives. [Table 1 Participant characteristics] Care support as a landscape of Isolated Islands Conversations with healthcare and social care professionals revealed that support for people with dementia at home is often fragmented. Many described the situation as a landscape of isolated islands, meaning that different initiatives, organizations, and disciplines coexist but remain insufficiently connected. A social worker from a national organization that empowers people with dementia explained: Sometimes it really feels like working on islands, you know. Care institutions often say: ‘Yes, we offer daytime activities,’ but they don’t look beyond that. For example, they’re not even aware of things like the ‘Kwiek route’ [a support route to walk outside]. Collaboration between healthcare and social care often depends on chance or individual initiative. If a key person leaves, projects can quickly come to a halt. Professionals frequently lack awareness of what others are doing, leading to duplicated efforts or blind spots in support. A Nursing instructor observed: The actual collaboration and co-creation often fall short. Someone takes the lead, puts their name on it, and that’s it. The sense of urgency isn’t really felt. It’s all too non-committal. The challenge is especially pronounced in large municipalities, where scale and staff turnover complicate cooperation. In smaller towns and villages, by contrast, communication lines are shorter, familiarity is greater, and support is more quickly established. A religious social worker focused on elderly welfare noted: What we do—and that’s important—is look at how it works in a village. It’s organized very differently than in a city. In a village, everyone knows each other, and that sense of connection and control has largely been lost in urban areas. Across interviews and focus group sessions with different health- and social care professionals, the primary care practice nurse and the dementia case manager were seen by social care workers, occupational therapists, municipal officers and geriatrics as pivotal actors, bridging medical and social support. However, their effectiveness is constrained by limited time, unclear responsibilities, and insufficient overview of the social domain. As one municipality officer noted: People with dementia are known to the case managers, and they’re real multitaskers. But because they’re so busy, they invest little in social activities. As a result, people with dementia are often unaware of what social support is available. At the same time the interviews and focus groups highlighted that municipalities in the Netherlands play a crucial role in facilitating social activities close to where people live, so that individuals do not have to travel long distances to participate. In practice, however, the scope and nature of this support vary considerably. Some municipalities take an active lead, investing in dementia-friendly initiatives and creating accessible opportunities for social engagement, while others are less involved. Several professionals report that collaboration with municipalities is often hindered by bureaucracy, frequent staff changes, or unclear frameworks. A municipality officer admitted: “ We lack collaboration within the municipality itself.” Timing and focus of support Professionals emphasized that assistance often begins too late. Early signs of dementia may be masked or minimized, leaving caregivers overwhelmed before formal help arrives. A primary care practice nurse reflected: What’s difficult is that people seem fine during consultations, but at home and with their partner, problems arise. The caregiver becomes overwhelmed because they no longer understand their partner. It leads to a lot of conflict. It’s hard to assess and respond to that. When support is eventually offered, it tends to focus primarily on medical care and symptom management. Preventive guidance and activities that could enhance quality of life early on—for both the person with dementia and their caregiver—often receive too little attention. Dementia is still too often approached solely as a disease leading to inevitable decline, which means the potential of early interventions aimed at self-reliance, meaning, and social connection remain underused. As a result, valuable opportunities to prevent overburdening and to maintain stability at home for longer, are missed. A nursing instructor comments: “Healthcare could take a step back—it’s not just about healthcare. Social care needs to be more at the forefront.” Specific knowledge about dementia According to the participants, a major barrier lies in the limited knowledge of dementia among many professionals, which often results in inappropriate or ineffective action. Healthcare providers, social care workers, and volunteers frequently lack the skills to respond to the specific characteristics of dementia. Communication can easily become unintentionally patronizing: professionals tend to talk about the client rather than with them, and discussions often remain stuck in meetings without leading to concrete action. Many professionals feel insecure, either underestimating or overestimating the abilities of people with dementia, or withdrawing altogether when faced with so-called “difficult behaviour.” The result is little space for autonomy, and people with dementia are seldom involved in decisions about their own lives. An occupational therapist reflected: "Once the diagnosis is made, a dementia case manager is immediately assigned, and, perhaps somewhat bluntly put, they immediately start directing things toward day care. I think that in this process, what people with dementia and their caregivers often consider important and meaningful is not always properly taken into account." This connects to another crucial signal: many people with dementia have lost their sense of initiative. This loss of initiative is not only a consequence of the disease itself but is reinforced by several factors. People often lose confidence in their abilities through negative experiences, feel unmotivated when they are not taken seriously, or encounter activities that are too healthcare-focused, insufficiently stimulating, or poorly matched to their interests. As a social worker explains: " There is simply too much—so many initiatives that they overwhelm people, taking away the ordinary rhythm of life and making it harder to maintain natural human behaviour." As a result, a dependent care relationship can quickly emerge, in which individuals lean heavily on others—especially when family members take over everything. A social worker in a museum offering programmes for people with dementia remarked: “There’s a piece of misunderstanding, being unheard, unseen—and that can result in the feeling that you no longer matter.” Professionals increasingly highlight the importance of understanding how people with dementia themselves experience their situation. Their emotions, resilience, and coping strategies are often overlooked. Many feel defeated, confused, or ashamed about memory loss, and find it difficult to talk about—or choose denial instead. Some are able to mask their condition for years, especially when family members unconsciously take over daily tasks. As one GP explained: No, it really takes many years. First, it takes years before a patient even realizes it. And those years are filled with denial, cover-up, avoidance. And the family doesn’t notice either—because unconsciously, they take over the care. This highlights how memory issues often remain hidden in the early stages. It also illustrates that there are significant interindividual differences in how dementia is experienced—for instance, depending on whether cognitive decline progresses gradually or rapidly. Knowledge about these variations is often lacking in professionals, even though understanding them is crucial to fully grasp the lived experience of dementia. Differences also appear between older and younger people with dementia. Younger individuals are usually more receptive to support, while older people often show more resistance to accepting help and to participating in care programs. A dementia case manager adds: “Whether the help works also depends on the person’s age. Younger people with dementia are more approachable and open to help. Older people often have a heavier care burden, also due to other physical problems.” Resource Constraints Living at home with dementia often involves high needs but at the same time, there is little structural support. Due to staff shortages in home care, only minimal contact is provided, leaving hardly any room for personalized attention. Case managers and other healthcare professionals report that they simply lack the time to offer tailored care, coordinate care effectively, or pick up on changing needs. A geriatrician remarks: “Home care is barely available; people get a diagnosis—which feels like an ill fate—and then they’re left to figure things out on their own for a long time.” Financial barriers add to this challenge. Care covered by insurance is often limited, non-transparent, and difficult to access—especially for people with middle incomes who fall outside the scope of social care support The findings from the above themes reveal how professionals experience the current organization, collaboration, and quality of home-based support for people living with dementia, highlighting various gaps and challenges. Building on these insights, the following section focuses on the improvements that health- and social care professionals consider necessary. Specifically, it examines the types of activities available, the key conditions required to ensure their effectiveness and meaningful engagement, and how these activities can best be implemented, evaluated, and delivered. Aligning Activities with Everyday Life and Existing Routines Professionals emphasized that activities for people with dementia should be simple, familiar, and closely aligned with daily routines to prevent participants from feeling overwhelmed. Activities need to connect with participants’ everyday lives and interests without placing excessive demands on cognitive abilities. Complex, fast-paced, or cognitively demanding activities often lead to disengagement, whereas straightforward, routine-based approaches foster familiarity and encourage sustained participation. As one primary care practice nurse explained: “ You have to make it super simple—two buttons and you’re done, for example.” Ensuring that persons living with dementia feel personally addressed and supported, particularly in relation to technology or new initiatives, further enhances engagement and promotes meaningful involvement in daily life. Simplicity also applies to the organization and continuity of activities. Participation should be as normal as possible, often requiring local adaptation and a redefinition of participants’ roles. Activities that rely on a single key person or are located far away frequently fail to maintain engagement over time. Inclusivity was highlighted as equally important: initiatives should mix people with and without memory problems to reflect everyday social life. As one occupational therapist noted: “It has to be accessible for everyone. Everyone is welcome. The mix of people with and without memory problems—that’s how society is, and that’s how a social activity should be.” Flexibility and personalization are essential to meet the changing needs of people with dementia. Because dementia is a progressive condition, participants’ roles within activities must be continually reassessed. Activities that foster emotional connection, social participation, and shared experiences are especially beneficial, as they can be adapted to the changing abilities and needs of people with dementia. A social worker concluded: “A client can change, right? A client is no longer who they once were.” Promotion of Activities The scope of available activities must also include effective communication and promotion. Many people with dementia and their families become lost in the large, municipality-specific offerings. Social activities often receive less attention than medical care, leaving families unsure where to start. As a dementia social worker explained: “ It’s very diffuse. There is so much that people can’t see the forest for the trees. If you don’t know something exists, you won’t go looking for it. We still think too often in medical solutions: doctor, pill, done.” Passive promotion, such as distributing leaflets, is usually insufficient. Personal and proactive approaches via trusted professionals—particularly general practitioners—prove more effective. An informal caregiver emphasized: “GPs should recommend it—if a GP says it, more people will use it.” A broad range of promotion channels is needed to reach different target groups. Digital tools such as social media, short videos, and neighbourhood apps work well for younger people with dementia, while local, tangible means—such as community newspapers, posters, monthly calendars, handwritten GP referrals, and flyers in GP practices, libraries, or supermarkets—are more suitable for older generations. A geriatrician observed: “I have the feeling—but I haven’t studied it—that handwritten letters make people feel truly heard: this is especially for me, someone has taken the time.” It is important that logos, visual symbols, and language are inviting and non-stigmatizing, and that communication resonates with the daily lives and interests of the target group. Mobilizing community resources—such as neighbours, volunteers, and church groups—strengthens the sustainability and visibility of activities. Familiar faces and recognizable settings make participation feel like a natural part of daily life rather than a care intervention. An occupational therapist explained: “Introduce social initiatives right away, make sure everything works, and do it immediately. Inform the family in advance—that often works best.” Central Coordination The fragmented nature of dementia care and the scattered availability of social activities—often described by professionals as “isolated islands”—highlights the need for a trusted and recognizable coordinating actor. Professionals frequently point to the case manager or practice nurse as natural candidates for this role. These coordinators should maintain direct communication channels with both healthcare and social care professionals and have a comprehensive overview of available and appropriate social initiatives. A GP described the role of central coordination: “Then a case manager is brought in, and they monitor the situation together. Step by step, more care forms around the patient.” Occupational therapists identify themselves as providing added value by bridging the gap between people’s abilities and the support they need, focusing on participation rather than limitations. However, they remain underutilized because their value is not widely recognized, often being introduced too late despite the significant potential benefits in early-stage dementia. An occupational therapist explained: “I would also want the practice nurses and the case managers to play a more active role. Then you’d have a strong network entering people’s homes. We don’t all have to be involved all the time, but if we align who does what, we can act quickly and focus more on preventive care—instead of cleaning up the mess afterward.” Dutch municipalities also emerge as crucial in creating accessible local initiatives and supporting sustainable collaboration among stakeholders. Yet professionals emphasized that this requires stronger leadership and less bureaucracy. A GP added: “Yes, I believe that municipalities could certainly take more leadership in this. For example, by offering training programs, but also by inviting people who reach a certain age, for instance 75, to come in for a conversation. In this way, they can be involved in a meeting for 75-year-olds, where they can also contribute themselves. It is important that municipalities have a clearer picture of these people, so that they can indicate which matters are relevant to them based on their age. Families should also be involved in this process.” Discussion This study explores how professionals in healthcare and the social domain experience the current organization, collaboration, and quality of home-based support for people living with dementia. Findings show that such support remains fragmented and overly medicalized. Professionals described the organization of dementia care as a “landscape of islands,” meaning that communication between professionals is limited, initiatives often exist in isolation, and structural integration is lacking. Participants noted that collaboration is frequently coincidental, easily disrupted, and particularly challenging in large municipalities, whereas smaller communities benefit from shorter lines of communication. Literature suggests that such fragmentation makes care highly dependent on individual initiatives and vulnerable to staff turnover or organizational change (Sorrentino et al., 2025). Scarce time, staff shortages, and financial barriers further constrain personalized and continuous care, leaving families to cope largely on their own during the early stages of dementia. A central challenge in dementia care is the quality of home-based support, which often lacks both timing and focus. Support is frequently initiated too late, partly because early signs of dementia can be subtle, easily masked, or minimized by patients and families. Research indicates that home care services frequently operate according to predetermined routines rather than individualized needs, resulting in care that is insufficiently tailored to the person’s condition or stage of dementia (Hoel et al., 2021). This routine-based approach can delay recognition of emerging needs, contributing to a lag in appropriate support. Stephan et al. (2018) similarly found that people with dementia and carers often struggle to access timely help and feel uncertain about when and how to seek services, underscoring that delays in support are not only organizational but also linked to limited clarity for users themselves. Moreover, systematic reviews show that dementia-specific interventions are limited and poorly integrated with broader health and social care systems (Chen et al., 2022), which may further exacerbate delays or inadequacies in support. By the time support is provided, caregivers are often already overwhelmed, and interventions tend to prioritize medical care and symptom management over preventive guidance or social measures that could enhance quality of life, with insufficient emphasis on individuals’ strengths, capabilities, and potential (Dieleman-Bij de Vaate et al., 2020; WHO, 2021). As a result, opportunities to support autonomy, prevent caregiver burden, and maintain stability at home are often missed (Sorrentino et al., 2025). Stephan et al. (2018) reinforce this point: their participants repeatedly emphasized that available services are often reactive rather than preventive and that psychosocial or community-based support is insufficiently visible or accessible. Limited knowledge of dementia among professionals can lead to patronizing communication, which may make people with dementia feel devalued or withdrawn (Williams et al., 2017). Our results indicate that discussions are often conducted about rather than with people living with dementia, limiting their involvement in decision-making. This aligns with Alsawy et al. (2017), who found that only one of fifteen studies included people with dementia as primary informants. Stephan et al. (2018) add an important nuance here: people with dementia in their study reported that feeling excluded from conversations or not being taken seriously acted as a major barrier to seeking formal care. This suggests that communication challenges not only affect relational dynamics but may directly influence whether individuals engage with services at all. Professionals may also over- or underestimate abilities or withdraw in response to challenging behaviours (Dupuis et al., 2012; Popham & Orrell, 2012), further restricting autonomy and meaningful engagement. The expertise and presence of key professionals, particularly primary care practice nurses and dementia case managers, are critical for improving coordination and supporting people with dementia. Primary care practice nurses often serve as the first point of contact, bridging medical, psychological, and social support, while case managers oversee the care trajectory and coordinate access to services. Previous studies indicate that practice nurses are crucial for early identification and timely interventions (Dieleman-Bij de Vaate et al., 2020), and case managers play a central role in maintaining continuity and preventing fragmented care (Ee et al., 2024). This study further highlighted occupational therapists as providing valuable support in maintaining daily routines, participation, and autonomy, although participants noted they are often introduced too late, limiting early preventive interventions. Literature confirms the importance of these roles: Graff et al. (2006) show that occupational therapy preserves functional abilities, and the WHO (2021) recommends embedding such roles in primary care to enhance continuity and proactive, person-centered care. Building on these insights, we studied what improvements professionals consider necessary to enhance the coordination, communication, and visibility of innovative social initiatives that promote quality of life. Our results indicate that social activities for people with dementia are most effective when they are simple, familiar, and embedded in everyday routines, connecting to participants’ lives and interests without causing overwhelm, and fostering participation, autonomy, and emotional engagement. These findings are reinforced by Alderliesten and Ramaker (2021), who show that tailoring activities to individuals’ daily lives and personal preferences enhances engagement and overall well-being, and by Dupuis et al. (2012), who emphasize that routine-based and familiar activities help preserve identity, support social inclusion, and maintain meaningful participation. Professionals emphasized that inclusivity is essential, ensuring that activities accommodate both people with and without dementia, reflecting natural social environments. Flexibility is also critical, as participants’ abilities and needs change over time. Effective promotion and accessibility of social activities for people with dementia are equally important, as passive approaches, such as leaflets, are insufficient. Personal and proactive communication via trusted professionals, particularly general practitioners and case managers, is essential, a point supported by the research of Sorrentino et al. (2025), who found that participation is often hindered by unclear access pathways, fragmented care services, and logistical or cultural barriers. They emphasize that having a single trusted professional — a “key contact person” — can significantly facilitate access and engagement by providing guidance and continuity of care. To reach diverse populations effectively, multiple channels should be used, combining local, personalized methods for older adults with broader community networks to increase visibility and accessibility, while familiar settings and trusted faces help embed participation naturally into daily life. Central coordination is needed to overcome fragmentation and improve alignment between health and social care. Case managers and practice nurses are seen as natural coordinators, maintaining communication across sectors and ensuring appropriate services are accessible. Municipalities play a critical role in creating accessible initiatives and supporting sustainable collaboration among stakeholders, though their involvement varies. According to Sorrentino et al. (2025), stronger leadership, clearer responsibilities, and reduced bureaucratic barriers are necessary to facilitate proactive engagement and coordinated, preventive support. To translate these insights into practice, a structured co-creation approach is essential. Professionals emphasized that meaningful change requires rethinking how support is organized and aligned. Design-driven approaches—such as living labs or iterative co-creation—can help articulate shared goals, map existing barriers, and prototype new service models across sectors. Importantly, designing the service itself can serve as a research method: by actively creating and testing service prototypes, researchers and practitioners can generate rich insights about what works in real-world contexts, uncover unforeseen challenges, and iteratively refine solutions. Rather than producing isolated interventions, these processes support the emergence of an integrated model that strengthens continuity, clarifies roles, and embeds successful elements such as trusted contact persons, flexible coordination, and everyday meaningful activities. This participatory approach offers a practical mechanism to reduce fragmentation and ensure that innovations genuinely meet the needs and living contexts of people with dementia and their families. The findings of Stephan et al. (2018) further support the need for such participatory redesign, as their participants emphasized the importance of being involved, informed, and supported throughout the care journey. Strengths and limitations of this study also need to be considered when interpreting these findings. Strengths include its qualitative, exploratory design, combining focus groups and interviews to capture in-depth, lived experiences across multiple regions and professional backgrounds. Triangulation and expert validation enhance reliability. Limitations include a relatively small sample and reliance on self-reported experiences, which may limit generalizability. Additionally, the findings are context-specific to the Dutch healthcare system; care structures and professional roles may differ in other countries, which could affect the applicability of the results elsewhere. Future research could benefit from larger, mixed-methods or longitudinal study designs to examine how collaboration and initiatives develop over time. Conclusion Professionals perceive dementia care as fragmented, reactive, and overly medicalized but identify clear opportunities for improvement. Strengthening the roles of practice nurses and case managers, introducing occupational therapy earlier, and investing in meaningful, familiar, and inclusive social activities are critical steps. Achieving these improvements requires closer collaboration across healthcare, social care, and municipal systems, supported by proactive, personalized communication. By embedding coordination, preventive interventions, and person-centered approaches, dementia care can evolve into a more integrated system that supports autonomy, participation, and quality of life for people with dementia and their families. Abbreviations International organizations and reports WHO – World Health Organization OECD – Organisation for Economic Co-operation and Development GBD – Global Burden of Disease ADI – Alzheimer’s Disease International Eurostat – Statistical Office of the European Union Research and educational institutions / funding SIA – Taskforce for Applied Research SIA (part of NWO) NWO – Netherlands Organisation for Scientific Research Methodology and research approaches IPA – Interpretative Phenomenological Analysis Healthcare and guidelines (Netherlands) NHG – Dutch College of General Practitioners M21 – NHG Dementia Guideline (guideline code) GP – General Practitioner Legislation / ethics GDPR – General Data Protection Regulation AVG – Dutch Implementation of GDPR (Algemene Verordening Gegevensbescherming) FCEO – Fontys Committee on Ethics in Research WMO – Dutch Medical Research Involving Human Subjects Act Declarations Acknowledgements I would like to express my gratitude to the Geriatrics Department of the Catharina Hospital, the Dementalent Foundation, and Switch2Move for their valuable support and helpful guidance throughout this work. Funding 'Not applicable' Authors' contributions All authors conceived and designed the article. FA conducted the qualitative study and analysis. EW, RB, and CL made significant contributions to the theoretical concept and analysis. FA drafted the text, and all authors have read and approved the manuscript. Ethics approval and consent to participate 'Not applicable' Consent for publication 'Not applicable' Competing interests The authors declare that they have no competing interests Author details ¹ Department of Geriatrics, Catharina Hospital, Eindhoven, The Netherlands ² Fontys University of Applied Sciences, Paramedical Institute, Health Innovations & Technology / Warm Technology & Design, Eindhoven, The Netherlands ³ Tranzo, Tilburg University, Tilburg, The Netherlands ⁴ Expertise Center Dementia & Technology, Eindhoven University of Technology, Eindhoven, The Netherlands References Alsawy S, Mansell W, McEvoy P, Tai S. What is good communication for people living with dementia? 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Health at a glance 2023: OECD indicators. Retrieved May 20, 2025, from https://www.oecd.org/en/publications/health-at-a-glance-2023_7a7afb35-en.html Popham C, Orrell M. What matters for people with dementia in care homes? Aging Ment Health. 2012;16(2):181–8. https://doi.org/10.1080/13607863.2011.609529 . Rahman S, Swaffer K. Assets-based approaches and dementia-friendly communities. Dementia. 2018;17(2):131–7. https://doi.org/10.1177/1471301216644115 . Ramaker R, Alderliesten M. (2021). Dementia and daytime activities: An exploration of possibilities. Vilans. Retrieved May 20, 2025, from https://www.vilans.nl/artikelen/dementie-en-dagbesteding-een-verkenning-van-de-mogelijkheden Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April. Official J Eur Union. 2016;L119:1–88. https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32016R0679 . 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data (General Data Protection Regulation). Smith JA, Flowers P, Larkin M. Interpretative phenomenological analysis: Theory, method and research. 2nd ed. SAGE; 2021. Stephan A, Bieber A, Hopper L, Joyce R, Irving K, Zanetti O, Portolani E, Kerpershoek L, Verhey F, de Vugt M, Wolfs C, Eriksen S, Røsvik J, Marques MJ, Gonçalves-Pereira M, Sjölund B-M, Jelley H, Woods B, Meyer G. Barriers and facilitators to the access to and use of formal dementia care: Findings of a focus group study with people with dementia, informal carers and health and social care professionals in eight European countries. BMC Geriatr. 2018;18. https://doi.org/10.1186/s12877-018-0816-1 . Article 131. Sorrentino M, Fiorilla C, Mercogliano M, Stilo I, Esposito F, Moccia M, Lavorgna L, Salvatore E, Sormani MP, Majeed A, Triassi M, Palladino R. Barriers for access and utilization of dementia care services in Europe: A systematic review. BMC Geriatr. 2025;25(1):162. https://doi.org/10.1186/s12877-025-05805-z . Switch2Move. (n.d.). Improve quality of life with movement & music. Retrieved October 29. 2025, from https://switch2move.com/ Williams KN, Herman R, Gajewski B, Wilson K. Elderspeak communication: Impact on dementia care. Am J Alzheimer’s Disease Other Dementias. 2017;32(1):10–8. https://doi.org/10.1177/1533317516674308 . World Health Organization. (2021). Dementia. Retrieved May 20, 2025, from https://www.who.int/news-room/fact-sheets/detail/dementia Wrede C, Braakman-Jansen A, van Gemert-Pijnen L. Smart monitoring technology to support home-based dementia care: Market-specific business model development and implementation considerations in the Netherlands. Digit Health. 2025;11:2055207625133182. https://doi.org/10.1177/20552076251331825 . Tables Table 1 Participant characteristics Participant Gender Profession Years of experience with dementia Region Setting 1 Female District nurse 5-10. North Brabant Care home 2 Female District nurse 10-15. North Brabant Care home 3 Female District nurse 10-15. North Brabant Home 4 Female Primary care practice nurse 15-20 North Brabant Out-patient 5 Male Informal care giver 0-5 South Holland Home 6 Female Casemanager dementia 0-5 South Holland Home 7 Female Geriatrician 15-20 North Brabant Out-patient 8 Female Geriatrician 20-25 North Brabant Out-patient 9 Female Geriatric nurse 20-25 North Brabant In-patient 10 Female Geriatric nurse 5-10. North Brabant In-patient 11 Female Geriatric nurse 0-5 North Brabant In-patient 12 Female General practitioner 0-5 Limburg Out-patient 13 Female General practitioner 0-5 Gelderland Out-patient 14 Female Occupational therapist 15-20 North Holland Home 15 Female Occupational therapist 20-25 North Brabant Home 16 Male Physiotherapist 5-10. North Holland Care home 17 Female Physiotherapist 5-10. North Holland Care home 18 Female Hostess at a day activity centre 15-20 North Holland Care home 19 Female Municipal officer 10-15. Utrecht Other 20 Male Religious social worker 20-25. North Brabant Home 21 Female Social worker 5-10. Utrecht Home 22 Female Social worker 5-10. Utrecht Care home 23 Female Social worker 5-10. Utrecht Care home 24 Female Social worker 5-10. Utrecht Home 25 Female Social worker 0-5. Utrecht Care home 26 Female Social worker 0-5. Utrecht Care home 27 Female Social worker 10-15. North Brabant Home 28 Male Manager Health and innovations 10-15. North Brabant Other 29 Female Nursing instructor 5-10. North Brabant Other 30 Female Nursing instructor 5-10. North Brabant Other 31 Female Social worker museum 5-10. North Brabant Other Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Dec, 2025 Editor assigned by journal 29 Nov, 2025 Submission checks completed at journal 29 Nov, 2025 First submitted to journal 26 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8214306","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":552695551,"identity":"bbeca499-f50c-4a4c-85aa-aa8fa6aae091","order_by":0,"name":"Frank 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impair memory, cognitive functioning, and the ability to carry out daily activities (WHO, 2021). In the Netherlands, approximately 290,000 people are currently diagnosed with dementia\u0026mdash;a number expected to rise to over 500,000 by 2050 (Alzheimer Nederland, 2022). Worldwide, more than 55\u0026nbsp;million people suffer from dementia, including about 8\u0026nbsp;million in Western Europe (WHO, 2021; OECD, 2023; Eurostat, 2023). Dementia is also one of the leading causes of disability and dependency among older people worldwide (GBD, 2019).\u003c/p\u003e\u003cp\u003eThe global economic cost of dementia is estimated to exceed USD 1.3 trillion annually and is expected to rise sharply in the coming decades (ADI, 2022). These figures likely underestimate the true scale of the challenge. Dementia remains significantly underdiagnosed, particularly in the early stages, when symptoms may be subtle or misinterpreted (Lang et al., 2017). As a result, many individuals miss the opportunity for early intervention and appropriate support.\u003c/p\u003e\u003cp\u003eBeing diagnosed with dementia profoundly alters an individual\u0026rsquo;s daily life, as it is a progressive condition that gradually affects memory, independence, and social participation. However, the impact of dementia extends far beyond the individual diagnosis: it affects families, communities, and national health and social systems. As cognitive and functional decline progresses, quality of life decreases not only for people with dementia but also for their informal caregivers, who often experience emotional distress, physical exhaustion, and social isolation (Graff et al., 2010; Brodaty \u0026amp; Donkin, 2009). In most Western countries, policy encourages people with dementia to remain at home for as long as possible, placing substantial responsibility on informal caregivers, who are frequently older adults themselves (Zwaanswijk et al., 2009; Schulz \u0026amp; Eden, 2016).\u003c/p\u003e\u003cp\u003eAlthough professional care services are available\u0026mdash;ranging from nurses and case managers to occupational therapists and social workers\u0026mdash;these services are primarily focused on immediate or medical needs. The current landscape of formal and informal support tends to address deficits rather than strengths, with services largely reactive and aimed at managing symptoms instead of promoting the personal well-being, identity, and remaining abilities of the individual (Berkovic et al., 2023).Even valuable offerings, such as day programs, are often rigid in design, medically oriented, and inaccessible without a formal diagnosis or referral (Ramaker \u0026amp; Alderliesten, 2021). Consequently, they frequently lack the flexibility and person-centered focus needed to respond to the evolving nature of dementia. This misalignment underscores a broader issue: despite the increasing prevalence of dementia, both people living with the condition and professionals in the field often remain unaware of the full range of support and activities available (Swaffer, 2014; Innes et al., 2012).\u003c/p\u003e\u003cp\u003eCurrent support structures are often limited by bureaucratic barriers, insufficient interdisciplinary collaboration, and a lack of shared understanding regarding the possibilities for non-medical interventions that promote autonomy and social participation (Vernooij-Dassen \u0026amp; Jeon, 2016). It is therefore crucial to explore how the social domain can better support people living with dementia, particularly those living at home.\u003c/p\u003e\u003cp\u003eIn addition, communication between professionals from different care services remains inconsistent, often hindered by institutional silos, differences in language and priorities, and a lack of shared digital infrastructure (Iliffe et al., 2013). These communication and knowledge gaps create barriers to integrated, proactive support and contribute to missed opportunities for enhancing well-being and quality of life, particularly in home-based settings (WHO, 2021).\u003c/p\u003e\u003cp\u003eIn this study, we aim to understand how professionals experience collaboration across healthcare and social sectors, identify where communication and knowledge-sharing break down, and explore how awareness of (innovative) support options can be increased (Popham \u0026amp; Orrell, 2010; WHO, 2021).\u003c/p\u003e\n\u003ch3\u003eCentral Research Questions\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eHow do professionals in healthcare and the social domain experience the current organization, collaboration, and quality of home-based support for people living with dementia?\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eWhat improvements do these professionals identify as necessary to enhance the coordination, communication, and awareness of innovative social initiatives that promote quality of life?\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTo answer these research questions, we took a qualitative approach and examined in depth the perspectives of professionals across healthcare, social care, and community services. This study aims to uncover systemic shortcomings and identify actionable strategies for improving the coordination, accessibility, and overall quality of support for people living with dementia.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cp\u003eThis study is part of a broader project titled Moving Towards a New Practice for People Living with Dementia and Professionals, a professional doctorate trajectory funded by the Taskforce for Applied Research SIA (part of the Netherlands Organisation for Scientific Research, NWO). The overarching aim of this project is to transform and innovate professional practices related to the care and support of people living with dementia in home settings.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResearch Design\u003c/h3\u003e\n\u003cp\u003eThis study adopted a qualitative approach grounded in Interpretative Phenomenological Analysis (IPA) as described by Smith, Flowers, and Larkin (2021). IPA is well-suited for exploring individuals\u0026rsquo; lived experiences across diverse populations and research questions, enabling a nuanced understanding of personal perspectives, including those of professionals in care and support contexts.\u003c/p\u003e\u003cp\u003eTo explore these experiences, we engaged both professionals directly and indirectly involved in supporting people with dementia at home. Focus groups were organized to capture a range of perspectives and stimulate dynamic discussion (Krueger \u0026amp; Casey, 2015). Individual interviews were conducted to fill gaps in the data and allow deeper exploration of personal experiences and reflections. In total, seven focus groups and nine individual interviews were conducted.\u003c/p\u003e\n\u003ch3\u003eParticipants and Recruitment\u003c/h3\u003e\n\u003cp\u003eTo involve a broad range of professional groups, a preparatory field study was conducted prior to recruitment. This exploratory phase included accompanying and observing professionals during home visits, as well as visiting care homes, social organizations, and community services to understand how people with dementia are supported across different settings.\u003c/p\u003e\u003cp\u003eDirectly involved professionals included case managers and general practitioners who provide day-to-day care and support for people living with dementia at home. Indirectly involved professionals included those whose engagement in home-based dementia care is less official but still relevant, such as religious or cultural social workers, museum-based wellbeing facilitators, nursing home staff, municipal policy officers, and educational or training coordinators. These professionals influence how dementia support is envisioned and organized, for example through policy-making or the development of educational frameworks. Including both direct and indirect perspectives allowed for a comprehensive understanding of the professional ecosystem surrounding home-based dementia care.\u003c/p\u003e\u003cp\u003e The Dutch College of General Practitioners (Nederlands Huisartsen Genootschap NHG) Dementia Guideline (M21) (Dieleman-Bij de Vaate et al., 2020) was used as a supplementary reference to guide the identification of relevant care providers. This evidence-based guideline (NHG), provides a structured framework for recognizing, diagnosing, managing, and treating people with dementia in primary care. It also outlines the key professional groups involved in home-based dementia care, including general practitioners, practice nurses, community nurses, elderly care physicians, physiotherapists, occupational therapists, social workers, and case managers. This helped determine which professional groups were essential for inclusion in the study.\u003c/p\u003e\u003cp\u003eFollowing the identification of relevant disciplines, recruitment was carried out through professional networks, [removed for review]. Additional connections were established through national social initiatives such as Switch2Move (Switch2Move, n.d.) and DemenTalent (DemenTalent, n.d.), both of which actively involve people with dementia and focus on their talents and abilities rather than their care needs. Initial contact with potential participants was made by phone, email, or through intermediaries from these organizations.\u003c/p\u003e\n\u003ch3\u003eFocus Group Topic List and Translation to Interviews\u003c/h3\u003e\n\u003cp\u003e To collect qualitative data, a semi-structured approach was employed, combining focus group sessions with in-depth interviews guided by an interview protocol. This approach was chosen for practical reasons, as some participants could not attend focus groups but were essential to include for their perspectives on supporting people with dementia at home.\u003c/p\u003e\u003cp\u003eThe development of the topic list was informed by two key theoretical frameworks. First, the Person-centred Nursing Framework (McCance \u0026amp; McCormack, 2025) provided a foundation for exploring professionals\u0026rsquo; experiences and reflections across domains such as care prerequisites, the care environment, person-centred processes, and expected outcomes. Second, the Social Health and Dementia framework (Dr\u0026ouml;es et al., 2017) guided the inclusion of themes related to autonomy, participation, and the ability of people with dementia to live meaningfully and independently within their social environment.\u003c/p\u003e\u003cp\u003eThe topic list was further refined through iterative discussions among the co-authors to ensure its relevance, clarity, and grounding in practice. Accordingly, the topic list comprised three central domains: (1) Perceptions of Organization, Collaboration, and Quality of Home-Based Support \u0026ndash; professionals\u0026rsquo; reflections on how dementia care and support at home are currently organized and experienced, including interprofessional collaboration; (2) Identified Needs and Opportunities for Improvement \u0026ndash; perspectives on what is needed to strengthen coordination, communication, and overall quality of life for people with dementia; and (3) Awareness and Applicability of Innovative Social Initiatives \u0026ndash; experiences with and assessments of well-being initiatives designed to support home-based dementia care. An overview of the topic list and sample questions used during the focus group sessions is provided in the supplementary material.\u003c/p\u003e\u003cp\u003eTo ensure the clarity and practical feasibility of the questions, a pilot focus group was conducted within a long-term care facility in Amsterdam. Feedback from this pilot informed minor refinements to the phrasing and sequencing of questions. Based on the finalized topic list, the structure and content were translated into individual in-depth interviews to allow for deeper exploration of the same core themes from a personal perspective.\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eThe anonymized transcripts of the focus group sessions and in-depth interviews were analyzed using qualitative content analysis, following a six-step procedure based on the methodology of Graneheim and Lundman (2004). In the first phase, all textual material was carefully reviewed to gain a holistic understanding of the data and to identify the three predefined main topics that served as the foundation for further analysis.\u003c/p\u003e\u003cp\u003eIn the second phase, meaningful units of text relevant to the research questions were selected. In the third phase, these units were condensed into succinct formulations that closely reflected the original content. Subsequently, in the fourth phase, the condensed units were coded, with each code assigned a conceptual label.\u003c/p\u003e\u003cp\u003eDuring the fifth phase, the codes were analyzed for similarities and differences and grouped into subcategories. In the sixth and final phase, these subcategories were further abstracted into broader overarching categories. These main categories formed the basis for reflection on the underlying level of meaning, ultimately leading to the formulation of an overarching latent theme that captured the essence of the findings (Graneheim \u0026amp; Lundman, 2004).\u003c/p\u003e\u003cp\u003eTo enhance reliability and intersubjective validation, a second student researcher was involved in the coding process. This student researcher contributed to the project as part of her graduation research. She was present as an observer during data collection and was closely involved in both the coding and thematic interpretation of the material.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData collection and quality assurance\u003c/h2\u003e\u003cp\u003eTo ensure the accuracy, credibility, and reliability of the research findings, multiple quality strategies were used. Interviews and focus group discussions were audio-recorded using a secure mobile application. Transcriptions were generated using Microsoft OneNote and were manually verified for completeness and accuracy.\u003c/p\u003e\u003cp\u003eFurthermore, data collection continued until thematic saturation was reached\u0026mdash;meaning that no new topics or insights emerged during subsequent interviews or focus groups. This criterion ensured that the thematic scope was sufficiently comprehensive and representative of participants' experiences.\u003c/p\u003e\u003cp\u003eFinally, the principle of \u003cem\u003ethick description\u003c/em\u003e was applied. Rather than presenting the experiences of care and welfare professionals as isolated accounts, findings were embedded within the broader social, organizational, and normative contexts in which they occurred. Quotations are presented alongside contextual information to provide a rich and nuanced understanding of everyday professional practices in supporting people living with dementia.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e Ethical integrity in this study was maintained through adherence to established guidelines on research involving human participants. Informed consent was obtained from all participants following the distribution of an information letter that clearly described the study\u0026rsquo;s objectives, procedures, potential risks, and the voluntary nature of participation. Participants were assured of their right to withdraw at any time without consequence.\u003c/p\u003e\u003cp\u003eData security was rigorously upheld; all personal data were pseudonymized to protect participant identities, and securely stored within the Fontys research drive environment, with access strictly limited to the research team. Data handling and storage practices conformed to the General Data Protection Regulation (GDPR; Regulation (EU) 2016/679), as implemented in Dutch law through the Algemene Verordening Gegevensbescherming (AVG). Institutional data retention policies were followed, stipulating a maximum storage period of fifteen years. Furthermore, the study was reviewed by the Fontys Committee on Ethics in Research (FCEO), which concluded that the research did not fall under the scope of the Dutch Medical Research Involving Human Subjects Act (FCEO Advice Number 156a Antonissen, 2024; Wet medisch-wetenschappelijk onderzoek met mensen, WMO).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn total, 31 professionals from 17 different professional practices participated in the study. They represented a diverse range of disciplines within the health and social care sectors, spread across multiple provinces in the Netherlands (Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eAnalysis of the interviews and focus groups yielded four main themes in response to the first research question, which explored how professionals in healthcare and the social domain experience the current organization, collaboration, and quality of home-based support for people living with dementia: (1) \u003cb\u003eCare support as a landscape of isolated islands\u003c/b\u003e, (2) \u003cb\u003eTiming and focus of support\u003c/b\u003e, (3) \u003cb\u003eSpecific knowledge about dementia\u003c/b\u003e, and (4) \u003cb\u003eResource constraints\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eFor the second research question, which focused on identifying suggested improvements to enhance coordination, communication, and awareness of social initiatives, two themes emerged: (1) \u003cb\u003eCentralized Control\u003c/b\u003e and (2) \u003cb\u003eKeep it Simple\u003c/b\u003e. These themes build directly on the barriers identified in the first research question, suggesting ways to overcome fragmentation and complexity by providing a clear coordinating role and promoting accessible, user-friendly social initiatives.\u003c/p\u003e\u003cp\u003e[Table\u0026nbsp;1 Participant characteristics]\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCare support as a landscape of Isolated Islands\u003c/h2\u003e\u003cp\u003eConversations with healthcare and social care professionals revealed that support for people with dementia at home is often fragmented. Many described the situation as a landscape of isolated islands, meaning that different initiatives, organizations, and disciplines coexist but remain insufficiently connected.\u003c/p\u003e\u003cp\u003eA social worker from a national organization that empowers people with dementia explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSometimes it really feels like working on islands, you know. Care institutions often say: \u0026lsquo;Yes, we offer daytime activities,\u0026rsquo; but they don\u0026rsquo;t look beyond that. For example, they\u0026rsquo;re not even aware of things like the \u0026lsquo;Kwiek route\u0026rsquo; [a support route to walk outside].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCollaboration between healthcare and social care often depends on chance or individual initiative. If a key person leaves, projects can quickly come to a halt. Professionals frequently lack awareness of what others are doing, leading to duplicated efforts or blind spots in support. A Nursing instructor observed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe actual collaboration and co-creation often fall short. Someone takes the lead, puts their name on it, and that\u0026rsquo;s it. The sense of urgency isn\u0026rsquo;t really felt. It\u0026rsquo;s all too non-committal.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe challenge is especially pronounced in large municipalities, where scale and staff turnover complicate cooperation. In smaller towns and villages, by contrast, communication lines are shorter, familiarity is greater, and support is more quickly established. A religious social worker focused on elderly welfare noted:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhat we do\u0026mdash;and that\u0026rsquo;s important\u0026mdash;is look at how it works in a village. It\u0026rsquo;s organized very differently than in a city. In a village, everyone knows each other, and that sense of connection and control has largely been lost in urban areas.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e Across interviews and focus group sessions with different health- and social care professionals, the primary care practice nurse and the dementia case manager were seen by social care workers, occupational therapists, municipal officers and geriatrics as pivotal actors, bridging medical and social support. However, their effectiveness is constrained by limited time, unclear responsibilities, and insufficient overview of the social domain. As one municipality officer noted:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePeople with dementia are known to the case managers, and they\u0026rsquo;re real multitaskers. But because they\u0026rsquo;re so busy, they invest little in social activities. As a result, people with dementia are often unaware of what social support is available.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt the same time the interviews and focus groups highlighted that municipalities in the Netherlands play a crucial role in facilitating social activities close to where people live, so that individuals do not have to travel long distances to participate. In practice, however, the scope and nature of this support vary considerably. Some municipalities take an active lead, investing in dementia-friendly initiatives and creating accessible opportunities for social engagement, while others are less involved. Several professionals report that collaboration with municipalities is often hindered by bureaucracy, frequent staff changes, or unclear frameworks. A municipality officer admitted: \u0026ldquo;\u003cem\u003eWe lack collaboration within the municipality itself.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eTiming and focus of support\u003c/h2\u003e\u003cp\u003eProfessionals emphasized that assistance often begins too late. Early signs of dementia may be masked or minimized, leaving caregivers overwhelmed before formal help arrives. A primary care practice nurse reflected:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhat\u0026rsquo;s difficult is that people seem fine during consultations, but at home and with their partner, problems arise. The caregiver becomes overwhelmed because they no longer understand their partner. It leads to a lot of conflict. It\u0026rsquo;s hard to assess and respond to that.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen support is eventually offered, it tends to focus primarily on medical care and symptom management. Preventive guidance and activities that could enhance quality of life early on\u0026mdash;for both the person with dementia and their caregiver\u0026mdash;often receive too little attention. Dementia is still too often approached solely as a disease leading to inevitable decline, which means the potential of early interventions aimed at self-reliance, meaning, and social connection remain underused. As a result, valuable opportunities to prevent overburdening and to maintain stability at home for longer, are missed. A nursing instructor comments: \u003cem\u003e\u0026ldquo;Healthcare could take a step back\u0026mdash;it\u0026rsquo;s not just about healthcare. Social care needs to be more at the forefront.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSpecific knowledge about dementia\u003c/h2\u003e\u003cp\u003eAccording to the participants, a major barrier lies in the limited knowledge of dementia among many professionals, which often results in inappropriate or ineffective action. Healthcare providers, social care workers, and volunteers frequently lack the skills to respond to the specific characteristics of dementia. Communication can easily become unintentionally patronizing: professionals tend to talk about the client rather than with them, and discussions often remain stuck in meetings without leading to concrete action. Many professionals feel insecure, either underestimating or overestimating the abilities of people with dementia, or withdrawing altogether when faced with so-called \u0026ldquo;difficult behaviour.\u0026rdquo; The result is little space for autonomy, and people with dementia are seldom involved in decisions about their own lives.\u003c/p\u003e\u003cp\u003eAn occupational therapist reflected: \u003cem\u003e\"Once the diagnosis is made, a dementia case manager is immediately assigned, and, perhaps somewhat bluntly put, they immediately start directing things toward day care. I think that in this process, what people with dementia and their caregivers often consider important and meaningful is not always properly taken into account.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis connects to another crucial signal: many people with dementia have lost their sense of initiative. This loss of initiative is not only a consequence of the disease itself but is reinforced by several factors. People often lose confidence in their abilities through negative experiences, feel unmotivated when they are not taken seriously, or encounter activities that are too healthcare-focused, insufficiently stimulating, or poorly matched to their interests. As a social worker explains: \"\u003cem\u003eThere is simply too much\u0026mdash;so many initiatives that they overwhelm people, taking away the ordinary rhythm of life and making it harder to maintain natural human behaviour.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAs a result, a dependent care relationship can quickly emerge, in which individuals lean heavily on others\u0026mdash;especially when family members take over everything. A social worker in a museum offering programmes for people with dementia remarked: \u003cem\u003e\u0026ldquo;There\u0026rsquo;s a piece of misunderstanding, being unheard, unseen\u0026mdash;and that can result in the feeling that you no longer matter.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eProfessionals increasingly highlight the importance of understanding how people with dementia themselves experience their situation. Their emotions, resilience, and coping strategies are often overlooked. Many feel defeated, confused, or ashamed about memory loss, and find it difficult to talk about\u0026mdash;or choose denial instead. Some are able to mask their condition for years, especially when family members unconsciously take over daily tasks. As one GP explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eNo, it really takes many years. First, it takes years before a patient even realizes it. And those years are filled with denial, cover-up, avoidance. And the family doesn\u0026rsquo;t notice either\u0026mdash;because unconsciously, they take over the care.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis highlights how memory issues often remain hidden in the early stages. It also illustrates that there are significant interindividual differences in how dementia is experienced\u0026mdash;for instance, depending on whether cognitive decline progresses gradually or rapidly. Knowledge about these variations is often lacking in professionals, even though understanding them is crucial to fully grasp the lived experience of dementia.\u003c/p\u003e\u003cp\u003eDifferences also appear between older and younger people with dementia. Younger individuals are usually more receptive to support, while older people often show more resistance to accepting help and to participating in care programs. A dementia case manager adds: \u003cem\u003e\u0026ldquo;Whether the help works also depends on the person\u0026rsquo;s age. Younger people with dementia are more approachable and open to help. Older people often have a heavier care burden, also due to other physical problems.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eResource Constraints\u003c/h2\u003e\u003cp\u003eLiving at home with dementia often involves high needs but at the same time, there is little structural support. Due to staff shortages in home care, only minimal contact is provided, leaving hardly any room for personalized attention. Case managers and other healthcare professionals report that they simply lack the time to offer tailored care, coordinate care effectively, or pick up on changing needs. A geriatrician remarks:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Home care is barely available; people get a diagnosis\u0026mdash;which feels like an ill fate\u0026mdash;and then they\u0026rsquo;re left to figure things out on their own for a long time.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFinancial barriers add to this challenge. Care covered by insurance is often limited, non-transparent, and difficult to access\u0026mdash;especially for people with middle incomes who fall outside the scope of social care support\u003c/p\u003e\u003cp\u003eThe findings from the above themes reveal how professionals experience the current organization, collaboration, and quality of home-based support for people living with dementia, highlighting various gaps and challenges. Building on these insights, the following section focuses on the improvements that health- and social care professionals consider necessary. Specifically, it examines the types of activities available, the key conditions required to ensure their effectiveness and meaningful engagement, and how these activities can best be implemented, evaluated, and delivered.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eAligning Activities with Everyday Life and Existing Routines\u003c/h2\u003e\u003cp\u003eProfessionals emphasized that activities for people with dementia should be simple, familiar, and closely aligned with daily routines to prevent participants from feeling overwhelmed. Activities need to connect with participants\u0026rsquo; everyday lives and interests without placing excessive demands on cognitive abilities. Complex, fast-paced, or cognitively demanding activities often lead to disengagement, whereas straightforward, routine-based approaches foster familiarity and encourage sustained participation. As one primary care practice nurse explained: \u0026ldquo;\u003cem\u003eYou have to make it super simple\u0026mdash;two buttons and you\u0026rsquo;re done, for example.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eEnsuring that persons living with dementia feel personally addressed and supported, particularly in relation to technology or new initiatives, further enhances engagement and promotes meaningful involvement in daily life. Simplicity also applies to the organization and continuity of activities. Participation should be as normal as possible, often requiring local adaptation and a redefinition of participants\u0026rsquo; roles. Activities that rely on a single key person or are located far away frequently fail to maintain engagement over time.\u003c/p\u003e\u003cp\u003eInclusivity was highlighted as equally important: initiatives should mix people with and without memory problems to reflect everyday social life. As one occupational therapist noted: \u003cem\u003e\u0026ldquo;It has to be accessible for everyone. Everyone is welcome. The mix of people with and without memory problems\u0026mdash;that\u0026rsquo;s how society is, and that\u0026rsquo;s how a social activity should be.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFlexibility and personalization are essential to meet the changing needs of people with dementia. Because dementia is a progressive condition, participants\u0026rsquo; roles within activities must be continually reassessed. Activities that foster emotional connection, social participation, and shared experiences are especially beneficial, as they can be adapted to the changing abilities and needs of people with dementia. A social worker concluded: \u003cem\u003e\u0026ldquo;A client can change, right? A client is no longer who they once were.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePromotion of Activities\u003c/h2\u003e\u003cp\u003eThe scope of available activities must also include effective communication and promotion. Many people with dementia and their families become lost in the large, municipality-specific offerings. Social activities often receive less attention than medical care, leaving families unsure where to start. As a dementia social worker explained: \u0026ldquo;\u003cem\u003eIt\u0026rsquo;s very diffuse. There is so much that people can\u0026rsquo;t see the forest for the trees. If you don\u0026rsquo;t know something exists, you won\u0026rsquo;t go looking for it. We still think too often in medical solutions: doctor, pill, done.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePassive promotion, such as distributing leaflets, is usually insufficient. Personal and proactive approaches via trusted professionals\u0026mdash;particularly general practitioners\u0026mdash;prove more effective. An informal caregiver emphasized: \u003cem\u003e\u0026ldquo;GPs should recommend it\u0026mdash;if a GP says it, more people will use it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA broad range of promotion channels is needed to reach different target groups. Digital tools such as social media, short videos, and neighbourhood apps work well for younger people with dementia, while local, tangible means\u0026mdash;such as community newspapers, posters, monthly calendars, handwritten GP referrals, and flyers in GP practices, libraries, or supermarkets\u0026mdash;are more suitable for older generations. A geriatrician observed: \u003cem\u003e\u0026ldquo;I have the feeling\u0026mdash;but I haven\u0026rsquo;t studied it\u0026mdash;that handwritten letters make people feel truly heard: this is especially for me, someone has taken the time.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIt is important that logos, visual symbols, and language are inviting and non-stigmatizing, and that communication resonates with the daily lives and interests of the target group. Mobilizing community resources\u0026mdash;such as neighbours, volunteers, and church groups\u0026mdash;strengthens the sustainability and visibility of activities. Familiar faces and recognizable settings make participation feel like a natural part of daily life rather than a care intervention. An occupational therapist explained: \u003cem\u003e\u0026ldquo;Introduce social initiatives right away, make sure everything works, and do it immediately. Inform the family in advance\u0026mdash;that often works best.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eCentral Coordination\u003c/h2\u003e\u003cp\u003eThe fragmented nature of dementia care and the scattered availability of social activities\u0026mdash;often described by professionals as \u0026ldquo;isolated islands\u0026rdquo;\u0026mdash;highlights the need for a trusted and recognizable coordinating actor. Professionals frequently point to the case manager or practice nurse as natural candidates for this role. These coordinators should maintain direct communication channels with both healthcare and social care professionals and have a comprehensive overview of available and appropriate social initiatives. A GP described the role of central coordination: \u003cem\u003e\u0026ldquo;Then a case manager is brought in, and they monitor the situation together. Step by step, more care forms around the patient.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e Occupational therapists identify themselves as providing added value by bridging the gap between people\u0026rsquo;s abilities and the support they need, focusing on participation rather than limitations. However, they remain underutilized because their value is not widely recognized, often being introduced too late despite the significant potential benefits in early-stage dementia. An occupational therapist explained: \u003cem\u003e\u0026ldquo;I would also want the practice nurses and the case managers to play a more active role. Then you\u0026rsquo;d have a strong network entering people\u0026rsquo;s homes. We don\u0026rsquo;t all have to be involved all the time, but if we align who does what, we can act quickly and focus more on preventive care\u0026mdash;instead of cleaning up the mess afterward.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eDutch municipalities also emerge as crucial in creating accessible local initiatives and supporting sustainable collaboration among stakeholders. Yet professionals emphasized that this requires stronger leadership and less bureaucracy. A GP added: \u003cem\u003e\u0026ldquo;Yes, I believe that municipalities could certainly take more leadership in this. For example, by offering training programs, but also by inviting people who reach a certain age, for instance 75, to come in for a conversation. In this way, they can be involved in a meeting for 75-year-olds, where they can also contribute themselves. It is important that municipalities have a clearer picture of these people, so that they can indicate which matters are relevant to them based on their age. Families should also be involved in this process.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explores how professionals in healthcare and the social domain experience the current organization, collaboration, and quality of home-based support for people living with dementia. Findings show that such support remains fragmented and overly medicalized. Professionals described the organization of dementia care as a \u0026ldquo;landscape of islands,\u0026rdquo; meaning that communication between professionals is limited, initiatives often exist in isolation, and structural integration is lacking. Participants noted that collaboration is frequently coincidental, easily disrupted, and particularly challenging in large municipalities, whereas smaller communities benefit from shorter lines of communication. Literature suggests that such fragmentation makes care highly dependent on individual initiatives and vulnerable to staff turnover or organizational change (Sorrentino et al., 2025). Scarce time, staff shortages, and financial barriers further constrain personalized and continuous care, leaving families to cope largely on their own during the early stages of dementia.\u003c/p\u003e\u003cp\u003eA central challenge in dementia care is the quality of home-based support, which often lacks both timing and focus. Support is frequently initiated too late, partly because early signs of dementia can be subtle, easily masked, or minimized by patients and families. Research indicates that home care services frequently operate according to predetermined routines rather than individualized needs, resulting in care that is insufficiently tailored to the person\u0026rsquo;s condition or stage of dementia (Hoel et al., 2021). This routine-based approach can delay recognition of emerging needs, contributing to a lag in appropriate support. Stephan et al. (2018) similarly found that people with dementia and carers often struggle to access timely help and feel uncertain about when and how to seek services, underscoring that delays in support are not only organizational but also linked to limited clarity for users themselves. Moreover, systematic reviews show that dementia-specific interventions are limited and poorly integrated with broader health and social care systems (Chen et al., 2022), which may further exacerbate delays or inadequacies in support.\u003c/p\u003e\u003cp\u003eBy the time support is provided, caregivers are often already overwhelmed, and interventions tend to prioritize medical care and symptom management over preventive guidance or social measures that could enhance quality of life, with insufficient emphasis on individuals\u0026rsquo; strengths, capabilities, and potential (Dieleman-Bij de Vaate et al., 2020; WHO, 2021). As a result, opportunities to support autonomy, prevent caregiver burden, and maintain stability at home are often missed (Sorrentino et al., 2025). Stephan et al. (2018) reinforce this point: their participants repeatedly emphasized that available services are often reactive rather than preventive and that psychosocial or community-based support is insufficiently visible or accessible.\u003c/p\u003e\u003cp\u003eLimited knowledge of dementia among professionals can lead to patronizing communication, which may make people with dementia feel devalued or withdrawn (Williams et al., 2017). Our results indicate that discussions are often conducted about rather than with people living with dementia, limiting their involvement in decision-making. This aligns with Alsawy et al. (2017), who found that only one of fifteen studies included people with dementia as primary informants. Stephan et al. (2018) add an important nuance here: people with dementia in their study reported that feeling excluded from conversations or not being taken seriously acted as a major barrier to seeking formal care. This suggests that communication challenges not only affect relational dynamics but may directly influence whether individuals engage with services at all. Professionals may also over- or underestimate abilities or withdraw in response to challenging behaviours (Dupuis et al., 2012; Popham \u0026amp; Orrell, 2012), further restricting autonomy and meaningful engagement.\u003c/p\u003e\u003cp\u003eThe expertise and presence of key professionals, particularly primary care practice nurses and dementia case managers, are critical for improving coordination and supporting people with dementia. Primary care practice nurses often serve as the first point of contact, bridging medical, psychological, and social support, while case managers oversee the care trajectory and coordinate access to services. Previous studies indicate that practice nurses are crucial for early identification and timely interventions (Dieleman-Bij de Vaate et al., 2020), and case managers play a central role in maintaining continuity and preventing fragmented care (Ee et al., 2024). This study further highlighted occupational therapists as providing valuable support in maintaining daily routines, participation, and autonomy, although participants noted they are often introduced too late, limiting early preventive interventions. Literature confirms the importance of these roles: Graff et al. (2006) show that occupational therapy preserves functional abilities, and the WHO (2021) recommends embedding such roles in primary care to enhance continuity and proactive, person-centered care.\u003c/p\u003e\u003cp\u003eBuilding on these insights, we studied what improvements professionals consider necessary to enhance the coordination, communication, and visibility of innovative social initiatives that promote quality of life. Our results indicate that social activities for people with dementia are most effective when they are simple, familiar, and embedded in everyday routines, connecting to participants\u0026rsquo; lives and interests without causing overwhelm, and fostering participation, autonomy, and emotional engagement. These findings are reinforced by Alderliesten and Ramaker (2021), who show that tailoring activities to individuals\u0026rsquo; daily lives and personal preferences enhances engagement and overall well-being, and by Dupuis et al. (2012), who emphasize that routine-based and familiar activities help preserve identity, support social inclusion, and maintain meaningful participation.\u003c/p\u003e\u003cp\u003eProfessionals emphasized that inclusivity is essential, ensuring that activities accommodate both people with and without dementia, reflecting natural social environments. Flexibility is also critical, as participants\u0026rsquo; abilities and needs change over time.\u003c/p\u003e\u003cp\u003eEffective promotion and accessibility of social activities for people with dementia are equally important, as passive approaches, such as leaflets, are insufficient. Personal and proactive communication via trusted professionals, particularly general practitioners and case managers, is essential, a point supported by the research of Sorrentino et al. (2025), who found that participation is often hindered by unclear access pathways, fragmented care services, and logistical or cultural barriers. They emphasize that having a single trusted professional \u0026mdash; a \u0026ldquo;key contact person\u0026rdquo; \u0026mdash; can significantly facilitate access and engagement by providing guidance and continuity of care. To reach diverse populations effectively, multiple channels should be used, combining local, personalized methods for older adults with broader community networks to increase visibility and accessibility, while familiar settings and trusted faces help embed participation naturally into daily life.\u003c/p\u003e\u003cp\u003eCentral coordination is needed to overcome fragmentation and improve alignment between health and social care. Case managers and practice nurses are seen as natural coordinators, maintaining communication across sectors and ensuring appropriate services are accessible. Municipalities play a critical role in creating accessible initiatives and supporting sustainable collaboration among stakeholders, though their involvement varies. According to Sorrentino et al. (2025), stronger leadership, clearer responsibilities, and reduced bureaucratic barriers are necessary to facilitate proactive engagement and coordinated, preventive support.\u003c/p\u003e\u003cp\u003eTo translate these insights into practice, a structured co-creation approach is essential. Professionals emphasized that meaningful change requires rethinking how support is organized and aligned. Design-driven approaches\u0026mdash;such as living labs or iterative co-creation\u0026mdash;can help articulate shared goals, map existing barriers, and prototype new service models across sectors. Importantly, designing the service itself can serve as a research method: by actively creating and testing service prototypes, researchers and practitioners can generate rich insights about what works in real-world contexts, uncover unforeseen challenges, and iteratively refine solutions. Rather than producing isolated interventions, these processes support the emergence of an integrated model that strengthens continuity, clarifies roles, and embeds successful elements such as trusted contact persons, flexible coordination, and everyday meaningful activities. This participatory approach offers a practical mechanism to reduce fragmentation and ensure that innovations genuinely meet the needs and living contexts of people with dementia and their families. The findings of Stephan et al. (2018) further support the need for such participatory redesign, as their participants emphasized the importance of being involved, informed, and supported throughout the care journey.\u003c/p\u003e\u003cp\u003eStrengths and limitations of this study also need to be considered when interpreting these findings. Strengths include its qualitative, exploratory design, combining focus groups and interviews to capture in-depth, lived experiences across multiple regions and professional backgrounds. Triangulation and expert validation enhance reliability. Limitations include a relatively small sample and reliance on self-reported experiences, which may limit generalizability. Additionally, the findings are context-specific to the Dutch healthcare system; care structures and professional roles may differ in other countries, which could affect the applicability of the results elsewhere. Future research could benefit from larger, mixed-methods or longitudinal study designs to examine how collaboration and initiatives develop over time.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eProfessionals perceive dementia care as fragmented, reactive, and overly medicalized but identify clear opportunities for improvement. Strengthening the roles of practice nurses and case managers, introducing occupational therapy earlier, and investing in meaningful, familiar, and inclusive social activities are critical steps. Achieving these improvements requires closer collaboration across healthcare, social care, and municipal systems, supported by proactive, personalized communication. By embedding coordination, preventive interventions, and person-centered approaches, dementia care can evolve into a more integrated system that supports autonomy, participation, and quality of life for people with dementia and their families.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eInternational organizations and reports\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWHO \u0026ndash; World Health Organization\u003c/li\u003e\n \u003cli\u003eOECD \u0026ndash; Organisation for Economic Co-operation and Development\u003c/li\u003e\n \u003cli\u003eGBD \u0026ndash; Global Burden of Disease\u003c/li\u003e\n \u003cli\u003eADI \u0026ndash; Alzheimer\u0026rsquo;s Disease International\u003c/li\u003e\n \u003cli\u003eEurostat \u0026ndash; Statistical Office of the European Union\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eResearch and educational institutions / funding\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSIA \u0026ndash; Taskforce for Applied Research SIA (part of NWO)\u003c/li\u003e\n \u003cli\u003eNWO \u0026ndash; Netherlands Organisation for Scientific Research\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology and research approaches\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eIPA \u0026ndash; Interpretative Phenomenological Analysis\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eHealthcare and guidelines (Netherlands)\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eNHG \u0026ndash; Dutch College of General Practitioners\u003c/li\u003e\n \u003cli\u003eM21 \u0026ndash; NHG Dementia Guideline (guideline code)\u003c/li\u003e\n \u003cli\u003eGP \u0026ndash; General Practitioner\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eLegislation / ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eGDPR \u0026ndash; General Data Protection Regulation\u003c/li\u003e\n \u003cli\u003eAVG \u0026ndash; Dutch Implementation of GDPR (Algemene Verordening Gegevensbescherming)\u003c/li\u003e\n \u003cli\u003eFCEO \u0026ndash; Fontys Committee on Ethics in Research\u003c/li\u003e\n \u003cli\u003eWMO \u0026ndash; Dutch Medical Research Involving Human Subjects Act\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to express my gratitude to the Geriatrics Department of the Catharina Hospital, the Dementalent Foundation, and Switch2Move for their valuable support and helpful guidance throughout this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u0026apos;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors conceived and designed the article. FA conducted the qualitative study and analysis. EW, RB, and CL made significant contributions to the theoretical concept and analysis. FA drafted the text, and all authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u0026apos;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u0026apos;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026sup1; Department of Geriatrics, Catharina Hospital, Eindhoven, The Netherlands\u003cbr\u003e\u0026nbsp;\u0026sup2; Fontys University of Applied Sciences, Paramedical Institute, Health Innovations \u0026amp; Technology / Warm Technology \u0026amp; Design, Eindhoven, The Netherlands\u003cbr\u003e\u0026nbsp;\u0026sup3; Tranzo, Tilburg University, Tilburg, The Netherlands\u003cbr\u003e\u0026nbsp;⁴ Expertise Center Dementia \u0026amp; Technology, Eindhoven University of Technology, Eindhoven, The Netherlands\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlsawy S, Mansell W, McEvoy P, Tai S. 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Aging Ment Health. 2012;16(2):181\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13607863.2011.609529\u003c/span\u003e\u003cspan address=\"10.1080/13607863.2011.609529\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRahman S, Swaffer K. Assets-based approaches and dementia-friendly communities. Dementia. 2018;17(2):131\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1471301216644115\u003c/span\u003e\u003cspan address=\"10.1177/1471301216644115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamaker R, Alderliesten M. (2021). Dementia and daytime activities: An exploration of possibilities. Vilans. 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Official J Eur Union. 2016;L119:1\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32016R0679\u003c/span\u003e\u003cspan address=\"https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32016R0679\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data (General Data Protection Regulation).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith JA, Flowers P, Larkin M. Interpretative phenomenological analysis: Theory, method and research. 2nd ed. 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Digit Health. 2025;11:2055207625133182. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/20552076251331825\u003c/span\u003e\u003cspan address=\"10.1177/20552076251331825\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 Participant characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of experience with dementia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eDistrict nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eCare home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eDistrict nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e10-15.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eCare home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eDistrict nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e10-15.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003ePrimary care practice nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e15-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOut-patient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eInformal care giver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e0-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eSouth Holland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eCasemanager dementia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e0-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eSouth Holland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eGeriatrician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e15-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOut-patient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eGeriatrician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e20-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOut-patient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eGeriatric nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e20-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eIn-patient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eGeriatric nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eIn-patient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eGeriatric nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e0-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eIn-patient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eGeneral practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e0-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eLimburg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOut-patient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eGeneral practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e0-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eGelderland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOut-patient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eOccupational therapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e15-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Holland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eOccupational therapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e20-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003ePhysiotherapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Holland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eCare home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003ePhysiotherapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Holland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eCare home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eHostess at a day activity centre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e15-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Holland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eCare home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eMunicipal officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e10-15.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eUtrecht\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eReligious social worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e20-25.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eSocial worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eUtrecht\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eSocial worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eUtrecht\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eCare home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eSocial worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eUtrecht\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eCare home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eSocial worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eUtrecht\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eSocial worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e0-5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eUtrecht\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eCare home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eSocial worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e0-5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eUtrecht\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eCare home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eSocial worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e10-15.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eManager Health and innovations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e10-15.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eNursing instructor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eNursing instructor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8955%;\"\u003e\n \u003cp\u003eSocial worker museum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.7595%;\"\u003e\n \u003cp\u003e5-10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eNorth Brabant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0862%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Home-based dementia care, Interprofessional collaboration, Social participation, Person-centred support, Care coordination","lastPublishedDoi":"10.21203/rs.3.rs-8214306/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8214306/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDementia poses a rapidly increasing global and national challenge, with growing demands on home-based care systems, families, and communities. Although policies encourage people with dementia to remain at home, current support structures remain fragmented, reactive, and overly medicalized. As a result, opportunities to promote autonomy, social participation, and well-being are often missed. This study examines how professionals in healthcare and the social domain experience the organization, collaboration, and quality of home-based dementia support, and identifies ways to improve coordination and awareness of innovative social initiatives.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA qualitative study design grounded in Interpretative Phenomenological Analysis (IPA) was used. Data were collected through seven focus groups and nine individual interviews with 31 professionals from healthcare, social care, community services, and municipal organizations across the Netherlands. Interviews and focus groups were transcribed and analyzed following Graneheim and Lundman\u0026rsquo;s six-step qualitative content analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eProfessionals described dementia support as a \u0026ldquo;landscape of isolated islands,\u0026rdquo; marked by minimal interprofessional communication, inconsistent collaboration, and unclear responsibilities. Support often starts too late, focuses predominantly on medical needs, and insufficiently addresses everyday routines, autonomy, and social participation. Limited dementia-specific knowledge across sectors contributes to patronizing communication and reduced involvement of people with dementia in decision-making. Resource constraints\u0026mdash;including staff shortages, time pressure, and bureaucratic barriers\u0026mdash;further hinder continuity and person-centred support. Participants highlighted the effectiveness of simple, familiar, and inclusive social activities embedded in daily life, and emphasized the need for proactive promotion and a recognizable coordinating professional, such as a practice nurse, case manager, or occupational therapist.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eImproving home-based dementia support requires stronger cross-sector collaboration, earlier and more proactive interventions, and enhanced coordination across health, social, and municipal systems. Embedding simple, meaningful, and community-based activities within everyday life, supported by knowledgeable and trusted professionals, is essential to fostering autonomy, participation, and quality of life for people living with dementia at home.\u003c/p\u003e","manuscriptTitle":"Rethinking Dementia Support at Home: Bridging Gaps Between Healthcare and the Social Domain","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-03 06:44:42","doi":"10.21203/rs.3.rs-8214306/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-03T09:51:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-29T14:38:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-29T14:36:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-11-26T14:51:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce319357-5305-4cef-8850-6a6b3cc7b6fe","owner":[],"postedDate":"December 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T10:09:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-03 06:44:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8214306","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8214306","identity":"rs-8214306","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}