All-inclusive care for the elderly is making way for a pick-and-mix system of care, says Barend van Lieshout.

It’s a paragraph from the spring accord that has almost gone unnoticed: the abolition on January 1 of the last comprehensive care schemes in the long-term care for the elderly. The care home as we know it will disappear. The elderly are set to become the critical buyers of their own care packages. At the same time, providing healthcare for the elderly will become terribly complicated.

It seems innocuous enough: care schemes 1 to 3 will no longer be allocated. At the moment, an elderly person who can no longer cope with the stairs, who is tired of being alone or who can’t look after him or herself any more can choose to go into a care home. That move is more than a simple change of address: the total care of the person involved (housing, food, cleaning, healthcare) will be the responsibility of the care home and, via the Exceptional Medical Expenses Act (AWBZ), of the collective sector.

All-inclusive

The extent of the care for the elderly can be considered as a sign of civilisation, an achievement of the welfare state. And that would be right: it’s not every country that can afford the high cost of this type of all-inclusive care. At the same time, relieving the elderly of all responsibility and most of their daily activities may not be such a good idea. Use it or lose it, as the saying goes. A number of elderly will go downhill quicker because of all that loving care. And then there is the Club Med effect: if everything is all-inclusive anyway, why not use it all? It would be a shame not to take advantage of all that food/cleaning/toilet paper. It’s an expensive way of going about it.

Although the Spring accord has come in for a lot of flack, no-one will try to turn back the clock on this measure. It will save a lot of money and is, after all, very sensible. The all-inclusive scheme will be phased out over the next five years. The elderly will be renting instead of staying, they will be paying for meals, a sandwich and a cup of coffee.

Chaos?

The care homes are in for a rapid change. At the moment, the whole care organisation is geared towards giving each elderly person an equal share of the care it’s understaffed care homes can muster but soon every person will have his or her own care package. One row of apartments can harbour such diverse inhabitants as person A, who still has all-inclusive care, person B who has a comprehensive care package, person C with just home help, and person D who’s just renting the accommodation and doesn’t need care. On top of this come the subscriptions to hot meals, the 24-hour service system, the handyman..who is going to keep track, and bill, all these different configurations?

Separating care from the actual building is going to cause another effect: the care worker who is now looking after his or her own clients in her own building will, in future, run into cleaners from different companies, and home care organisations poaching clients in what used to be the care home.

Creative solutions

Healthcare is not known for its revolutions but I think this constitutes one. It’s not going to be limited to the care for the elderly but will eventually include long-term psychiatric care and the care for the disabled as well. This transition promises to be an exciting one. No-one knows exactly what the client’s needs will be once the Club Med bracelet comes off, whether they will be able to pay the rent or if things can be organised in time.

I can’t wait to hear about all the creative solutions that will take the place of the all-inclusive package. One thing is certain: in six months’ time ‘sexy’ hospital care will have to hand over the crown for dynamism and innovation to long-term care.

Barend van Lieshout is a care adviser at Rebel