Life after a stroke

Care network

Various care providers may be involved in the care of patients after a cerebral infarction or cerebral hemorrhage. The list below lists most care providers and what they offer, how you can get there, and whether they will be reimbursed. You can find these by region on the zorgzoeker (care search) website.

• Outpatient supervisors

  A stroke can have major consequences for your life. This changed life requires adjustments from you and your environment. The outpatient supervisor pays attention to these changes in the situation at home, so that you can continue to function in your familiar environment. An outpatient supervisor remains in contact for a longer period of time and supports you, for example, in social contacts, in the planning of household and administrative tasks, money matters, and contact with institutions. You can also get support in finding suitable work activities or hobbies.
  
  Referral information: Through your general practitioner, treating specialist, or nursing specialist, you can contact an organization in your area that offers outpatient assistance. You can also contact this kind of organization on your own. The municipality is responsible for the care indication. This is done by means of a “kitchen table talk”. There may be a waiting period for this.
  
  Fees: The reimbursement for outpatient supervision is made via the municipality.

• Vocational rehabilitation

  In the case of vocational rehabilitation, rehabilitation specialists provide specific support for vocational rehabilitation linked to the rehabilitation treatment. They take a practice-oriented look into your possibilities and restrictions with respect to work. The aim of the evaluation is to get more clarity about your work and education opportunities.

  
  Referral information: referrals are made by medical and nursing specialists, external rehabilitation doctors, employers, company doctors, or labor experts.
   
  Fees: Vocational rehabilitation combined with rehabilitation treatment falls within the basic package and is therefore reimbursed.

• Treatment program - Hersenz

  If you want to learn to deal better with the invisible consequences of acquired brain injury after completing the rehabilitation program, Hersenz offers a nationwide treatment program for this. You will be participating this program from home. Various social workers are involved in this. You will receive a combination of individual and group treatment to ensure that you can function better both personally and physically. Attention is paid to learning to better deal with the problems of thinking, memory, concentration and attention problems, slower information processing, difficulty with dual-tasking, and problems with mental retention.
  The treatment program of Hersenz is offered nationwide in collaboration with local care institutions.
  
  Young adults can take part in a special program (in Dutch).
   
  Referral: You can register for the Hersenz treatment program yourself via the website (in Dutch).
   
  Fees: If you have a care indication for the treatment process, this will be reimbursed via the Wet Langdurige zorg (Long-Term Care Act - WLZ) and, from 2021 on, likely via the basic health insurance package.
   

• Coaching

  At a later stage after a cerebral infarction or hemorrhage, there are various forms of counselling and projects with special programs for young patients. They offer various forms of support to young people after brain injury. For more information please see:

  • Edwin van der Sar Foundation
  • Breinsupport (in Dutch)

  
   

• Occupational therapist

  If you have a problem carrying out everyday actions and activities, you can contact the occupational therapist for an examination, treatment, and guidance. These include activities in the areas of self-sufficiency, housekeeping, and leisure. Treatment by an occupational therapist starts as soon as possible after the stroke. After your stay in the hospital, the treatment will be transferred to a colleague in a rehabilitation center, nursing home, or at home.
   
  Referral information: Referral is made based on a valid referral by a doctor or nurse specialist. This can be your general practitioner or your attending physician in hospital/rehabilitation center/nursing home.
   
  Fees: Occupational therapy in the hospital and in the rehabilitation clinic is reimbursed within the basic package. Your own deductible excess will be charged once after hospitalization.
  Occupational therapy treatments in a practice or at home (primary care) are reimbursed within the basic package up to 10 treatments per year.

• Physiotherapist

  A physiotherapist offers treatment and guidance if you have a problem with movement as a result of a stroke. Treatment by a physiotherapist starts as soon as possible after the stroke and is then transferred to colleagues in the rehabilitation clinic, nursing home, or at home. Physiotherapists who specialize in brain injury have formed a network so that they can easily find each other and treat you according to the same principles.
   
  Referral information: Referral is made based on a valid referral by a doctor or nurse specialist. This can be your general practitioner as well as your attending physician or nursing specialist.
   
  Fees: Physiotherapy at the hospital and the rehabilitation clinic is reimbursed within the basic package, your deductible excess is charged once only after hospitalization.
  Physiotherapy treatments in a practice or at home (primary care) are reimbursed, depending on your agreements with the health insurance company. After a stroke, you are entitled to chronic treatment after 20 treatments. This is then reimbursed by the health insurance. Up to these 20 treatments, the reimbursement depends on your chosen reimbursement package.

• General practitioner

  The general practitioner and the nurse practitioner are the first point of contact for all your health problems or questions when at home. The potential problems, limitations, and demands of patients who suffered a stroke at a young age can have many layers to them. Sometimes these are immediately clear, but it can also happen that this only emerges over the course of time. Even then you can always contact your general practitioner. The general practitioner can guide and support you, mainly in the medical and psychological field. In addition, they also have an extensive network with other (aid) organizations in your area.
   
  Referral information: Not applicable. You can always consult your general practitioner on your own initiative.
   
  Fees: Consulting a family doctor is always covered by the basic package, and you do not pay any deductible excess.

• Job coach

  Throughout the Netherlands, there are coaches who supervise the final phase of the treatment or rehabilitation process and the beginning of the reintegration phase. They specialize in preventing absenteeism among young people and adults with acquired brain injury (ABI).
  Slight restrictions can create the necessary obstacles for employment. A job coach offers support to prevent absenteeism and helps you and your employer better cope with the limitations in relation to work.
  The aim is to offer young people, after a stroke, the prospect of continued and sustainable participation in the labor market.
   
  Fees: Coaching people in their own work or to adapted work at their own employer (track 1) or to another organization (track 2) are routes that are usually paid for by the employer within the framework of the Wet Verbetering Poortwachter (gatekeeper improvement act).
   
  Job coaches often work on behalf of the UWV (Dutch Employee Insurance Agency), the municipality, or insurers, but are also assigned by employers at the recommendation of a company doctor.

• Speech therapist

  A speech therapist treats and guides you and your loved ones with problems in the field of communication (speech, language, cognition), chewing, and swallowing as a result of a stroke. The treatment is started as soon as possible at the hospital after the stroke has occurred and is then transferred to colleagues in a rehabilitation clinic, nursing home, or at home (primary care).
  There are speech therapists in primary care who specialize in the treatment of neurological language, speech, and/or swallowing disorders. To find out what these practices are in your region, you can contact a speech therapist from a hospital in the region. They can advise you on which practice is suitable.
   
  Referral information: A referral from a doctor (general practitioner or treating specialist) or nursing specialist is required in order to be reimbursed for a speech therapy treatment.
   
  Fees: Speech therapy at the hospital and the rehabilitation clinic is covered by the basic package. Your own deductible excess will be charged once after hospitalization.
  Speech therapy treatments at home are also covered by the basic insurance. The health care insurer does not set any requirements for the maximum number of treatments.
   
  Check out afasienet (in Dutch) for speech therapists in your area.

• Social worker

  Care provider with the aim of supporting people in solving and dealing with problems in social or societal functioning.

• ABI centers

  At ABI centers, people with acquired brain injuries (ABIs) can receive specialized information, advice, and support. If you need it, “social rehabilitation” can be continued at the ABI center by means of training and programs in various areas.
   
  Referral: In the first instance, you can contact the institution in question yourself. Depending on the service you want to use, you may need a referral from your general practitioner, rehabilitation doctor, neurologist, or nursing specialist.
   

  Fees: Reimbursement depends on the service you use. The institution in question can help you with this.

• Neurosurgeon

  Medical specialists in the surgical treatment of disorders of the brain, spinal cord, and nerves. Within neurosurgery, the vascular neurosurgeon specializes in the treatment of diseases of the brain vessels.
   
  Referral information: Referral is based on a valid referral from the doctor in the department where you are being treated.
   
  Fees: Specialized medical treatments are reimbursed within the basic package, your deductible excess will be charged once only.

• Neuro-interventional radiologist

  A radiologist is a medical specialist in the diagnosis of injuries or conditions by means of rays or waves, such as X-rays, echoes, or magnetic fields (MRI). A neuro-interventional radiologist uses catheters to examine the blood vessels in the head or to carry out a treatment through a small opening in the skin under X-ray.
   
  Referral information: Referral is based on a valid referral from the doctor in the department where you are being treated.
   
  Fees: Specialized medical treatments are reimbursed within the basic package, your deductible excess will be charged once only.

• Neurologist

  The medical specialist who works with diagnostics and treatment of diseases of the brain, spinal cord, and nerves. Within neurology, the vascular neurologist specializes in the diagnosis and treatment of diseases of the brain vessels.

   
  Referral information: Referral is based on a valid referral from the doctor in the department where you are being treated.
   
  Fees: Specialized medical treatments are reimbursed within the basic package, your deductible excess will be charged once only.

• Psychologist

  A healthcare psychologist is a psychologist who is trained to provide mental health care. A neuropsychologist specializes in treating people with a brain injury. They can help you if you have trouble dealing with your symptoms after a stroke. For example, if you have difficulty coping with the changes, or how to explain them to the outside world. If you are having anxiety issues since the stroke or a lot of unpleasant memories or nightmares, you can still contact a neuropsychologist.
   
  Referral information: Referral is made based on a valid referral from the general practitioner and an insured DSM diagnosis in order to be reimbursed. An adjustment disorder is not reimbursed. Anxiety and mood disorders and trauma-related disorders such as PTSD are reimbursed.
   
  Fees: Treatment by a healthcare psychologist in a rehabilitation clinic is reimbursed within the basic package. Your practitioner can tell you more about treatments that may or may not be reimbursed.
  Treatments at a practice (primary care) may be reimbursed, depending on your agreements with the health insurance company.

• Physician assistant (PA)

  A care provider who takes over medical tasks from the medical specialist. In the Netherlands, the PA may, in cooperation with a medical specialist, carry out medical actions independently.
   
  Referral information: Referral is based on a valid referral from the doctor in the department where you are being treated.
   
  Fees: Specialized medical treatments are reimbursed within the basic package, your deductible excess will be charged once only.

• Nurse practitioner (NP)

  A care provider in general practitioner care; literally the assistant of the (general practitioner's) practice.  There are two specializations in somatic (physical care) and mental health care.
   
  Referral information: Not applicable. You can always consult your doctor or nurse practitioner on your own.
   
  Fees: Visiting a general practitioner or nurse practitioner is always part of the basic package, and you do not pay any deductible excess.

• Rehabilitation

  Rehabilitation following your admission to hospital

  The rehabilitation doctor in the hospital or rehabilitation clinic will work with you to identify the problems that occurred after the stroke (brain hemorrhage or infarction). Examples of this are problems that prevent you from functioning independently, such as standing, walking, balance, arm and hand function, speaking, communicating, thinking, emotional and behavioral functioning. Based on your situation, it will be assessed how and where you can best recover. If you are registered for specialized medical rehabilitation at a rehabilitation center, the rehabilitation doctor will arrange for transfer to a colleague at the rehabilitation center.
  
  Referral information: Referral is based on a valid referral from the doctor in the department where you are being treated.
  
  Fees: Specialized medical rehabilitation at the rehabilitation clinic is reimbursed within the basic package, the deductible excess is charged once. 

  Rehabilitation at home

  You can also sign up for an outpatient rehabilitation program from home if you have problems with the less apparent effects of a stroke, such as problems with your memory, concentration and attention, slower information processing, difficulty with dual-tasking, and problems with mental retention. Your emotions and behavior may also be different from before the stroke. This can lead to problems in social and work situations.
  
  To learn to deal with the consequences of the stroke and approach activities and situations differently you can take part in an outpatient rehabilitation program. Also called Poliklinische Revalidatie Behandeling (outpatient rehabilitation treatment - PRB). This is a treatment program supervised by a team of specialized care providers, such as a rehabilitation doctor, neuropsychologist, physiotherapist, occupational therapist, speech therapist, movement therapist, and/or social worker.
   
  Referral information: Referral is made based on a valid referral by a doctor or nurse specialist. This can be done by both the family doctor and the attending (nursing) specialist.
   
  Fees: A rehabilitation program at a Medical Specialist rehabilitation clinic is part of the basic package and is always reimbursed. 

  Rehabilitation after brain injury at young age/programs

  In the Netherlands there are 2 centers that specialize in rehabilitation after serious brain injury among young people. These are located in Woerden and Tilburg. These centers use specific criteria to admit people.
   
  Referral: via rehabilitation physician for clinical rehabilitation and a referral from a general practitioner or specialist for outpatient rehabilitation.
  
  Fees: this is covered by the health insurance.
   
  More information (in Dutch):

  • Daan Theeuwes Centrum
  • Libranet
     

• Sex therapist

  The sex therapist discusses questions and sexual problems you experience as a result of your stroke. The sex therapist offers a sympathetic ear and has no prejudices, and if there are problems, they work with you and advise you on how you can deal with these problems.
   
  Referral information and reimbursement:
  Primary care: If you go to an independent sex therapist, you can do so on your own (without a referral) via the NVVS website (in Dutch) under the heading “zoek een seksuoloog” (find a sex therapist). NVVS sex therapists are usually reimbursed by the supplementary packages. Your health insurance determines how much you get reimbursed per session/how many sessions.
   
  At the hospital (secondary/tertiary care), things are different. You can only go to a sex therapist with a referral from a medical specialist (usually a urologist/gynecologist, but it can also be someone else), but not directly from your general practitioner.

• Social district team

  After a stroke, you may have a lot to deal with. Things that were easy to do before may no longer be so effortless today. This demands a lot from you and your environment. A social district team can support you in this. They can also support you with all kinds of practical matters concerning work and income, potentially a program, hobbies, contacts with the people around you, and your household. The district coach listens to your story. This conversation allows you to tell how the stroke has changed your life and what you are up against. Together with the district coach, you'll find out what can help you to stay afloat in this new situation.

• Nursing Specialist (NS)

  A care provider who does so independently and is allowed to perform medical activities in the context of their own described field of expertise.
   
  Referral information: Referral is based on a valid referral from the doctor in the department where you are being treated.
   
  Fees: Specialized medical treatments are reimbursed within the basic package, your deductible excess will be charged once only.