Neighborhood and care cooperatives

Independent Living for Seniors: "The whole plan is only going to work if there is a good community around it"

In recent years, there has been an explosion of neighbourhood initiatives in our country. From village cooperatives to urban villages, more and more citizens are uniting in their neighbourhood, area, village or region. According to expert Jasper Klapwijk, who supports residents’ initiatives in the Amsterdam metropolitan region on behalf of Nederland Zorgt Voor Elkaar (the Netherlands Cares for Each Other), the tally now stands at more than 5,000. These initiatives engage in a variety of activities under a common denominator: for and by the neighbourhood. For instance, most cooperatives have a system whereby neighbours can be called upon for household chores, a lift to the hospital or lending a helping hand with groceries. But some are also working on delivering home care more effectively, or even creating residential and care complexes.
An example of such a complex is the Lang Leven Thuis (Independent Living for Seniors) flat in Osdorp. It is one of the ten Lang Leven Thuis flats in Amsterdam, but the only one that originated from a resident’ initiative. On a freezing cold Monday evening, I visited Ans Smits and Leo Schrader, residents and initiators of the Lang Leven Thuis flat project. Their daughter and fellow neighbourhood resident Sascha Schrader was also at the table – as project manager, she is the one calling the shots.

How it all started
When Ans and Leo moved into the senior flat eight years ago, there was no residents' committee, so they started one themselves. They started organising fun activities such as a neighbourhood day, a vegetable garden, and even a music festival. "We don't like sitting still," Sascha says. "And well, Osdorp is just a neighbourhood that never gets any exciting news coverage. So from there, we thought, you know what? Let's put it on the map with a festival like this. "
But it didn't stop there. The committee – which has since been renamed the Omnibus Foundation – also wanted to improve life within the flat. "That came about because the residents got to know you very well and came to you with all their problems, which allowed you to look behind people's doors and hear the harrowing stories," says Sascha. Like the 90-year-old resident who provided informal care to a 100-year-old neighbour, or residents who had multiple intake interviews in one day. In total, as many as ten different home care agencies visited the flat. Getting a new face each time is painful because, as Sascha explains, "you receive quite vulnerable care. Someone has to help you take a shower. You have to get completely naked, you know." Ans adds, "So before we had actually come into contact with all kinds of organisations, we had said, we actually want to see if we can just bring back old-fashioned 24/7 in the building. "

Market forces in home care create distressing situations: costs are rising and the human touch has disappeared.

Changing care in the Netherlands
What exactly does she mean by old-fashioned? Until 2013, there were nursing homes in the Netherlands, but due to rising costs in elderly care, the Rutte II cabinet closed them. At the same time, the insurance system changed: where previously the Exceptional Medical Expenses Act (AWBZ) insured elderly people for their old age in such nursing homes, in 2015 this was reduced and fragmented into three partitions: (1) the Long-Term Care Act (Wlz),(2) the Social Support Act (Wmo 2015), and (3) the Health Insurance Act (Zvw). People with a Care Intensity Package (in Dutch: zorgzwaartepakket, ZZP) below 4 – numbering from 1 to 10 – were no longer covered by this and were therefore no longer reimbursed for housing and care. As a result, only the most severe cases could still be accommodated in a nursing home, and the rest of the care had to be arranged extramurally. That is, outside the walls of the nursing home, through home and informal care.
The effect on society? A greater demand for healthcare personnel, less turnover in the housing market, more loneliness among the elderly, and long queues at nursing homes.⁽¹⁾ Moreover, market forces in home care create distressing situations: costs are rising and the human touch has disappeared, as Ans and Leo also saw in their flat. In short, a yawning gap has emerged between independent living and intensive care in nursing homes. 'Old-fashioned nursing homes' could help fill part of this gap. For example, Ans and Leo had a neighbour who fell down, broke her tailbone, and never returned. She had to go to the nursing home. "All because she needed a hand going to the toilet," says Ans.

Neighbourhood and care initiatives
However, having improved formal care alone won't suffice, Sascha also acknowledges. "Getting all that care here at home will be feasible, but this whole plan is only going to work if there is a good community around it, where you have a good neighbour who can provide informal care." She tells about the clients whom highly educated care workers took to the movies because there was no one else who could do it. Or take the two ladies from Ans' flat, for instance, who partake in social activities twice a week when their real issue is loneliness. To systematically address such cases, a (caring) neighbourhood initiative is necessary.
But what exactly are neighbourhood initiatives? A neighbourhood initiative is essentially an umbrella term (similar to a city village) encompassing various categories. Each initiative chooses its own legal form: foundation, cooperative association, or no legal form (a movement or network). The form depends on what suits the initiative best. For example, an ANBI foundation can receive tax-free donations, but in a cooperative, all members also serve as owners, which can provide democratic weight. Sometimes it can also be a combination. A neighbourhood initiative might start as a cooperative and eventually take over a community centre with a foundation, as in the case of neighbourhood cooperative De Eester. Good examples (like De Eester) are widespread and receive a lot of media attention. For instance, King Willem Alexander visited Hengevelde, and Queen Maxima visited Austerlitz. But places like Hogeloon, Elsendorp, and Klooster and Buren have also become renowned care initiatives. Generally, such initiatives emerge mainly in places where facilities are lacking. Or, in other words, places where needs are not met by the market or government.

Politicians and established parties acknowledge that neighbourhood initiatives are essential for the future of care but they have yet managed to integrate them into their approach.

The future
However, this recognition does not mean that society is already used to citizens leading the way. On the contrary, citizens are structurally the ones missing from the meeting tables, and established parties rarely tend to align with them.⁽²⁾ For example, residents of the other (non-citizen initiatives) Lang Leven Thuis flats had to read in the newspaper that their building would be renamed — causing anger and dismay. Additionally, Samen Hengevelde emerged from a failed project: Blijven Wonen in Hengevelde. This was a planned residential and care complex where, after five years of work (and a solid business plan), the corporation started to baulk. "They simply weren't interested," says Tim Jongman, the project's former initiator. And yet, this complex was exactly what the area needed, the municipality agreed. Furthermore, the division of insurance into three partitions makes it complicated for initiatives to provide well-founded care to local residents. Money comes from three different funds and two different providers, the municipality and insurance companies. Marcel Canoy, professor of Health Economics and Dementia at the Vrije Universiteit (VU University) and advisor to the Authority for Consumers & Markets (ACM), concludes that while politicians and established parties acknowledge that neighbourhood initiatives are essential for the future of care, they have yet managed to integrate them into their approach.⁽³⁾
It is clear that when municipalities and care institutions sit down with residents, we get a different picture of care. That of a flat coach, for example, as Sascha suggests. Someone who goes door to door in the flat and maps out the issues. This coach might discover that a lonely woman enjoys knitting and put her into contact with the local knitting club. That way, you relieve the burden of care and social activity programmes. This is necessary because, as Sascha puts it, "lonely elders need someone to actively approach them. Of their own accord, they won’t go to gatherings." The question for the future, however, is whether the system, the municipality and involved parties can adapt to this... ⁽⁴⁾

English translation by Fairlingo
 

Foototes:

1) Roep om terugkeer verzorgingshuis steeds luider: 'Thuis wonen is doorgeslagen'. Read more

2) Waarom het niet opschiet met zorgzame buurten. Read more

3) Waarom het niet opschiet met zorgzame buurten. Read more

4) Waarom doen gemeenten niet meer met zorgzame buurten? Read more