Care network
Various care providers may be involved in the care of patients after a cerebral infarction or cerebral hemorrhage.
read moreCare 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.
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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. -
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. -
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.
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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)
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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. -
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. -
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. -
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. -
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. -
Care provider with the aim of supporting people in solving and dealing with problems in social or societal functioning.
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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.Fees: Reimbursement depends on the service you use. The institution in question can help you with this.
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.
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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. -
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. -
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. -
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. -
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. -
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 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): -
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. -
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.
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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.
Work and study
Information about the effects of a stroke on your situation at work or at school.
read moreWork and study
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The largest recovery from the effects of a stroke occurs within 3-6 months. Further recovery may occur up to about 2 years after the stroke.
After 3 months of absence from work, the chance of returning to work slowly decreases. If you still have severe physical or mental disabilities after 3-6 months, it is important to discuss targeted rehabilitation with your medical team.
It is also important that rehabilitation is aimed at improving the skills needed for your own work.Denkhulp (information tool)
The Denkhulp Werk en Chronisch ziek (information tool on work and chronically illness, in Dutch) gives useful information about your rights and obligations. It also provides possible choices for people with a chronic disorder, who are employed and are on long-term sick leave. The Denkhulp (information tool) also provides insight into the effects that different scenarios may have on your income.
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Important
- The Wet Poortwachter (gatekeeper improvement act) applies. More information on the website of the UWV (Employee Insurance Agency)(in Dutch).
- In principle you have 2 years to reintegrate. After 1 year, it often has already switched to reintegration into other work (at one's own work or with another employer).
- Your employer is obliged to continue to pay the salary for 2 years.
- Your employer is obliged to make an effort to have you reintegrate into suitable work for 2 years.
- You are obliged to cooperate fully.
- Things that influence the chance of successful reintegration into work are: cooperation and support from the work environment (manager and colleagues), and possibilities and willingness to adapt the work if necessary.
- Keep as much contact as possible with your work from the start.
- In principle you have 2 years to reintegrate. After 1 year, it often has already switched to reintegration into other work (at one's own work or with another employer). The chances of successful reintegration into your own workplace will already be greatly reduced at that point. After 2 years, the UWV (Employee Insurance Agency) will carry out an inspection to assess the ability to work and the entitlement to benefits (WIA). In principle, the Poortwachter program will then end and the employer's obligations will also end.
- Make the best use of the possibilities, 2 years seems a long time, but is also goes by quickly. Do not waste any time.
- The chance of receiving a full, permanent disability benefit is small. The WIA is a kind of insurance with insurance conditions, like most others. The UWV’s (Employee Insurance Agency) assessment is not about the severity of your condition, but about the extent to which you are still able to earn your own income according to the insurance terms and conditions. If, theoretically, you can still earn income (in full or partially) in suitable work and it has not been possible to start working in the first 2 years, you will not receive disability benefit for work for that part, but a (temporary) unemployment benefit.
Permanent or temporary employment
If you have a temporary contract (“fixed term”), it is possible that the contract may end while you are still sick.
If you have a temporary employment contract and you have not yet been able to resume all or part of the work at the time that your employment contract ends, the employer's obligations end at that moment and you “have departed your post due to illness” as it is called. Your reintegration file will then be transferred to the UWV (Employee Insurance Agency) and from that moment on the Sickness Benefits Act will apply, you will receive a sickness benefit from the UWV (Employee Insurance Agency), and the UWV will be responsible for supervising your reintegration.
Not yet back to work
Your focus is probably not on work during the initial period after the stroke. On the other hand, you may soon be worried about what to do with work and income.
In this phase there is still great uncertainty about how the recovery will proceed and whether you will completely return to your old self. As long as you are not able to work (fully), you are entitled to continued payment of your wages. This applies at least for the first 2 years.
If possible, it is important to maintain contact with your employer and colleagues. For example, if you can, stop by every now and then for a cup of coffee and a chat. That will make it much easier to start again later. Whether, and when, you can progressively return to work depends on the mental and physical consequences of the stroke. However, it also relies on the nature of your work and the possibilities for adapting your work.
Your employer is obliged to call in a company doctor in order to map this out with you and to advise you on the approach to reintegration. The company doctor must do this within 6 weeks of you becoming ill. They will then create a “problem analysis”. For you and your employer, this problem analysis is the basis for drawing up a plan of action for the return to work. Of course, you may still not able to go to work after 6 weeks. This will then be the conclusion of the company doctor and will be the recommendation to you and your employer.
One year of illness
After a year of illness, you and your employer must conduct the first-year evaluation. You will receive a letter from the UWV (Employee Insurance Agency) with information about this.
The evaluation focuses on the approach to further reintegration in the second year of illness. Your company doctor will draw up an employability profile or functional possibilities list (FML) for this purpose. Is it possible to achieve a complete return to work? If not, an employment expert must be called in to use the FML to investigate which work is suitable and whether your own employer has suitable work for you. If this is not the case, the employer must accompany you to suitable work with another employer. The employer often hires a reintegration agency for this purpose.Two years of illness
If you have still not fully returned to work after 2 years, your employer's obligation to continue payment of wages will cease. You can then apply for disability benefit (WIA) from the UWV (Employee Insurance Agency). You have to do this three months before having been sick for two years. -
If the temporary employment agency/payroll company is responsible as a risk bearer and for the rights and obligations of the wet Verbeterde Poortwachter (gatekeeper improvement act), then everything is the same as when you are employed by an employer.
If this is not the case, the vangnetbepaling (safety net provision) applies. You will then enter the Sickness Benefits Act and the UWV (Employee Insurance Agency) is responsible for the continued payment of your (average) salary and for your assistance in finding suitable employment. The situation is the same as if you were an employee with a temporary contract, after the contract has ended. -
In this case, whether or not you have taken out disability insurance is important. Even if you are insured for work disability, the conditions in the insurance policy can be very different. Please consult the terms and conditions of your insurer.
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Employed before the stroke
If you are unemployed following your time as an employee, you are entitled to unemployment benefits for a certain period. These benefits are generally WW-uitkering (unemployment benefits), paid by the UWV (Employee Insurance Agency). The duration of the right to WW benefits depends on your employment history. If you become ill while receiving unemployment benefits, it is important that you report your illness to the UWV. The Ziektewet (sickness benefits act) will apply and you will receive sickness benefits from the UWV. In that case, the rules of the Wet Poortwachter (gatekeeper improvement act) that are relevant when you work for an employer will largely apply as well. You would then be in the same situation as someone who becomes ill during a temporary contract and falls under the Sickness Benefits Act at the end of the contract (see salaried employee).Not employed before the stroke
If you were not a salaried employee before the stroke, you are not entitled to unemployment benefits. It may turn out that you despite not being employed, you will not receive any unemployment benefits either. This is usually the case if the unemployment benefits (WW) have ended or because you were self-employed or studying before you became a job seeker. In that case you normally have the right to social welfare benefits. If you become ill while receiving social welfare benefits, there will be little or no change. You will continue to have the right to social welfare benefits. However, it is important that you report your illness to the municipality. You must be exempted from the obligation to search for jobs if this applies. If there are permanent health problems and limitations in this situation, the municipality is responsible for providing support in the search for suitable employment. The Participatiewet (participation act) then applies. This has only been the case since 2015 and many municipalities have little experience with it. This is mostly the case for smaller municipalities. If you want to be supported well, you must often insist on it yourself and demand the support to which you are entitled. For example, this can also be any form of education, training, or targeted rehabilitation, which is necessary in order to have a chance of finding suitable work again with the limitations. -
Unfortunately, you can also suffer a stroke at a young age, while you are still studying. It is important to know that there are special facilities in regards to rehabilitation and counselling that you can use. Breinsupport (brain support, site is in Dutch) is an organization that knows everything about the rights you have to to study facilities and to adjust your studies. They offer specialized support to young people in an educational situation with a brain disorder.
Aids
If you have had a stroke, you may suffer from symptoms that limit your independence. It may then be easy to use aids for certain actions. Below are some websites that can help you find the right aids. You may also be eligible, via the municipality, for the purchase of aids or support in this regard. This is done via the WMO (Social Support Act) point of contact of your municipality. This can vary from one municipality to another.
- Regelhulp (care and support help): WMO (Social Support Act) (Dutch)
- Medipoint (Dutch)
- Thuisleefgids (home life guide, in Dutch)
- Hulpmiddelenwijzer (aids guide, in Dutch)
- Hulpmiddelen via Bol.com (aids on Bol.com)
- Hersenletseluitleg (brain injury explanation, in Dutch)
- In eigen hand (in our own hands, in Dutch): baby and toddler care for functional one-handed people
- Weerhandig: advice on aids, in Dutch.
Sports
Do you wonder what opportunities there are in the area for disability sports? Are you looking for
advice about looking for a buddy or, for example, aids? Unique Sporten helps with finding a suitable sport or exercise option. You can look in the sports locator yourself, but the coordinator for adapted sports can also provide you with personalized advice.
- Check out the website of Uniek Sporten (in Dutch) for more information, tips, and sports possibilities in your area.
- Meet me at the gym (in Dutch) offers a customized sports program for people with brain injury.
Fees: You pay the costs for practicing a sport yourself. There are no fees for this.
Sexuality
A stroke is a major event for you and your partner. It can have both physical and mental consequences. The consequences of a stroke depend on several factors, including the type of stroke (infarction or hemorrhage) and the location of the stroke.After a stroke, a lot changes in your life. Your relationship and sex life may also change. Many people do not feel like having intimate contact and intercourse after a stroke as much as they did before the stroke.
Do you have questions about intimacy and sexuality after a stroke, but do you find it difficult to talk about it? This applies to many patients and their partners. After all, these are subjects that we regard as private and prefer to keep to ourselves. But it can help to discuss the changes in your sexual relationship with each other or to ask for help from a doctor or other specialist.
This brochure offers support in this respect (in Dutch).
Life insurance for the chronically ill
If you are chronically ill, for example after a stroke, you may encounter many problems taking out a life insurance policy to take out a mortgage, such as a life insurance policy.
read moreLife insurance for the chronically ill
Read more information about this:
- Choice of advice (in Dutch)
- ICZ (in Dutch)
Childcare with socio-medical care assessment
In some cases a hemorrage can lead to problems in the care of your children. You may then be eligible for a contribution towards the costs of childcare.
read moreChildcare with socio-medical care assessment
When people suffer a stroke at a young age, there often is a young family too. Due to the consequences of a cerebral infarction or hemorrhage, this can lead to problems because of the limited strength (fatigue), sensitivity to irritation, and problems with dual-tasking. Sometimes a person can no longer work after a stroke and the partner starts working full time to avoid financial problems.This can lead to problems in the care of your children. You may then be eligible for a contribution towards the costs of childcare. Unfortunately, this is not known to everyone. For more information, please contact your municipality. Read more information here:
- VNG (in Dutch).