More people, less administration

Senior citizens who do not live in a retirement or nursing home often use the services of Spitex. This non-profit organisation is basically available to all people who need support at home. It helps to relieve the burden on hospitals and nursing homes. The care services are paid for in accordance with the Health Insurance Act (KVG). The administrative burden is high, and carers and patients alike are increasingly complaining that human care is falling by the wayside.

Are there alternatives?

Quite so, as a look at the Netherlands shows. The country is known for taking unconventional paths every now and then. This is also true of care for the elderly. The country has abolished old people's homes. In doing so, the state wants to ensure that senior citizens can remain in their own homes and be cared for as long as possible. Only those who really need medical care will be admitted to a nursing home if they are referred by a doctor.

When it comes to care for the elderly outside of nursing homes, the Netherlands relies entirely on neighbourhood assistance (buurtzorg in Dutch). This organisation was founded in 2006 by Jos de Blok. The trained caregiver was upset that the administrative burden and paperwork in elderly care was so great. His wish was to return to a care organisation where the focus is on the human aspect and the administration is as lean as possible. The concept of Buurtzorg is that the teams have a high degree of self-responsibility. They make most of the decisions autonomously, organise the schedules, and also decide themselves how many people they want to care for, so that resources are not overstretched. In short, all management tasks are taken on by the teams themselves, which in a sense constitute themselves. The team size is limited to twelve people.

Time spent instead of tax points

Buurtzorg pays for the time spent. This is completely different from care planning according to RAI Home Care, the assessment tool used by Spitex. This is very detailed and involves a lot of administrative work. In addition, Spitex employees have to write a report after each visit to a client. In the Dutch Buurtzorg model, this effort is almost completely eliminated, or a specially developed software supports the employees in this.

What works in Holland could also revolutionise care for the elderly in Switzerland? Yes, at least according to a feasibility study conducted by the University of Applied Sciences Northwestern Switzerland between 2016 and 2018. The Buurtzorg model has undisputed advantages, the study concludes. However, while in the Netherlands the model could be developed virtually "on the green field", its introduction in Switzerland would be associated with an elaborate change process. This change process would not only involve the complete restructuring of the Spitex administration, but would also require a change in culture. Enrico Cavedon, a member of the FHNW research team that conducted the feasibility study, summarises this as follows: "The Buurtzorg model is based on a double concept of trust: internally, many nurses first had to get used to being trusted again and to being able to tackle a large number of the relevant issues independently and solve them competently. At the same time, Buurtzorg also receives a great deal of trust from the outside: for example, from clients, health insurers, professional bodies, politicians and society. This culture of trust cannot be prescribed. It must be lived, developed, nurtured and constantly renewed. In addition, there are other tasks to be solved, for example in the interaction with health insurance companies, municipalities and cantons."

Adapt to local conditions

Despite reservations, some Spitex teams have already decided to adopt the Buurtzorg model - adapted to local conditions. And the first experiences are positive: Spitex Zürich Limmat AG has successfully completed the restructuring to self-organisation and is very satisfied with it, as the article on the previous pages shows.