Unlike Canada and Quebec, the Dutch model of healthcare for people elderly is centered on home support. Barring exceptions, people at the end of life are monitored daily at home by nurses, until their last breath.
Nurse Gert-Jan Bleeker at the bedside of Leen Vermaas
It is 7 a.m. and the small group of nurses we meet is already hard at work. Quick review of medical records, confirmation of the appointment list, we exchange a few jokes and presto, it's time to leave.
Gert-Jan Bleeker, the team leader, grabs a box of surgical masks in one hand, a handful of sterile gloves in the other and runs to his small service car identified in the colors of Alerimus , a non-profit organization used by the Dutch state to provide home care for the elderly.
Gert-Jan Bleeker, team leader at Alerimus
No time to lose, the first patient on her list is a very sick 90-year-old man who lives alone and is waiting for help to get out of bed and start his day.
Leen Vermaas is at the end of her life. He suffers from cardiac and respiratory failure.
The nurse triggers the door to open with his mobile phone and enters. Most people want to die at home, nurse Gert-Jan Bleeker tells us. A person feels more like himself when he is in his own house.
This is the case with Mr. Vermaas. This sympathetic man with a thin body tells us that he can hardly do anything on his own. At the slightest effort, I am completely exhausted, he says. Her son and daughter can only visit her once a week. His life is completely dependent on the nursing and medical services provided by the Dutch public system: hygiene care, meals, medication, injections…
The nurses come to his house twice a day. The doctor, about once a week. And Mr. Vermaas can communicate with them at any time at the press of a button, in case of an emergency.
Gert-Jan's small team of four nurses takes care of around fifty patients. These healthcare specialists are part of a nationwide system of dozens of non-profit organizations responsible for caring for more than 3 million elderly patients, the vast majority of them.
Some are seen several times a day, such as Truus Vlasblom, an 82-year-old woman with several illnesses that make her highly dependent on caregivers and who, until recently, lived with an affected husband dementia.
Now it's calmer at home. My husband shouted and insulted me all the time, she told us. Her husband is now hospitalized. She receives psychological help once a week, in addition to daily visits from the nurses.
Gert-Jan Bleeker bandages her, disinfects a wound, helps her get dressed and leave. Once outside he specifies: We prefer to do a little less to maintain autonomy while hoping that the patient will ask us for more care if it is insufficient.
The nurses are in contact with a doctor who intervenes if necessary.
Dre Maria Veldhoen, general practitioner
I don't have time to see each elderly patient to make sure he is taking his medication correctly, says doctor Maria Veldhoen. She relies heavily on the nursing staff to assess needs and do the required follow-ups.
These follow-ups can be done by videoconference. It must be said that Dr. Veldhoen and her husband, also a family doctor, have a list of 5,700 patients. She adds: Care would be sufficient if nurses could do more prevention at home. But we are short of nurses.
The Dutch model is far from perfect. There is a lack of human resources in this country as elsewhere. But it starts from an intention diametrically opposed to those of Quebec and Canada: in the Netherlands, the first goal is to keep people at home. Home care and social activities for sick elderly people are funded by the Dutch state and by one of the most generous insurance schemes in the world.
- Netherlands : 2.5 beds/100 people
- Quebec: more than 4 beds/100 people
There are almost half as many beds for seniors in public care centers in the Netherlands compared to Quebec. Staying at home saves considerable amounts of money. And yet, the Netherlands devotes almost three times more (3.7% of GDP) of its budget to supporting the elderly than Quebec (1.7% of GDP) and Canada (1.7%).
Mirella Minkman, Professor Tilburg University and CEO of Vilans Group
It is primarily a question of philosophy and mentalities that explains this difference, says researcher Mirella Minkman, president of the Dutch research group Vilans, and professor at the University of Tilburg.< /p>
In the Netherlands, people value the notion of autonomy very much. And research shows us that it leads to better self-esteem. We must learn to take better care of each other in our towns and villages to allow us to age well.
Our system still has its limits, note for his part Elly Sanders, a resident of Numansdorp, near Rotterdam. She lives with a husband suffering from several serious illnesses which prevent him from making the slightest movement. He is totally dependent on her and the visits of nurses from the Alerimus organization are not enough.
At 75, she knows she won't be able to continue at this pace for long. It's good because you can stay at home, but it's difficult to find a place for old people with disabilities. Or else you will have to move very far away. That's why we want to stay at home as long as possible, like now. There are not enough places.
It's a bit the other side of the coin. The Dutch state lacks places to accommodate people who are no longer independent.
Trix Van Os, General Manager Alerimus
The only limit of our system is people who need to be hospitalized for specialized medical care, counters Alerimus director Trix van Os. Otherwise, there are no limits. I sometimes see people who are very sick and who manage to manage to stay at home. The real limit is in the patient's head, she says.
Nurse Gert-Jan Bleeker has doubts. At the end of his day, he tells us: Sometimes I worry, I'm afraid that one of my patients will fall… A small voice tells me that maybe I should have called a doctor at such or such occasion.
But he remains convinced that the Dutch approach is the right one: The charming advantage of aging in place is not having to submit to rules like in care homes, he says. You also have to keep in mind that you can't control everything and that sometimes life is difficult.
The Netherlands is banking on keeping the elderly at home by offering them health care in their living environment.