Who will take care of the elderly? 'The professional puts on the support stockings, the informal caregiver comes to vacuum'

A physiotherapist who only does six treatments, even if the patient's knee is only completely fine again after nine sessions. Or the community nurse who comes by less often during the week to shower an elderly person. “We just have to get used to it,” says health economist Jochen Mierau of the University of Groningen. “Care is being put on the back burner.”

On the eve of the budget discussion of the Ministry of Health, Welfare and Sport, Wednesday and Thursday, orphan the State Commission on Demographic Developments once again points out the biggest problem in healthcare: the staff shortage. This is already large and will only grow thanks to the double aging of the population – more and more elderly people are living longer. One in seven workers currently works in healthcare, but by 2060 this should increase to one in three. “This means that in the near future almost all people who enter the labor market will be needed in healthcare, and especially in nursing and care,” the committee noted dryly.

ActiZ, the trade association of healthcare organizations, wrote to MPs last year that “politics waited too long before making fundamental decisions to make care for the elderly future-proof.”

Only: what are those solutions?

Anyone who had put their hopes on migration: forget it. The state commission argues for limited migration to maintain prosperity in the Netherlands – a plea that politically fits in perfectly with the wishes of the forming parties PVV, VVD, NSC and BBB. Labor migration does not work in any case to solve staff shortages in healthcare. These “are so large that you cannot solve them structurally by flying in nurses and teachers,” said committee chairman Richard van Zwol. In fact, more migrant workers means greater pressure on healthcare. And migrants are also getting older, which in turn contributes to the aging problem.

Technological innovations then? Neither, the committee notes. Care for the elderly (and the disabled) in particular is labor intensive: “Time and attention for the patient are essential parts of the work. The possibilities for improving labor productivity are more limited than in other economic sectors.” So many hands are always needed at the bedside.

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'Men must do more'

What remains: more informal caregivers. But the committee also foresees problems there. Informal care often comes from people aged 50 to 75. But that group is shrinking. In 1950, for every person over 85, there were 62 people between the ages of 50 and 75, in 2021 there were only 14.5. In 2050, this will drop further to 5. Informal care also comes at the expense of paid work or free time, can last for years because older people live independently for longer, and the heaviest care often ends up with the child who lives closest. It all leads to overburdened informal caregivers.

Yet Robbert Huijsman, professor of management and organization of elderly care at Rotterdam Erasmus University, still sees opportunities. Informal caregivers are now often women, he says, “men have to do that much more too. There's potential there. We all become informal caregivers, whether we want to or not. This applies to all adults, young and old. This is already very normal in many other countries.”

This requires more than just good will, he says. He advocates extra-generational homes (“living in your child's garden”) and more extensive informal care leave for workers. Healthcare professionals must also dare to outsource care and focus more on guidance and coaching of informal caregivers. “The question should be: what do you still do as a professional and what do you no longer do? For example, the professional makes the bed and puts on the support stockings, you come and vacuum, do the laundry or help with the Christmas celebration.”

Anneke Westerlaken, chairman of ActiZ, also sees that informal caregivers can do more. Eye drops a few times a day can also be done by a partner, or with special drop glasses. “Nowadays, at many nursing homes you are asked the standard question during intake: 'And what can the family themselves do?'”

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Scarcity

Yet “those partial solutions” – including more prevention and less administration – will not solve the capacity shortage, says health economist Mierau. Then only one conclusion remains: it is getting less. Mierau: “Because what is the quality of care if you are on the waiting list or there is no one available? I'd rather wait a little less time for less good care.”

According to him, politics and society must discuss how to distribute the scarcity. “Look at the number of healthcare staff and how you can deploy them in such a way that we can help the most people. If you don't, those choices will automatically be made for us. Then you get longer and longer waiting lists, places where there is no supply at all, and people with enough money who buy their own care.”

“The care we were used to is no longer sustainable,” says Anneke Westerlaken of ActiZ. “The cabinet should also say that honestly. These difficult issues must be brought to the table honestly.”

Many issues that are now being resolved by healthcare are actually not healthcare, but welfare, she adds. “If you are used to having a chat with the community nurse because you are lonely, we can also arrange for you to go to a community center. The question is: what is care and what is not?”

It is “a difficult message,” say both Mierau and Westerlaken. The Netherlands, mainly thanks to its expensive nursing homes, internationally spends a lot of money on elderly care, while our country is less aging. Unsustainable, concluded the WRR in a report in 2021: “The people to provide that care are simply not there. This means that there is an increasing gap between people's expectations – healthcare can continue to grow – and the consequences thereof.” With “a more realistic story about healthcare you immediately get a lot shit over you,” is also Mierau's experience. “But it's simple. You can still borrow money, but not staff.”

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