How many sugar cubes does it take to qualify for healthcare?

June 3, 2015 | 2 min read

We have gone from “do care” to “talk care.” It is possible that in the past decisions were made too quickly. But now we may be lingering too long in an extensive range of “talk care,” says Professor Jo Caris. He came across a particularly striking example during an information meeting on dementia.

Image: © Nationale Beeldbank

I have recently attended an information meeting for people with dementia, their partners and volunteers. The meeting was well attended and two experts gave excellent information about the possibilities of care for people with dementia.

There was an older gentleman with dementia sitting in front of me. He had a cup of coffee in front of him and a cup with sugar cubes. He listened "carefully" while focusing on his coffee.

The information session started with: "There is a case manager.” A difficult title. 

The gentleman in front of me adds a sugar cube to his coffee. 

It is explained, in response to a question, that the case manager does not do anything but coordinate and adjust. Patients are referred to a family doctor for diagnosis. 

The gentleman adds another sugar cube to his coffee. The family doctor then asks the nurse practitioner (a third sugar cube is added) to perform a test to make a diagnosis. A dementia consultant may also be involved. 

The gentleman, still in trance, adds a fourth sugar cube to his coffee. 

The patient will then be discussed by the Social District Team. Fifth sugar cube. 

Following that, a "first district nurse” will come to determine a care indication. The gentleman carefully aims a sixth cube in his coffee. Followed by the seventh because a “second district nurse” will visit to see what the client can still do himself. 

A confusing discussion then arises about daycare (eighth cube) and outpatient day care (cube nine). It all has to do with the Social Support Act (tenth cube) and the Long-Term Care Act (eleventh cube). 

These provisions are called upon when care by volunteers is no longer sufficient. The care will be determined after a “kitchen table conversation” (cube twelve!).

Sometimes or often the patient is referred to a medical specialist (cube!) by his family doctor.

We had arrived at cube fourteen, but still no one had actually done anything. Then it was time for a break.

The fact that so many questions were asked shows how confusing and complicated the system of provisions is and that it mainly discusses, diagnoses, indicates, coordinates, and delegates.

Can you also receive day care without diagnosis? Where do you go for respite care to complement care by volunteers? Those are difficult questions because they show that the care on offer is hard to navigate. 

It is possible that in the past we did too much. Encouraging personal responsibility (self-care and care by volunteers) is fine, but are we now developing structures and procedures with Kafkaesque characteristics?

Are we not letting down all those people who need care and all those wonderful caregivers who are forced to become bureaucrats?

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