Faced with the combination of an increase in the elderly population and longer average life spans across the board, the Netherlands is expected to see the number of people with dementia double over the next two decades, rising to more than half a million by 2040. This presents the country with several major challenges: how will we offer the high-quality, affordable care all those people and their families will need when the time comes? Annemieke Bambach and Clasien Schakenraad, founders and directors of the Het Gastenhuis chain of care homes, endorse an approach where clients remain tied to their communities as much as possible.
“The Gastenhuis provides loving, affordable residential care for people with dementia, in a homely setting and at locations right at the heart of the community. Each of the homes is managed by a married couple with all the required credentials who live right beside the home. This creates a warm and welcoming atmosphere and ensures accessibility of the management and highly personal support for residents and their families.”
The brief introduction on the Het Gastenhuis website lists all the elements which make up this exceptional model: affordable residential care, a homely setting and locations at the heart of the community. According to Annemieke Bambach, the latter is crucial if we are to continue managing the growing demand for dementia care over the next few decades:
“The prevailing opinion is still that people with dementia need to be locked up in closed facilities. This urge to put people away in care homes and regard them simply as patients is very strong and persistent in our country. We offer an alternative: providing care that helps people who have been diagnosed to continue to live full and meaningful lives as long as possible by focusing on what they can do, rather than their limitations, as well as assisting and supporting their families. The best way to do that is by offering care in people’s own communities, preferably without isolating them from their social network. We need to start taking a completely different approach to care and focus a lot more on building a coherent and interrelated system involving care, welfare and housing. If we neglect to do that, the current system will inevitably run itself into the ground.”
Since Bambach and her former colleague Clasien Schakenraad established Het Gastenhuis in 2014, a total of 11 branches have been opened and 10 new ones are under development. It’s an impressive growth trajectory by any measure, backed by investor NPM Capital. Schakenraad: “Our goal is to open between six and eight new branches a year. It’s no small challenge to get that done, as it takes at least three years to set up a Gastenhuis branch, which includes the whole planning permission process. Construction time is one year. Some local authorities are extremely cooperative, but unfortunately that is not the case everywhere.”
Excessive laws and regulations
A recurring problem encountered by Het Gastenhuis is the lack of affordable building locations. Bambach: “We tend to compete in the market with housing developers; that is, commercial property developers that can afford higher land prices. This puts us in a bind, as we want to keep our dementia care affordable for the middle end of the market. It is tempting for local authorities to accept the offer from the highest bidder, especially if they have trouble balancing their budgets. But fortunately we’ve begun noticing a change: a growing number of councils are becoming aware of the increased demand for 24-hour care and of the fact that they have a public responsibility in facilitating that care. Besides, the public expense of people continuing to live independently for too long is often higher than nursing home care, if you factor in the cost of emergency hospitalisations, housing adaptations and overworked carers. That’s why it’s better to get it right from the start.”
Even more than the dearth of building locations, another barrier to expanding the Gastenhuis model across the Netherlands is the excessive laws and regulations relating to care, including administrative expenses. Bambach: “The health minister, Hugo de Jonge, has made reducing unnecessary administrative expenses a priority, but unfortunately there’s a tendency throughout the healthcare industry to introduce new rules, protocols and checklists.” Schakenraad adds: “We are not opposed to legislation on principle, but you need to make sure healthcare entrepreneurs can do what they do best, which is offering high-quality and affordable dementia care. Even if a new law might be based on a good idea – as with the new Care and Coercion Act in the Netherlands – it could still result in all kinds of complex implementing protocols, defeating the purpose.”
Bambach: “That’s right; we don’t want our carers to have to focus too much on paperwork. They would do better to spend that time on residents, as this gives them a chance to get to know them well and makes it easier to accommodate their needs and demand for care. The focus in recent years on keeping people at home as long as possible has created a gap between home care and the care provided in nursing homes. Dementia sufferers who live at home are left to their own devices between home visits from carers, whereas in the nursing home – where we have 24-hour supervision – every risk needs to be identified and documented so that the appropriate countermeasures can be taken. I do wonder to what extent the current system will remain viable in the future, given the rise in demand for this type of care.”
Across all communities
According to data provided by the Deltaplan Dementie (the Dutch national platform to address and manage the growing problem of dementia), there are currently roughly 2.8 million people in the Netherlands aged 65 and over. By 2040, this number will have increased to 4.7 million: one in four people in the Netherlands will be aged 65 or older by then, one-third of whom will be over 80. The percentage of people aged 80+ will continue to increase between now and 2055, resulting in a concomitant rise in the number of people with dementia. “There is a huge demand for high-quality, affordable care – much larger than Het Gastenhuis is able to handle,” Bambach says. “In a perfect world, every neighbourhood would provide a facility of this kind, integrated into the local community. Dementia care needs to accommodate the needs of clients and their loved ones. We need to avoid a situation where people spend all their time at home on their own until very late in life, dependent on informal carers to meet their complex care needs. This really increases the risk of social isolation.”
While Schakenraad believes the use of new types of care technology certainly offers opportunities, she warns that this is by no means a cure-all. We do follow these types of trends closely, although people-centred care and support will always remain our core business.”
Photo credit Het Gastenhuis: Clasien Schakenraad (left) and Annemieke Bambach
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