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The European voice for informal carers

THE NETHERLANDS

Towards carer-friendly societies
Demographic background

In the period 2019-2050 the share of 65+ people in the Dutch population is expected to grow from 19.2% to 26.6% (EU-28: 20%-28.5%), with most of the growth happening before 2030. At the same time the share of people 85+ will expand by a factor of 3 from 2.2% to 6% (EU-28: 2.7%-6.1%).

Over the same period, the old age dependency ratio measured as 65+ as percentage of the 15-64-year olds will rise from 29.0% (EU-28: 30.5%) to 52.5% (EU-28: 55.3%).

Life expectancy for men and women at age 65 is projected to rise from 18.7/21.2 years (EU-28: 18.1/21.4) in 2010 to 22.3/25.6 years (EU-28: 22.4/25.6) in 2060. From 2013 to 2017, healthy life expectancy for men and women increased by 0.6 and 0.4 years respectively.

Under an assumption of no policy change the Ageing Report scenario suggests that public expenditure as share of GDP would rise from 3.5% to 6.5% (EU-27: 1.6%-3.1%) by 2070. The impact of a progressive shift from the informal to the formal sector of care in France would entail an estimated increase by 104% in the share of GDP devoted to public expenditure on long-term care (128% on average for the EU27).

Current Long-term care provision

The Dutch system for the provision of long-term care has been reformed from a national scheme covered by one law, the Exceptional Medical Expenses Act (Algemene Wet Bijzondere Ziektekosten, AWBZ) to create a system that is divided up among the municipal domain (the Social Support Act (Wmo) and Youth Act/Jeugdwet) for which municipalities receive a budget from the state; the national domain of the Long-term Care Act (Wlz), which has a similar construction to the AWBZ; and the domain of the health insurers (Health Insurance Act, Zorgverzekeringswet, Zvw), which is funded by health insurance premiums.

The AWBZ was a national and largely contribution-based scheme which paid for the costs of personal and nursing care, counselling, medical treatment and accommodation. Between 1968 and the turn of the century, a steady increase can be observed in care provisions that were covered by the AWBZ. In response to the rising costs this induced, the last 15 years have seen a development to limit the coverage by the AWBZ to those who are in need of permanent care and/or supervision, in residential homes or close to home, and to those who are most vulnerable: elderly people in need of nursing/care, disabled people and people with (severe) mental disorders (SCP 2014). This has been accompanied by increasing individual responsibility, because in the old LTC system citizens had become overly dependent on publicly funded services. People in need of care are expected to arrange (and pay for) services that are considered “generally common” and to remain living in their own homes for longer. The care they need is provided by a combination of formal care (Wmo, Youth Act/Jeugdwet, Zvw), informal care by social networks (family, friends, neighbours and other close relatives), general public services, such as meal services or community centres, and services offered by volunteers. Residential care is reserved for those who need 24/7 supervision permanently.

Municipalities are free to choose how they organise the implementation of the Wmo. The Wmo itself states which services need to be provided. These are:

  • General services: services that are the same for and accessible to every citizen, for example provision of meal services at home or daytime activities in a neighbourhood centre.
  • Customised services: services that are customised to the needs, characteristics and possibilities of specific clients and that support their ability to cope (including respite care, aids, housing adjustments, domestic aid) and help them participate in society (for instance daytime activities, transport). These also include sheltered living and emergency shelter.[1]

The actual content of the care will not differ widely between municipalities, but the access procedures, the amount of care provided, the speed with which care and support are realised and (until 2019) the financial contributions that clients have to make can differ from one municipality to another.

The Wlz is administered by 32 regional care offices (zorgkantoren),[2] which perform several functions, including the contracting of private provider organisations and the material control of provider organisations. Funding under the Wlz is based on ‘care profiles’, which specify the type (though not the amount) of care each client needs. The Dutch Healthcare Authority (Nederlandse Zorgautoriteit, NZa) sets the tariffs of the packages. The Care Needs Assessment Centre (Centrum Indicatiestelling Zorg, CIZ) assesses whether someone is eligible for care under the Wlz. This care includes intensive care and nursing in healthcare institutes, such as nursing homes, rehabilitation centres and residential homes for disabled people, but also some parts of the care provided at home. The main eligibility criteria are:

  • A need for long-term care, needing care close to 24 hours per day;
  • A need for long-term care, needing permanent supervision.[3]

Most care is delivered in kind, but clients can also choose to contract care through a personal budget scheme (persoonsgebonden budget, pgb).

[1] Social Support Act (Wmo).

[2] In each region, a single insurer – usually the market leader in the region – administers the Wlz on behalf of all insurers. For that purpose, they receive a concession from the government. This is the so-called representation model.

[3] Long-term Care Act (Wlz).

Carer-friendly policy environment

Number of carers

Research by the Netherlands Institute for Social Research (Sociaal en Cultureel Planbureau, SCP) shows that 5 million people (aged 16+) – 1 in 3 Dutch people in that age category – provide informal care in the Netherlands.[1] According to this study, informal care is regarded both as care for a person in one’s social network (32%) and voluntary work (6%). People who care for a family member, neighbour or friend do so for on average 7 hours per week for more than 5 years. The 45-64 age group provides most informal care. This – the SCP suggests – is because they often have an older parent (or parent-in-law) of whom to take care.

About 4 million informal carers provide help for longer than 3 months while 865,000 informal carers provide help more than 8 hours per week (intensive). An estimated 750,000 carers provide both long-term and intensive care (more than 8 hours per week for a period that is longer than 3 months).[2]

[1] SCP, Kerncijfers: informele hulp in Nederland 2016, The Hague, 2017.

[2] Mezzo voor mantelzorgers – Mantelzorg in cijfers

Identification of carers and assessment of their needs

Municipalities are mainly responsible for the support for informal caregivers. The budget for this task is EUR 100 million per year.19 Municipalities offer many forms of support from this budget. Types of support may differ from one municipality to another; unfortunately, there is no overview of what municipalities supply in general, or of the main differences between municipalities. Types of support may include, for example:

  • Information and advice on benefits to carers and assessment of carers’ needs (most municipalities have a support function for informal caregivers to help them with any questions regarding care and support);
  • Emotional support/counselling by both professionals and volunteers, and through opportunities to meet other informal carers;
  • Courses on aspects of care, on diseases and on network formation;
  • Practical help for the person being cared for (e.g. domestic help and meal services) and for the carer (administrative help and mediation in employment issues);
  • Material help for the person being cared for, such as home adjustments, or a parking permit for the carer;
  • Respite support, such as day care, short-term residential care, crisis care or holiday care;
  • An active role in stimulating professional caregivers to cooperate with informal carers (Radar 2015).

Social inclusion of carers, access to education and employment

Short-term and long-term care leave

In the Netherlands, 5 out of 6 informal carers between 18 and 65 has a paid job. 11% of working carers must interrupt their work on a daily or weekly basis to be able to deal with their caregiving responsibilities[1].

Care leave is organised under the Employment and Care Act (Wet arbeid en zorg, Wazo). This gives carers the right to take leave to care for a sick partner, child or parent, siblings, grandparents, grandchildren, housemates or acquaintances. The Wazo Act provides short-term care leave, emergency leave (not relevant with regard to informal care) and long-term care leave. To make use of these types of leave, the employee is asked to inform the employer either beforehand or afterwards. The employer is allowed to ask for additional information about the situation.

  • Short-term care leave gives an annual right to 10 days of care leave if the employee works full time (40 hours/week). It can be taken over several spells during the year, so long as it does not exceed the maximum 10 days. During this leave, 70% of the wage is maintained and payed by the employer. The percentage may be higher if this is arranged in a collective agreement or other employer regulations.
  • Long-term care leave gives people the right to care on a more substantial basis when needed by the care recipient. The maximum duration of long-term care leave is six times the weekly working hours of the employee concerned (so, in the case of a full-time contract for 40 hours/week, the maximum is 240 hours or 30 days). Long-term care leave is unpaid, unless there is a collective agreement or other regulation in which employers have made their own decisions about payment. The long-term care leave has to be taken in one go.

The self-employed do not have access to short-term or long-term care leave (Yerkes and den Dulk 2015).

Due to a decrease in formal care (on a personal level), resulting from budget cuts in the healthcare sector, the care burden on informal carers has increased. SCP research mentions that municipalities must be aware of the fact that the decrease in formal care cannot (always) be compensated for by (more) informal care.[2] Two out of three informal carers feel they cannot provide any more care than they are already providing.[3]

 

Carer allowance

There are in the Netherlands no care allowances that compensate informal carers for their work. The only exception is the personal budget scheme (persoonsgebonden budget – PGB) that exists under all four laws that govern LTC. This budget can be used to finance care by both professional and informal carers. In order to obtain a personal budget, clients have to explain why the available in-kind care is not suitable for them. If they want to use their personal budget to pay for an informal carer, they have to comply with rules regarding forms of care and payment and lay down arrangements in a formal agreement. Rules regarding personal budget schemes under the Wmo and Jeugdwet may differ from one municipality to another. This has led to a lack of clarity about the criteria that has yet to be addressed. There are indications that some municipalities make it almost impossible to use the personal budget scheme to pay informal carers.[4] Personal budget payments differ from wages; in that they do not cover social or pension contributions. However, PGB payment is taxable income. Also, this payment can be included in the sum to calculate the amount and duration of unemployment benefits.[5]

Multiple organisations have been established to support informal carers and volunteers in municipalities. Together with the national government, representatives of these support organisations, professional and interest organisations (e.g. (municipal) care organisations, insurance companies and client organisations) have formulated a “future agenda for informal care and support” (VWS and Expertisecentrum Mantelzorg 2014). This agenda stresses the cooperation between government, professional care, informal care and several supporting organisations, in order to make it easier to give informal care.

[1] Mezzo voor mantelzorgers – Mantelzorg in cijfers

[2] SCP, Overall rapportage sociaal domein 2015, The Hague, 2016.

[3] SCP, Zicht op Wmo 2016: Ervaringen van melders, mantelzorgers en gespreksvoerders, The Hague 2017.

[4] Tweede Kamer der Staten-Generaal, Vergaderjaar 2015–2016, Aanhangsel 827.

[5] http://www.uwv.nl/particulieren/werkloos/ik-word-werkloos/detail/achtergrondinformatie-over-de-ww/uitleg-over-de-duur-van-een-ww-uitkering/totale-arbeidsverleden

Recognition and definition of carers

In the Netherlands, informal care is a form of care which is encouraged by the government. The government encourages informal care in various ways. Municipalities support informal carers by providing information, advice, respite care and a token of appreciation to informal carers. However, 1 informal carer in 10 feels overburdened, and the expectation that more informal care can compensate for the intended decrease in formal care seems unrealistic. In the Netherlands, people are not obliged by law to take care of a family member. However, the principle that people are first and foremost responsible for their own care is enshrined in the law: the safety net that is provided collectively through Wmo and Wlz is in addition to what is seen as ‘generally common care’ that people and families give each other – a concept, however, that has not been defined.[1] In practice, this means that both municipalities and care offices will always take into account the possibilities of informal care in a given case, but will not make informal care compulsory.

The main forms of support are: information and advice through municipal councillors and interest groups, respite care which temporarily relieves them of the burden of care, and a yearly token of appreciation via the municipality they live in.[2] One informal carer in six receives a form of this kind of support.[3]

in January 2017, the Central Court of Appeal (Centrale Raad van Beroep, CRvB) made it very clear that there are limits on what can be expected of informal carers, when it ruled that informal caregiving must not be seen as compulsory for the family and friends of the recipient: municipalities should provide the necessary support, whether through compensation by a personal budget or through care in kind.[4]

[1] Memorie van toelichting van Wet Maatschappelijke ondersteuning 2015, Ministerie van Volksgezondheid, Welzijn en Sport, 14/01/2014.

[2] https://www.mezzo.nl/pagina/voor-mantelzorgers/thema-s/geldzaken/mantelzorgwaardering, information about the compensation for informal carers.

[3] SCP, Kerncijfers: informele hulp in Nederland 2016, The Hague, 2017.

[4] Central Court of Appeal, pronouncement date 11 January 2017, case number 16/2027 WMO15, ECLI:NL:CRVB:2017:17.

Access to respite care

The national government wants to support municipalities in paying attention to the well-being of informal carers.

Most health insurers have included a certain number of days for respite support in the supplementary insurance packages (not the basic health insurance) In other cases, respite support is paid for out of the Wlz, if the person being cared for receives care under the LTC Act (Wlz), or out of the Wmo/Jeugdwet, if he or she receives care under these laws. There are no regulations as to the amount of respite support that carers should be able to rely on. With these acts, the national government wants to support municipalities in paying attention to the well-being of informal carers.

Training and recognition of carers’ skills

In the Netherlands there are no initiatives where informal carers are being trained to become formal carers.

References
  • The 2018 Ageing Report, Economic and Budgetary Projections for the EU Member States (2016-2070), EC, 2018
  • ESPN Thematic Report on Challenges in Long-Term Care, The Netherlands, EC, 2018
  • Mezzo – Mantelzorg in cijfers, 2017
  • ESPN Thematic Report on work–life balance measures for persons of working age with dependent relatives, The Netherlands, 2016
  • Joint Report on Health Care and Long-Term Care Systems and Fiscal Sustainability, EC, 2016
  • Adequate social protection for long-term care needs in an ageing society, European Commission, 2014
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