More and more people continue to live independently at home for longer, even as they age and struggle with medical issues. Therefore, they rely on home care. Yet, these people in need of care are far from receiving the care to which they are legally entitled. This is noted by a group of 50 district nurses, 200 home care organisations, care lawyers and care economists. According to them, the shortage of home care is dire, and the prospect is not hopeful. Martin Buijsen, Professor of Health Law at Erasmus School of Law, interprets this issue and explains who is legally obliged to take care of improvement.
In 2013, the Dutch Rutte II cabinet closed hundreds of nursing homes. This raised the threshold for elderly people to be allowed to go to a government-funded nursing home. It also ruled out scaling up the number of nursing home beds until 2040. More recently – last summer – the Dutch Minister of Long-term Care, Helder, announced that the elderly are expected to continue living independently at home for longer.
Falling back on homecare
Therefore, a large share of care fell into the hands of home care providers. However, home care and district nursing do not receive sufficient financial resources and hours to meet the required care. Elderly and other dependents received, on average, two to nine hours less care per month over the past five years. Hence, they do not receive the care they are entitled to, the Dutch Healthcare Authority (NZa) notes. “The NZa monitors the lawfulness of the implementation of the Health Insurance Act. It can issue instructions to enforce the law or, in case of violation, impose a penalty payment or disclose the party concerned offers or carries out insurances as health insurance that do not comply with the provisions laid down in the Health Insurance Act", Buijsen explaines.
“In doing so, health insurers neglect their duty of care.”
Yet the ultimate responsibility lies with health insurers, according to Buijsen. They are legally obliged to acquire adequate care but have been failing to do so. In recent years, health insurers have claimed that they need less money to meet care needs. They invoke more self-reliance, informal caregivers, and digital care. In practice, however, this turns out to be too idealistic, as not everyone can rely on themselves, their contacts or online care. “In doing so, health insurers neglect their duty of care”, Buijsen argues.
Care supply shrinks while care demand grows
While the number of care hours and therefore care costs per individual are decreasing, the demand for care and the quality of this care are increasing. District nursing also saw its budget shrink. Whereas over 30.000 people were added to home care in the past five years, home care providers received at least two hundred million euros less. In short, people are not receiving the care they need and are entitled to.
What can you do when you are not getting the care you are entitled to?
Buijsen explains that as an individual – a person in need of care or an informal carer, for example –there are a number of things you can do when you are not getting the care you are entitled to. For instance, you can report it to the NZa, which can lead to an investigation and possible instruction. In addition, you can point out the shortcomings to the health insurer concerned. “If the insurer does nothing about this, the issue can be referred by the person concerned to the Health Insurance Board. This can issue a binding decision very quickly. In addition, going to the civil courts always remains a possibility", Buijsen concludes.
- Professor