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There is no problem of informal care at all

There is no problem of informal care at all

Photo of Bernice Fransen, Rudi Westendorp and Joris Behr.Image by Daniel Rosenthal/De Volkskrant

Thinking deeply about the future of elderly care in the Netherlands with these “smart people” has been nothing short of an experience, says Rudi Westendorp. To be able to delve together into the alarming figures about an aging population, a growing elderly population and a shortage of young people, and the enormous problems posed by the number of informal carers, and then be able to conclude: People, don’t be fooled, there is no informal care problem at all. !

How Westendorp arrived at this startling conclusion, more on that later. Let us first introduce him and these two “daring ones.” Westendorp is a former professor of geriatrics in both the Netherlands and Denmark. During his career, his interest shifted from the individual patient to society as a whole and how it should deal with an aging population.

About the author
Michelle van der Geest is a healthcare correspondent at De Volkskrant It focuses on all forms of care: from hospitals to general practitioners, from disability care to big pharma, and from health disparities to fall risk.

For this reason he was the ideal man to lecture at the summer school of Bernice Fransen and Joris Behr, among others. This year they took part in the National Think Tank (Westendorp, exaggeratedly: “a group of high-potential people who all graduated with distinctions in two studies”), the idea being that bright young people will come up with solutions to a problem. A major social problem within a few months. The final event is on Tuesday.

This year’s theme: Meaningful Aging. “The nicest thing is that when I asked who had applied specifically for this topic, no one raised their hand,” says Westendorp. You’re not intrinsically concerned with getting older at 25. However, when I asked who wanted to leave the room because of the topic, no one stood up.

Beer and Fransen studied informal care, among others. Together they looked at all the numbers and research available on this topic. They wrote a position paper for the House of Representatives and a letter to this newspaper. An article on aged care described the following worrying trend in informal care over the next 25 years: There are currently 14.5 potential informal carers for every 85-year-old. At a minimum: if you see everyone between the ages of 45 and 65 as a potential informal caregiver (and no one else). In 2035 there will be 8, in 2050 there will be only 5. Reason enough for alarm bells to ring, and for aged care organisations, supervisors and independent advisory bodies to conclude.

Nonsense, say Beer, Francine and Westendorp in the café at Utrecht Central Station. The connections are clear: Westendorp speaks, he is a professor who likes to explain everything and who works hard to improve his students. Behr and Fransen have difficulty talking, but they are stubborn enough not to take everything Westendorp says seriously.

These numbers are from CBS, aren’t they correct?

Westendorp: ‘We are digging ourselves into a hole based on incorrect interpretations of those numbers. A huge number of reports have appeared in the past ten years – all of them incomparable, because each institute uses its own measurements – giving the impression that we are on the cusp of a tsunami of elderly people who will all be knocking on their doors in 2040. “…pulsing from the nursing home, While hospitals collapse next to them.”

this is not true?

Westendorp: No, from any side. It turns out that the moment when doctors diagnose the first disease in humans comes at an increasingly younger age. So people say: we’re getting sicker. But this is a stupid explanation.

“The disease now is different from the disease in the past. Thanks to medicine, we can diagnose the disease at a very early stage, with the great advantage of being able to intervene quickly and prevent further misery later in life.

“I understand very well that cancer is an unpleasant diagnosis, but you should be happy if they detect it in the early stages. If you take it away, it will not develop. We say: we get sick early, without mentioning that early diagnosis brings huge health benefits. This is the way we lead each other to madness.

“What matters is life expectancy without major defects. And it is only increasing. The average reader of the Volkskrant will also be able to live a life without restrictions for longer than ever before.” Furthermore, the projections are in CBS’s numbers That frayed edge of life, that brief period of dependence on others, is getting shorter. So you live longer with fewer dependent years. This is well known, but the numbers are always very colorful.

Why do people deliberately make these numbers so dramatic if they’re not?

Westendorp: This is part of the belittlement of aging. People don’t want to die, so there are undoubtedly unpleasant things about getting older. But the numbers also show something else: Everything declines as you get older, except quality of life. Seniors who do not have major health problems are the happiest. Just put that in the newspaper.

But even a longer healthy life expectancy will not solve the informal care problem all at once. The demographic shifts are too great to bear this.

Francine: ‘Many of these reports assume that informal care is something young people provide to older people. I’ve never interpreted it this way before, and I wonder if this is realistic in practice. According to the most commonly used definition, informal care is defined as at least eight hours of care per week for a loved one in need of assistance. Then you feel that most informal caregivers are partners, not children. But partners are rarely included in the numbers.

Westendorp (who now conjured up a graph from the elderly care organization Actiz on his phone): ‘Look here again. Then you will actually see that the number of elderly people is increasing and the number of children is decreasing. But what happens to the 65 to 85 year old group? Why don’t we talk about it? These are your neighbors, friends, and people you play bowling or bridge with. That’s a huge stock of baby boomers, who are healthier for longer, and who also live next to each other! So, isn’t it nonsense to say that the whole group can’t take care of each other?

“In the Netherlands we have a crazy idea that children should help their mother and father. But the majority of elderly people take care of each other, and they don’t want to burden the children with that at all. They say: If we can do it ourselves, we will do it.

Neighbors and acquaintances may not be interested in providing informal care at all.

Francine:’Now 12 percent of people help their neighbors. But 64% of people indicate they want to help; Walking the dog, taking the kids, going shopping. What we see is shame in asking and taking action. People don’t dare to ring the doorbell to offer help, and the elderly don’t dare to ask for help.

Bear: ‘I work in a GP practice, and I often see this happening there. Then an elderly person asks if the doctor can come. But sometimes there is no doctor available and I ask them if they cannot come to the doctor’s office. Can’t they ask the neighbors to take them? Sometimes they find it scary, but the patient always calls back shortly. That the neighbors are happy to help and that they come.

Francine:’Four out of five informal caregivers say they get meaning from it. that it particle Naturally. Helping others is human nature.

Westendorp: ‘If you let this sink in, you’ll see how screwed it is to talk to each other in knots. Anyone who continues to wait for help from others takes meaning away from themselves.

“I have not yet come to a conclusion about shame in asking and acting. Here’s the thing; people should dare to meet each other as soon as they need help.

Bear: ‘I would rather people meet each other before needing help. Preferably just somewhere nearby. Neighborhood events can help with this. Neighborhood BBQ, skittles competition for everyone I care. These types of events are important.

Westendorp: Yes, meetings, where the best things come out. As we met now. The joy you get from it is amazing.

You are now giving a very romantic representation of informal patronage. In practice it is often difficult.

Francine: ‘certainly, 10% of informal caregivers indicate that they are overburdened.’

Westendorp:’I’ll take your measurements. One in ten, is that a lot? What percentage of young parents find it very difficult to have young children?

“Having a partner with dementia means misery, and I completely understand that. I think 10 percent is remarkably low. And that probably has something to do with the fact that you get a lot of meaning out of it.”

Francine: ‘but, One in three nursing home admissions is the result of overburdened informal carers.’

Westendorp: ‘So we have a safety net. In the case of the crisis in the Netherlands, we are creating a floor through which no one falls, why paint that negatively?

“And the last thing I want to say against negativity, and perhaps you haven’t noticed it yet: (Westendorp looks at his young colleagues in the conversation meaningfully) Life is just hard work.”

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