106 Chapter 4 Supported housing aims at providing a stable environment, daily regularity and meaningful daily activities, such as different types of working experiences or non-work-related activities to provide rhythm and regularity (e.g. taking a group walk, doing crafts or helping with farm activities in a rural environment). The level of support provided varies in intensity and depends on the individual needs, including medication management, personal care, household chores such as cooking and cleaning, and financial administration. Besides the practical assistance there is also a focus on rehabilitating individuals to manage these tasks and achieving personal goals in social and occupational domains. Individuals might be incentivised to different levels of participation in the labour market, ranging from voluntary work to sheltered or competitive employment. As mentioned in the previous section, supported housing in the Netherlands does not include any clinical care, which individuals can receive in the outpatient setting from mental health care providers. The fact that supported housing intends to proxy living in the community and is fully separated from mental health services is a key aspect in distinguishing it from institutional care such as a hospitalization or living in a closed ward. During our study period most supported housing in the Netherlands would be offered by 21 large providers dedicated to this type of housing services [Dutch Regional Institutes for Residential Care – Regionale Instelling voor Beschermd Wonen (RIBW)] or by providers from the mental health care system that would have clinical care as their core activity [27]. The accommodations would be typically organised as grouped apartments, with or without a shared living room and kitchen, or as one-family homes that provide single bedrooms and a shared bathroom, kitchen and living room (usually for four residents). Staff on-site up to 24h a day on-site, and individuals would be allocated to a care coordinator, skilled in psychiatric rehabilitation support [27, 28]. According to the Simple Taxonomy for Supported housing (STAX-SA) [28, 29] most of these accommodation-based services would reflect type 2 and type 3 services: congregate setting, high to moderate support, strong emphasis on move-on [28]. Around the same period there was also an increase in other type of organizations offering supported housing, namely small-scale housing facilities and care farms, pioneered in the Netherlands [27, 30]. Individuals admitted paid a monthly co-payment adjusted to their age, income and family situation, and to the number of days in supported housing (but not on the intensity of the support). Co-payments ranged from 0 to 2,300 euros per month, but never exceeded income. People who received home care paid a lower copayment that depended on the same parameters but also on the amount of care used. Determination of supported housing eligibility Throughout the study period, individuals seeking long-term care in the Netherlands had to apply for eligibility at an independent needs-assessment agency (Centrum Indicatiestelling Zorg - CIZ). Applications were submitted to a regional office of the agency by the individual or by proxy, such as a family member, social worker or care provider.
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