Paul Schnabel, director of the government’s social policy unit SCP, proposes that the elderly use the value of their homes to help fund their care. Barend van Lieshout doesn’t think it’s a good idea.

Solidarity
Health care for the elderly is becoming increasingly unsustainable and this is one way of coping with it, Schnabel maintains. He calls his plan controversial: the inheritance would be spent on care instead of the children. But there is a greater controversy that is implicit in Schnabel’s plan: a lack of solidarity. Would it be right for the Netherlands to have a system of care for the elderly that would not be equally accessible to all?
Three ways to cope
The health budget deficit is going to be enormous and inevitable, that much is true. We are getting older, sicker and more demanding and that will make care much more expensive in the decades to come, not just here but in the whole of Europe. There are three ways of coping with the problem. One is to avoid the spiralling costs by prevention and improving productivity. The second would be to accept that we will have to shell out more and swap the new car or the holiday for care. The third cost controlling option to is to have skeleton care. The children will skip the skiing holiday and drive around in a second hand car that little bit longer.
Incentive
But what Schnabel seems to be forgetting is that there has to be an incentive to make the elderly hand over their home. Without an incentive the calculating soon-to-be-elderly citizen may want to use his home to finance things that are more fun than care. He or she could transfer the house to the children before old age sets in. Because of the need for an incentive, care will have be scaled down. In other words: the elderly will be given a very basic type of care and can use their home to crank it up to a decent level. Schnabel’s plan will only work if it is combined with the third option: turning health care for the elderly into skeleton care.
What does skeleton care mean?
Skeleton care means that I (and others of my generation who will live to see the health care deficit) will be left to fend for myself when I’m old. I may have to ask my relatives for help. It means I will not be given the life prolonging treatments that we have now. I would die sooner and in dire circumstances. That is what Schnabel’s ‘basic care’ entails.
To be totally honest, I think I will probably have the money to buy into an additional care package (with a daily wash, my own room, a g & t) when the time comes, abroad if necessary. It would be the not so well off elderly who would figure in the skeleton scenario. This basic health care will split society into people who have the means to buy care and those who don’t.
Prevention and productivity
The skeleton scenario would not be acceptable today. But would it be acceptable to expect the younger generations to foot the bill so the elderly will have good quality care until the end? The skeleton care scenario is the real controversy and people who are worried about it would do well to restrict future costs by working on prevention and productivity as of today. Those who don’t should not complain if they can’t go skiing or the nurse has no time to get you out of your pyjamas.
Barend Lieshout is care advisor at Rebel