Caring for the region: action research into regional geriatric care
The population is greying, living longer at home, and care is focussed more and more in the urban regions. The shortage of geriatric specialists is most acute in the rural areas. Action research into the regionalisation of geriatric care is helping to make the care future-proof.
The shortage of geriatric specialists (GS) is becoming increasingly acute. Some training positions remain empty, and a large group of GSs will be retiring soon, as will many GPs, especially in rural areas. But the elderly are living longer at home and are often dealing with multi-morbidity. So more care is needed rather than less. This demands a ‘different’ organisation of geriatric care.
Utilising existing capacity
Together with Vilans, the Ministry of Public Health, Welfare and Sport, healthcare administrative offices and the regions, we at the Erasmus School of Health Policy & Management (ESHPM) are busy regionalising geriatric care: collaboration outside the walls of care institutions offers new opportunities to utilise the existing capacity and provide care where it is needed. We have been criss-crossing the country to document the regional problems (and opportunities!) in twelve regions in order to experiment with regional players in pilots of innovative methods to organise and carry out care. Examples include employing nurses and caregivers for the triage and treatment of minor conditions, getting geriatric specialists to work regionally, and to carry out evening, night and weekend shifts jointly. But these are not simple solutions: they demand modifications of policy, the organisation and conduct of care.
Other hands helping at the bedside
At ESHPM, we have been researching possible solutions for the consequences of a personnel shortage in the healthcare sector for a longer period, and this is now going to be useful. Reassigning tasks is one such topic. In the Netherlands, so-called ‘new professions’ like nursing specialists and physician assistants are legally competent to suggest and carry out medical tasks (with restrictions). In practice, we find that their legal competence is rarely used to the full extent: doctors are often reluctant to let them and want to keep a certain level of control, sometimes frustrating the new professionals. We also note that as more trust develops between the doctor and these new professionals, much more becomes possible. Task reassignment seems primarily to be a growth model, requiring local input. The language used when transferring between practitioners from different professional backgrounds may lead to different interpretations, or the distance experienced between the care-giving and nursing specialist may be too great to raise the alarm in time. Our research during a pilot is then essential to be able to adjust immediately, and we also suggest possible solutions; solutions sometimes involve policy but often also the everyday practice.
From market forces to collaboration
In most regions, working differently within an institution is insufficient to be able to offer good geriatric care in the future. It is essential that all parties in a region work together and widely reassign tasks and responsibilities. Care providers, healthcare administrative offices, education institutions and employers’ organisations must ensure together that it is possible to create a network of suitable and high-quality care around a patient. This sometimes conflicts with the logic of market forces, which are still dominant in care. Regional care demands collaboration instead of competition. This requires a new set of instruments. Our research is contributing to this effort. In the meantime we are trying to create the preconditions for innovative pilots to succeed together with the involved parties, including the Ministry and supervisory authorities. This must lay a path towards more regionalisation of care, because that is where the solution ultimately lies.