The nursing home as a Wailing Wall
December 10, 2014
The black lists and political debates trip over each other where it concerns nursing home care. The most recent report by ABVA/KABO even concluded that the care is outright bad and that more funds are needed to swiftly resolve this issue. Yet, how do we perform in comparison with the surrounding countries?
In the recent decades, a world-class system of privatized eldercare has been developed in the Netherlands. Municipal eldercare institutions no longer exist. They have been converted into publicly funded private institutions. Nor do we still have charitable or religion-based institutions as is the case in some other countries. For example, 30% to 40% of the institutions in Germany are part of a church organization.
The Netherlands has the highest consumption of long-term care by people older than 65 (OECD, 2009), as well as the highest contribution of public funds to long-term care (OECD, 2012). When you add to that the large number of volunteers, it seems that the Netherlands has seen the rise of an infinite demand for care, more than in the surrounding countries. Are Dutch elderly people much sicker or weaker than those in e.g. Germany or Belgium? No, there are no indications that this is the case. Yet, how to explain this phenomenon?
In comparison with abroad, our eldercare is not just of a high quality, but also luxurious. You read it correctly. The eldercare is luxurious, maybe even too much so. I frequently visit nursing homes abroad, such as in Scandinavia, Germany, and the United Kingdom. The facilities in those countries are by far not as luxurious as those in the Netherlands. An American company that wanted set up a care center in the Netherlands was taken aback by the elevated basic level there. According to that company, elderly people pay at least USD 4,000 per month in the US for the same level of care. It is good to highlight this aspect for once, instead of always complaining about the nursing homes.
In the past years, we have set up a supervisory function for our care system that has a bureaucratic and time-consuming impact on the professionals in the field, who have opted for working with people instead of with checklists! When you add to that the plethora of verification marks, one thing is certain: this function has not been conducive to raising the quality of care to a level that satisfies residents, family members, and employees. Nevertheless, even now, the solution of all problems is being sought for in (even) more supervision and more checklists due to a deeply rooted distrust of providers.
Did we define the quality of care too much from the perspective of the professionals instead of from the perspective of the clients? In the past decades, did we build a care system for elderly people instead of with elderly people? And, in doing so, did we not take away the option for the elderly and their families to take control of that system themselves?
Family on the Board
This has needlessly brought about helplessness among elderly people, causing society to assign the care for elderly people to providers. However, this does potentially clarify the elevated consumption of professional care to elderly people. Co-creation is such a winged word that is becoming fashionable in elderly care. However, real co-creation means real influence of clients on the operating processes in the nursing home. Is it not becoming time for us to really open up the system to the influence from clients and their family?
In discussions with directors, I have therefore proposed to have family members participate in the Supervisory Board. Directors are resisting this idea because those family members would be insufficiently informed. Is this not a wake-up call telling us that we have transformed the management and organization of the eldercare into a business from which the soul has disappeared? This soul is called charity!