Opinion | Stop automatically treating the elderly as patients

Care is bursting at the seams. The labor market is overstretched, in 2040 one in four professionals will have to work in healthcare and the costs are skyrocketing. There have been warnings for years about the care infarction and then ‘suddenly’ it turns out to be there already, notes NRC recently.

The Integrated Care Agreement (IZA) should offer solace. It is a pattern: when the water rises, the plans are put on the policy table, where negotiations and compromises are made. The agreement offers the right direction in line with a broader social development: the redefinition of vulnerability and good care by de-medicalisation, de-professionalisation and normalisation.

Still, we are very concerned. Are the steps that are needed now being taken quickly enough? Isn’t the question of what really matters being postponed?

The key question is whether healthcare is prepared to question itself and whether this can be expected from organizations with their own interests at large consultation tables. The danger is that people spare each other for the sake of peace and the care supply continues to pile up. The NRC article also shows this: in practice, hopeful changes are ‘simply’ not introduced.


Changes are difficult with one whole-system-in-the-room approach, where all parties involved sit at the table and it is easy to polder and hide.

We don’t just say this. In line with IZA, we have started working with other parties on the Social Approach to Dementia. The reason was that people with dementia are burdened by the stigma of ’empty shells’ and are insufficiently supported in their daily struggle to still be meaningful.

Life’s questions shouldn’t necessarily be answered with care

The current answer to the question of how to deal with life under pressure, not only the result of illness but also of stereotypes, is medical guidance and care. That pushes people into a corner where they don’t want to be. Not only people with dementia, but also people with other vulnerabilities, chronic conditions and the elderly.

With social approach teams in social trials we build the bridge to ordinary life, like in the movie Untouchables. The severely paralyzed Philippe needs care, but what he craves most is color and meaning in his life. The non-medically trained Driss makes him feel that a person is more than his condition.

Social approach teams restore the damaged self-confidence and social network, which leads to more quality of life, which is what we started with, but also to more pleasant and therefore longer living at home. Because the teams mainly consist of professionals with a non-care background, this means fewer care hours and a relief of the care labor market.

This hopeful combination led to a motion by D66 in 2017, asking the minister for this social trials to enter, broadloom was accepted. We are putting this approach into practice in eight regions together with municipalities, welfare and care organisations, health insurers and care administration offices. The (interim) results are promising.

In the interest of people with dementia and the current problems in healthcare, you would say: act now. Also because this approach lends itself to people with other vulnerabilities and responds to the aging population.

Case managers

Yet this is complicated. Blockages are formed by the various funding streams, the deep-rooted medical treatment and care reflex, parties that want to reinvent the wheel themselves and remain at the helm.

For example, if we only think we can overcome the increasing waiting lists in dementia care with highly specialized case managers, who then form the new scarcity, the problems will not be solved.

It is hopeful that we already know the ingredients of the road ahead. Life’s questions shouldn’t be answered with care as a matter of course; care should only be used where necessary. Connect more to what people themselves can and want, and respond to the labor market shortage of healthcare professionals. The social trials and other initiatives, such as GEM (Ecosystem Mental Health) in the New GGZ and Community Care Dongen, are examples of how content and systems can be successfully adapted.

Of social trials show that adding people other than care-skilled leads to more appropriate support. By working together in this way, vulnerable people can give color and substance to their lives at home. Not as a patient, but as a person.

There’s no time to lose. Let’s focus on the causes of the barriers and our own role in the care infarction. If this does not happen, we will continue to form the file ourselves.


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