Everyone needs care. Without care, children do not grow up, the sick do not get better and the elderly do not grow old comfortably. Being cared for is good for us, but so is taking care of someone: care is the foundation for love, attachment, and meaning. And without care there would be no society: the economy, culture and politics would collapse immediately if people were not continuously cared for by and for people.
In short, there is little as fundamental as care.
Care is therefore everywhere. From the cold washcloth on a child’s feverish forehead to cutting open a patient on the operating table. From grandparents behind the pram to employees at the nursery. From volunteers in the community center to hands on the bed.
But something that is everywhere is difficult to oversee. And you can’t appreciate what you don’t see well. You can’t take care of what you don’t see well. And what you don’t take good care of, will break.
Parents of young children already feel rushed more often than any other population group and one in ten informal carers is overburdened, according to the Social and Cultural Planning Office. According to Statistics Netherlands (CBS), almost half of healthcare professionals experience a ‘high to very high’ workload. The shortage of healthcare personnel is large and growing, resulting in long waiting lists for youth care, mental health care and nursing home care and long waiting times for emergency care. Childcare organizations are forced to cancel contracts with parents because they cannot complete the occupation.
Those problems don’t go away on their own; if we don’t do anything, they just get bigger. Then we are heading for nothing less than a care stroke – a crisis of which the corona pandemic was only a friendly foretaste.
Much care is invisible
It is difficult to foresee that impending care infact coming, and that is because we rarely see care itself for what it is. This has to do with its ubiquity, and with the fact that care tends to make itself invisible. The aim of much care is to promote the independence of the care recipient. And the better that is successful, the more the carer can think that he does not need any care at all.
The American sociologist Lynn May Rivas notes in Invisible Care and the Illusion of Independence that parents tend to praise young children for their independence. “What delicious cookies you have baked,” a mother says to her child, even though it was she who set the ingredients, turned on the oven and, long after her child’s attention had already turned to something else, still left molds from the oven. dough is being cut. Parents do this on purpose: little is as stimulating as the feeling that you have done something yourself. But in this way the web of caring and dependence that makes that independence possible becomes out of sight.
A hospital nurse once told me what she did for her patients without them realizing it: consult with colleagues, call home care organizations and physiotherapists, ensure that examinations are well spaced, and that the doctor views the results and discusses them with the patient. ‘Nurses are the spider in the web’, she said, ‘but a large part of our work is literally and figuratively invisible’.
Care seems obvious
Care is essential work, work that makes all other work possible. But we don’t see most of it as work. In the course of history, informal care came to be known as an activity that women in particular would take on ‘naturally’. Care thus became a matter of course, and women who take care of loved ones or children are accused of ‘doing nothing’ – part-time decadence, part-time princesses.
This history has also contributed to the fact that the work of professional care providers is by no means always appreciated. Last December, nursing student Jorn Albers wrote in this newspaper that he and his fellow students are constantly told that ‘working in healthcare is a passion and a calling, you don’t do it for the money.’ According to the Social and Economic Council, the salary of nurses and carers is indeed about 9 percent behind the market.
Albers writes that nurses systematically work overtime to fill in for colleagues who drop out. ‘Why do we have to keep everything running at our own expense?’ he wonders. In his class ‘one after the other drops out’. Just because something is a ‘calling and a passion’ doesn’t mean it lasts forever, doesn’t mean it isn’t vulnerable.
During the corona pandemic it suddenly became very clear how fundamental care is, how much it keeps everything running. And also how vulnerable it is. With the ICUs unable to cope with the pressure from Covid patients and the emergency room, nursing units and home care were struggling with staff shortages, everything came to a standstill – right down to the front door of just about every family home, where parents had to combine paid work with caring for their children. Hundreds of thousands of mini-care strokes.
The country briefly applauded the care workers. But that appreciation has now faded into the background. This while the demand for care continues to grow: we live longer, have more complex health problems and 1 in 10 Dutch people has several chronic conditions at the same time. At the moment about 1 in 6 workers works in healthcare. If our healthcare needs continue to develop as expected, this should be 1 in 3 by 2060, according to the Scientific Council for Government Policy. A completely unrealistic ratio, if only because all those care providers would then no longer be able to work in other essential sectors.
Why healthcare needs inefficiency
Policy makers have been trying for years to better match supply and demand. For example, by focusing on prevention. And on efficiency – letting doctors and nurses do more in less time.
Only: care is by nature inefficient. A home nurse told me that she has to visit twenty-two patients on a four-hour evening shift and travel 50 kilometers. “That leaves me six minutes per patient,” she said. ‘I can take care of a wound, help put on or take off stockings. But worry also has an emotional component – comforting someone, chatting. That takes time, and there is no time.’ Her schedule was determined to the minute: ‘But it is a law in healthcare that things usually don’t go as expected.’
When you, as a healthcare provider, do not have enough time and space to respond to the unexpected, you are no longer really caring – and that is stressful. It is not surprising that figures from the Working in Care Committee two years ago showed that more than 40 percent of graduates of nurses and carers leave the profession within two years. Or that a quarter of health care providers indicated in a Nivel survey before the corona pandemic that they felt they were working in a ‘crisis situation’, where they tried to do too much too quickly. According to the Registration Committee for Medical Specialists, 138 young general practitioners left the profession last year because of the increasing workload – the highest number in a decade.
Not a solution, but a move
Another way to narrow the gap between the demand for professional care and the supply: let informal caregivers take over tasks from professionals. Currently, about five million Dutch people provide informal care, and if it is up to the government they should do that even more, especially in view of the aging population. However, because there are more and more elderly people and fewer and fewer young people, the number of available informal carers per person aged 85 and over will decrease from about fifteen in 2015 to only six in 2040, according to the Social and Economic Council.
Not a rosy prospect, because many informal carers are already struggling with the combination of paid work and unpaid care work. Just ask the mother whose daughter needed round-the-clock care due to a serious metabolic disease. She told me that although she did receive financial compensation from her daughter’s personal budget, for fewer hours than she cared for. It was also explicitly not a salary: she did not accrue pension with it and was not insured for illness or incapacity for work. She said, “Now I work really hard, but what if I fall down the stairs or get sick and can’t take care of her anymore? I don’t want to whine, but it feels crooked.’
Those who take care of others must also take care of themselves. If you give people an extra care task, but you do not have the means to fulfill that care task (for example, through generous, paid care leave and retention of social security benefits), you have not solved the problem. You just moved it to the unpaid domain.
This is often the case, with scarcity in healthcare: it is not replaced but relocated. Like a rubber duck that pushes you under water and then rears its head a little further on.
Take the suggestion of the SER to allow part-time working healthcare professionals to work more hours. Many care workers also have informal care tasks: they have children or provide informal care. If they start working more hours paid, the demand for professional care may increase. Who else takes care of their parents or children?
Attracting healthcare personnel from abroad, which is already happening a lot in our neighboring countries, is not a solution but a relocation of the problem. You can’t just open a can of foreign healthcare workers without this having consequences for their countries of origin – who should look after them there?
Why we should see care for what it is
Until we see care for what it is – namely: as ubiquitous and essential, but not inexhaustible – we will continue to undermine it. And in the end no one benefits from that.
If we want to prevent everything from coming to a standstill in the long run, we will have to take better care of care.
For example, with better working conditions and more freedom of movement for professional care providers – so that people who work in care also want to continue to do so. By investing substantially more in prevention, so that our demand for care becomes more manageable. By giving people time to care, for example with financial support for informal carers and generous birth and parental leave for mothers and fathers.
Because care is the beating heart of our species, but care does not happen by itself. Care needs time, space and support. It needs a value system in which maintenance and repair are rated just as highly as renewal and productivity, and people who understand that you cannot solve a shortage of healthcare staff with a greater appeal to efficiency and informal care alone.
That understanding starts with seeing. By realizing that care is a chain that does not stop at professional care, but runs right through all our neighborhoods and homes, right down to the most informal and intimate care. More than a chain: a fabric. Healthcare is a fabric that connects government, healthcare institutions, professional care providers, informal carers and parents – that connects people.
Such a broadening of vision starts with zooming in, until the dividing lines between care and work, between treatment and bedroom, between different forms of care and different people, disappear.
And with zooming out, until you see that everything and everyone is connected. And that it is care to maintain those connections.
Lynn Berger writes about care for De Correspondent. Her book Zorg – A better view of the human being will be published on 12 July (De Correspondent, 22 euros).