You don’t have to have studied to see that an aging population is creating an untenable situation, says Marcel Canoy. In addition to the climate, care for the elderly is one of the biggest financial problems for future cabinets. But cutting spending and making citizens pay more is not the solution, he says. That is the product of ‘number fetishism’ that creates a blind spot in the political debate.
Marcel Canoy gave his inaugural lecture as endowed professor of health economics dementia care at the Free University in Amsterdam on Tuesday. Dementia has many faces and a capricious clinical picture that can differ from day to day. Human size is crucial, Canoy argues. “But things we can’t calculate don’t exist. So while everyone agrees that citizens’ initiatives, human scale, more solidarity, or greater social cohesion have an enormous social return and can reduce expenditure, these do not count in the models of the Central Planning Bureau. That’s just common sense. The result is that we no longer look at those solutions and that dismal scenarios are now being calculated. The world of spreadsheets and models dominates.”
Before the summer, Minister Conny Helder (Long-term Care, VVD) launched a new approach to care for the elderly to manage the social shortage of money and personnel. Her credo: yourself if you can, at home if you can, digital if you can.
Canoy struggles with it. „At home if you can is only available to some of the people. And it sounds like we should do everything we can, no matter how expensive, to let people live in their own homes. While that is sometimes very unwise and people do not want that. Even if you can has the aftertaste of ‘figure it out yourself’. And digital if possible? We are not going to solve the problems in elderly care with video calling.”
We are not going to solve the problems in elderly care with image bubbles
Canoy fears increasing inequality. “You want everyone to be able to grow old in a decent way, not for this to become dependent on the individual wallet. There is already such a big dichotomy in which a higher educated lives fifteen years longer in good health than a lower educated, a gap that is hardly comprehensible. But the consequence of the current mores at the Ministry of Finance is that officials are now diligently calculating what it could bring us if we privatized some of the elderly care, which would be a disaster.”
Canoy is not by definition opposed to advancing commercial parties in elderly care. In his eyes, these can be very useful in solving problems. But “we have to be careful” because the childcare sector has learned that it can quickly go wrong with investors who use financial tricks for short-term gain at the expense of the user. The customer of services is vulnerable. “You don’t just ship your old father when things don’t go well. Markets where it is difficult to switch function poorly because voting with the feet does not have a disciplinary effect.”
You won’t just ship your old dad if things don’t go well
Many people with dementia do not need care so much as more attention and interaction, Canoy says. This is not a medical need, but a social issue that can also be solved by volunteers, friends or neighbors instead of professional healthcare personnel. “In fact, in dementia we don’t even know what the right treatment is.”
Don’t get him wrong, Canoy says, he is not arguing for more work by the informal carers – the partners or children of the elderly person with dementia – because they are already overburdened. But he points to the large group of fit citizens between 65 and 75 years of age who do not receive informal care themselves and do not currently provide it. That is one and a half million potential volunteers who can help support elderly people with dementia. “If you manage to mobilize part of that, you have won a world.”
Also read the comment of NRC: People in their forties: think about how you will pay for your care later
Those volunteers shouldn’t be doing things that require medical professionals to do. The professor is concerned with the tasks of nurses that can be performed by others.
More deployment of volunteers would be bread robbery of nurses, which is nonsense
“That is not being encouraged in any way at the moment. The cabinet does not tempt volunteers. The opposite is the case: unions oppose more deployment of volunteers because it would be bread-raising for nurses, which is nonsense.”
Should those new auxiliaries be removed from the golf course or from their apartment? No, says Canoy. The problem is that now no attempt is even being made to reach and motivate this group to do more voluntary work for the elderly. “We can start with that tomorrow. It is much simpler than the complex solutions to the climate problem. I don’t see any government plans on how we are going to increase people’s social networks. That is incomprehensible, when we know how important that is.”
The government should not interfere with friends or neighbors itself, Canoy says, but emphasize the importance of those relationships, propagate it as a government. “This is not soft shit. All the important advisory bodies of the cabinet advise it: building communities is the solution to the exploding demand for help from the aging population, that is not something I think of.”
Building communities is the solution to the exploding demand for help from the aging population
In practice, the authorities often get in each other’s way, care is unnecessarily divided up – the dementia case manager coordinates the tasks, the district nurse does the support stockings, another organization offers daytime activities, the domestic help cleans – and complicates the various sources of money customized care. Municipalities with money problems are showing ‘shearing behaviour’ to bring elderly people living at home under another law whereby the government pays the bills.
In his inaugural lecture, Canoy mentions various initiatives that are opposed by the system: separate funds from municipalities or health insurers prevent neighborhood cooperatives or other citizens’ initiatives from solving multiple problems at the same time.