Long-term care threatens to come to a complete standstill if the sector does not quickly and structurally embrace the help of relatives and volunteers. The Council for Public Health and Society warns about this in its advice Living and worrying differently to be released this Thursday. According to the council, an important advisory body to the government and parliament, the rapidly increasing staff shortage in, for example, care for the elderly and disabled requires ‘a fundamental overhaul’ of the relationship between care providers and informal carers. If relatives are not better involved in care, the council fears that ‘unorthodox solutions’ will be needed, such as the use of migrant workers in care.
The council notes the well-known problem that there are fewer and fewer healthcare workers while the number of people in need of help is growing. There is already a shortage of about 50,000 care providers, in nine years’ time that will be almost three times as large at 135,000. Although the Netherlands already has more than five million informal carers, the Council finds that they receive insufficient support and recognition while they are ‘an essential part’ of long-term care. “Family is sometimes seen as difficult or interfering, volunteers as handymen.”
Guidelines, regulatory pressure and concerns about liability often stand in the way of equal involvement of volunteers. As a result, care in the institution and the lives of those close to it are now often ‘two parallel worlds’, says Jet Bussemaker, chairman of the council. She sees a particular problem with the strict quality frameworks in, for example, nursing home care. “With the best intentions, things are recorded in it down to the smallest details, so that nothing more can be done. As a result, caregivers do not even dare to leave the delivery of coffee to a volunteer.”
Bussemaker herself was a caregiver for her sick father for a while and also saw how difficult it was in practice to help with something. She struggled to bring in a portion of Indian takeout food that he loved so much. “He also liked to eat soft-boiled eggs, but they could pose a risk of infection and two eggs was bad for his cholesterol, it was said. If you reason in this way, the quality of life is really no longer central.”
The Council makes a number of recommendations to close the gap between formal and informal care. For example, politicians should make better arrangements for informal carers, says Bussemaker, who are already often overburdened. “In the Netherlands you only get paid for two weeks if you take care of your sick parents, that’s not generous.” Bussemaker points to Denmark, where you have various forms of ‘care leave’ where people are paid for up to six months by their employer or municipality. “You can say: that is expensive. But letting the staffing problem run its course is even more expensive.”
Commercial informal care
Another suggestion from the Council is the ‘hybrid care team’. For every new client in long-term care, a team should be formed with caregivers, relatives and volunteers, so that the tasks are properly divided and clear agreements are made in advance. Bussemaker hopes this will bring about a cultural change. “Discuss with each other what someone can still do for themselves, what network someone has, what knowledge they have and what they can do. We really need to break with the assumption that everything is done by professionals.”
In its advisory report, the Council warns that the quality of long-term care could be jeopardized if nothing changes. Commercial informal care agencies are already responding to the increasing demand for care, but their emergence could lead to a split between the people who can and cannot pay for this support themselves, the Council fears. There is also a risk that these commercial agencies will attract healthcare workers themselves by paying them better, which will only increase the staff shortage.
Bussemaker warns politicians that “far-reaching steps” are needed if society fails to relieve long-term care by taking over tasks. The council suggests introducing a legal duty of care, which could force people to care for or pay for their parents, as is already happening in Germany. Another option is compulsory social service for young people.
The most sensitive suggestion is ‘the large-scale deployment of migrants’ in health care. According to Bussemaker, if politicians do not take other measures, the debate will inevitably come to us. It acknowledges that this solution is ‘very complicated’. “Experiments with this were not an unqualified success, mainly because of language barriers and cultural differences. But we do have to have a discussion about these difficult themes.”
A version of this article also appeared in the newspaper of May 19, 2022