Wednesday, July 29, 2015

There are Angels in Holland

There are angels in Bergen. Bergen is a small, affluent town in the northern tip of Holland, where my 101 year old mother settled in her old age. These angels surround her like silver-winged moths hovering around a light bulb, fluttering in and out of her apartment, gathering the mess that very old people inevitably create.

She cannot see, hear or smell much of anything any more, so they appear, polite, respectful. They greet her, gently squeezing her fragile, skinny hand as they bend over, so she can hopefully see their smiling faces. They call her 'Mevrouw Kando' and you can tell that they like her. She is a likeable centenarian, and there are not too many of them, so it could be that they feel privileged to take care of her.

They talk to her gently, sometimes asking where it hurts, or what they can do for her that day. They are there to feed her and wash her, clean the shower cell and the toilet, massage her swollen feet, clean her hearing aids and perform many other tasks that make up what they call in Holland 'Thuiszorg' (homecare). They do this without batting an eye, too polite to react to my mother's frequent snapping when they are too slow to bring her a glass of water or a pinch of salt for her soft boiled egg. She usually forgets to thank them, thinking that she is entitled. Entitled to having all these angels swarm around her, because they get paid, she says. They don't come for free. The government picks up (most of) the tab. I bite my lip as I witness the interaction, wondering if one day, I will also be short tempered with my angels. But then I realize that I live in America. There are no angels in America, the soil is not socially fertile that way.

Her opinion of these angels is low, telling me that she wished they wouldn't be so nosey and that she only shares her personal life with them out of a sense of obligation. It is understandable, she feels their presence as an intrusion on her privacy and her sense of independence. And Ata likes to feel special. Don't we all, really? In her case, what makes her special to the other residents of the assisted living complex where she lives, is not her impressive career as a photographer, but her age. They consider her their resident mascot. After all, most of them are only in their late 80's, early 90's, and having Ata around gives them hope, that they still have some time left on earth.

Being surrounded by old people since my arrival on this latest family visit has prompted me to research eldercare in Holland, wondering how this country finances all these angels. Holland is not unique in a world that is aging fast. By 2030, there will be more humans over 60 than under 10. Already there are more adults over 60 than children under 5. But the Dutch are tackling the graying of their country with more foresight than many other countries.

According to the Global Age Watch Index, out of 95 countries studied, Holland ranks number 6 for quality of life for older people. Norway takes first place, closely followed by Sweden. Apart from Japan (9) all the top 10 countries are in Western Europe, North America (number 8) and Australasia. 

In Holland, a new law was created in the 50's, called the AOW (Algemene Ouderdomswet), which shifted the responsibility for the welfare of the elderly from individual families to the State. Amongst my many memories of living in Holland was visiting grandparents of some of my friends who all were stashed away in clean, well-organized nursing homes, neatly taken care of by professionals. It felt a bit cold but a practical solution for busy, hard-working families. It was the Dutch way, I thought and didn't give it much thought at the time. (It's interesting to note that America's Social Security system, the equivalent of the AOW, predated it by more than a decade.)

Now that my own mother is part of that system, I pay closer attention. Many residential districts in Holland are “aging-proof”. The army of motorized wheelchairs zooming around the village of Bergen attests to the fact that the elderly are an accepted fixture of the community. Health Insurance in the Netherlands, which is universal, is divided into “cure care” (medical care) and 'health care' (help with social living). Long Term Care insurance in Holland has been mandatory since the 1960's, which is just as well: in some years this “Exceptional Medical Expenses Act” (AWBZ), makes up a greater share of total health spending than the health insurance program. It covers everyone, young and old, although you have to prove that you need the service before you get the benefits.

Most OECD countries have some form of LTC (Long Term Care): Japan, Norway, Sweden, even the United States. Unlike Holland, where 100% of the population is covered for Long Term Care, only 16% of the population in the United States is eligible, through Medicaid. But you have to be really really poor to be on Medicaid. The Middle Class, the majority of Americans, have to fend for themselves, either through private insurance or are dependent on the kindness of family members to take care of them. Home Care workers in America are classified as 'babysitters' and are not protected by Fair Labor Laws. There are no training requirements, no overtime pay, no minimum wage, etc. Being a home health aide in the US is equal to working at McDonald’s, a hard, badly paid, lonely job that nobody wants.

Many countries realize that LTC is not a medical issue but a social issue. It is not to cure someone (you cannot cure old age); it is truly to keep the elderly 'healthy'. If a daughter (yes, usually they are daughters that take care of older parents) doesn't have to spend her day taking care of her parents, she can become a productive member of the labor force. Besides, Long Term Care is far cheaper than having to place someone in a nursing home. The Dutch, being smart businessmen, have been pushing this Home Care trend for quite a while, trying to keep seniors in their own homes for as long as possible.

The Dutch Long Term Care system is private, non-profit and highly regulated. The different 'services' compete with each other for types of care they provide, which makes it more efficient, although the bureaucracy is at times overwhelming. Still, it is a small price to pay and it is the difference between heaven and hell for people beyond a certain age, who are dependent on others.

The fact that the United States has no formal policy in place to support the elderly in their daily lives is appalling. Its place on the Global Age Watch Index is due to an enormous amount of sacrifice on the part of family members. According to the Family Care Giver Alliance some 45 million Americans are caring for an elderly family member, giving up everything, selling cars, furniture, just to pay for their parents' care. This can only get worse as the population ages. Even though there is a trend, even in the Netherlands, to move to a more 'participatory' model (the Dutch critics of this trend call it the 'je zoekt het zelf maar uit' model ', which means 'you figure it out'), the concept of 'solidarity' is so ingrained in Dutch society, that there will always be public support for that age group, in some form or other.

At 101 years of age, my mother couldn't have chosen a better place than Holland. It is a country where people haven't forgotten the origin of the word 'solidarity'. It comes from the adjective solid, meaning "not empty or hollow. It means "firm, whole, undivided, entire". When an entire nation pools its strength to solve its problems, the outcome is bound to be better. leave comment here