Residents who stay in bed for one and a half or two days due to the lack of staff. The strong smell of urine in the rooms. Unmanned groups. Crying caregivers. Residents scratching and hitting each other. Smear those walls with shit.
De Volkskrant described the shocking abuses which have taken place at least since last year in the Amsterdam nursing home Ottho Heldring, a location of the large Amsterdam healthcare organization Cordaan. Ottho Heldring is a small nursing home, housing more than seventy elderly people with dementia or acquired brain damage.
The Healthcare and Youth Inspectorate, which monitors the quality of care, has been aware since last month after reports from residents’ families, says inspection spokesman Frank Wassenaar. It is not yet known what action the inspectorate will take.
1. What exactly is going on at Ottho Heldring in Amsterdam?
In January of this year, nursing home staff members sent a ‘burning letter’ to the management, writes de Volkskrant. There is neglect of clients, they write: care plans not adhered to, serious inadequate supervision, medication errors. “Disgraceful and shameless,” the newspaper quotes from the letter. “We would never take our parents to Cordaan.” The management talks to them, the situation seems to improve but then falls back again. The Healthcare and Youth Inspectorate only became aware in November this year, when one of the residents reported the abuses: Saida Zemouri, whose 87-year-old father with dementia lives in the nursing home. More reports are coming in, some anonymous. The inspectorate will immediately contact Cordaan. The management duo of the seventeen Cordaan nursing homes are resigning and, according to reports de Volkskrantthere are ‘suddenly’ more temporary workers and flex workers working in Ottho Heldring. A Cordaan spokesperson said in a brief telephone response that more temporary care workers have indeed been deployed and that the search for permanent staff is in “full swing”.
2. What action can the inspection take?
The ‘supervision activities’ are still ongoing, spokesperson Wassenaar reports, and so the inspectorate does not make any statements about possible measures. In a general sense, there are several options, should she decide to do so. The Inspectorate may proceed with ‘enhanced supervision’. There is then, says Wassenaar, “half confidence” that a nursing home can solve the problems itself and in the meantime the inspectorate keeps a finger on the pulse. For example, the inspectorate requests a monthly progress report and visits a location more often. Option two is stricter: the ‘instruction’. That is the task to solve the biggest problems in the very short term: ensure that sufficient staff are employed within two months. Ensure that you improve medication safety protocols within a month. This Thursday, the inspection imposed another instruction on the Amandelbloesem Woonzorg Groep nursing home, a small-scale Amsterdam residential care organization for elderly people with dementia and/or physical disabilities. After a visit to Almond Blossom, the Inspectorate spoke of “serious shortcomings in care”. For example, the expertise of healthcare providers does not match ‘what the clients need’. In this case, the instruction amounts to a client stop: until this nursing home meets the standards for good care, it is not allowed to accept new clients.
Level three in the arsenal of measures is the strictest and occurs when, according to the inspection, immediate action is necessary: the ‘order’. This means that all clients must be transferred to another healthcare provider. The inspectorate imposed this measure on May 31 at the Rayan nursing home in Amersfoort. Three days earlier, the Inspectorate at that location saw that residents were contaminated, that the care was substandard and there were “high health risks”, including due to a lack of control over residents’ use of medication.
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Such an order is an exception. It does not seem to be imposed on Ottho Heldring – then that would probably have already happened. “There has been contact with Cordaan and we have asked them the necessary questions. We are not legally allowed to say anything about its content at this time,” said Wassenaar.
3. To what extent are these abuses representative of elderly care?
“There are many good nursing homes,” says Wassenaar. “I think the word ‘excrescence’ is appropriate here.” At the same time: there are structural, sector-wide problems that encourage abuses.
There is a shortage of fourteen thousand nursing home employees and this is estimated to increase to more than fifty thousand in ten years. The word ‘understaffing’ keeps recurring, with abuses such as that in the Ottho Heldring nursing home.
The Inspectorate found that residents were polluted, the care was substandard and that there were ‘high health risks’
Due to a shaky workforce, healthcare providers are more likely to impose coercion, the inspectorate notes. Such as locking patients in their rooms and installing a bed rail. Coercion should be used as little as possible. But, as the inspectorate notes, the risk of coercion increases, especially as soon as gaps in the schedule are closed with flown-in staff who do not know the residents.
What plays a role in a general sense: retirement homes have been abolished, government policy is aimed at living at home for longer and longer. You are only eligible for placement in a nursing home if the care needs are so great that home care and informal care are no longer justified. Heavier care means higher workload, and that means higher chance of dropout. In Ottho Heldring, a figure of “almost 25 percent” absenteeism due to illness was circulated. Result: even higher workload.
One thing is certain: the demand for care will not decrease in the aging Netherlands. The number of elderly people is increasing and they are also getting older. The risk of dementia increases with age: the RIVM expects half a million people with dementia in 2050. This condition in particular places a high demand for care on staff.
The inspection spokesperson does not dare to say whether the number of incidents is increasing like Ottho Heldring: comparison with recent years is difficult due to the corona pandemic alone: fewer inspection visits took place at that time, they did not want to get in the way of healthcare providers.
The fact is that factors that encourage abuses appear to be gaining influence. Ottho Heldring may be an ‘excrescence’, but the underlying causes are not.
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