The dilemma: People are getting older, more people are getting dementia and more people are going to need major nursing home care. Fewer hands at the bedside are available and the resources to provide costly, intensive nursing home care are not unlimited. It’s time for significant expansion. Right?
In a blog published in the Dutch magazine, Zorgvisie (Care Vision), Professor Marcel Canoy from the Vrije Universiteit (VU) Amsterdam, asks himself why a cynical and cold-hearted Health Economist would advocate for fewer nursing homes? Has he gone mad?
“I advocate for good nursing home care but also for less nursing home care. At least fewer nursing homes that resemble most current nursing homes.”
2033
Imagine, we jump into the time machine and fly to 2033. We are in an ideal world. A world where municipalities and health insurers – who, after all, have the same interest in the broadest sense – stand shoulder to shoulder in support of older people, not sending people from pillar to post. A world where staff activate people as much as possible and, where possible, teach them again, things they have unlearned. A world where care personnel are a minority of the workforce, deployed only when care actually needs to be provided. A world in which the social network and the community are fully engaged to help patients have the best possible end of life, and in which the nursing home is not an enclave around which the community takes a wide berth.
On the move
It is inevitable that we all move in this direction. Only, the homes I describe do not resemble the nursing homes of today. A number of enthusiastic directors of care facilities are trying with all their might to move in this direction, but are experiencing resistance, not least from their own staff. Housing corporations, too, are busy adapting their housing units to the demands of tomorrow. There are even corporations that manage to provide substantial nursing home care within their walls so that their residents no longer have to move. But even there, things don’t happen automatically.
Modern facilities are good for residents and the neighbourhood, but also for staff. It is easier to serve mixed populations than a population with only very severe psychiatric or physical conditions.
Participants in the Dutch program ‘Waardigheid en Trots’ (Dignity and Pride) are making great strides in areas such as person-centred care, the use of volunteers and social activation, but ‘letting go’ of care professionals and involving the community is often still complicated.
It is essential to continue to provide quality nursing home care to the increasing numbers of frail older people in the future. Politicians, industry organisations and the media use the current waiting lists to argue for more nursing home beds. As far as I’m concerned, those should only come in nursing homes that are shown to be moving in the right direction, because then we won’t be investing in a world, where in 2033, we’ll be saying, “Gosh, did we used to do it that way?”
- Marcel Canoy is endowed professor in Health Economics at the department of Ethics, Governance and Society of the School of Business and Economics of the Vrije Universiteit Amsterdam.
- Dignity and Pride Programme
- Zorgvisie publication (Dutch)