'What you can do yourself, you should do yourself'

ZuidOostZorg is a care organization for the elderly, with 14 locations in Friesland. Nursing home Neibertilla in Drachten is by far the largest. It is a village in itself: various forms of geriatric care are offered. The starting point is that care for the elderly is aimed at helping people to stay themselves. ‘You'd also think it's weird if I suddenly wipe your mouth after you've taken a sip of coffee,’ says professor Hans Drenth.

Neibertilla is a fresh-looking and large complex, which is not immediately reminiscent of a nursing home. In the reception hall, two students are happily talking to each other. A third is looking at his phone. An elderly lady with a walker does not look up or back when she walks to the exit. ‘We have all forms of elderly care under one roof here,’ says Grietje Kooistra, Gerontology and Geriatrics nurse (HBO-VGG). ‘People here recover from a bone fracture or infarct, but we also offer care to people in the last phase of their lives.’ The vast majority of care is short-term,’ Kooistra explains, but apartments have also been set up for people who can no longer live at home. Of course, we prefer to keep our clients at home. Only when things really don't work out at home can they come here.’

Do it yourself

In the gym, an elderly lady is pedalling an exercise bike and on the other side of the hall, a group of people are playing a game with a ball. We walk to the Neurorehabilitation department, where people are recovering from, for example, a cerebral infarction. A living room has been set up and there are sober rooms where clients stay temporarily. ‘You don't actually live here,’ says Kooistra. She knows it sounds harsh, but it has a purpose. ‘Everything in this department is focused on recovery. You shouldn't want to stay here,’ she says. To promote recovery, clients are encouraged to do as much as possible themselves. Above the breakfast buffet there is an instruction: clients are allowed to serve themselves and they are asked to take back the dishes themselves.

Gerontologist Hans Drenth wholeheartedly agrees. As a professor of the research group Healthy Ageing, Allied Health Care and Nursing, he focuses on short-term care and interprofessional collaboration for frail older people. ‘When people hear the word 'nursing home,' they often think of people who are cared for from start to finish,’ he says. ‘But that concept is not only untenable, it also doesn’t contribute to improving or maintaining people’s independence and self-direction.’ He smiles, ‘You'd also think it's weird if I suddenly wipe your mouth after you've taken a sip of coffee. You don't need any help with that at all. What you can do yourself, you should do yourself. That's how we help people to be themselves.’

‘Nursing home care is changing,’ Drenth explains. ‘The focus is increasingly on living at home for longer and less likely to claim nursing care. Knowledge and research are needed to steer this transition in the right direction. That is why there is intensive cooperation with the Hanze. At ZuidOostZorg, Hanze students and researchers work on issues that play a role in the workplace every day. This creates a connection between practice, research and education, which can be used to respond to the challenges that elderly care will face in the coming years.’

Detective

When we walk on, a gentleman walks towards us. ‘Ha, Jan!’ Kooistra shouts enthusiastically. ‘How's it going today?’ He can't answer, but with a broad smile Jan presses his thumb and forefinger together: it's fine. Kooistra looks at him with a smile. ‘People often think that elderly care is boring because it's about old people. But for a nurse, 'old' is interesting. She explains: ‘Anyone can fall. But if an older person falls, there is often more to it. For example, a fall could be the result of an underlying heart problem or a lack of muscle strength. Lack of muscle strength can be caused by malnutrition and that malnutrition may have something to do with dementia.’ Elderly care is therefore actually a kind of detective work. She laughs: ‘Like a detective I find out what's really going on with someone.’

Drenth nods in agreement when he hears Kooistra talk about her 'detective work'. ‘Elderly care is a specialisation for a reason,’ he adds. ‘You are dealing with older people, who usually have multiple syndromes and are often vulnerable. In addition, psychosocial or cognitive problems often play a role as well. So the problem is very diverse and it rarely presents itself as it is in the books.’

Washing people and putting on stockings?

We walk towards the apartments where people live who need continuous care. It is a bright environment, which overlooks a courtyard. There are containers where vegetables grow and there is a fenced meadow with goats. A few residents are sitting at a table in a hall. Some paint planters and there is a shuffleboard on the table. One of the clients hesitates when she sees the photographer. Not because she doesn't want to be photographed herself, but she is not at all satisfied with her painting, she says. Jannick Oosterhoff, nurse in training, is a member of the tour. He looks on, smiling. He never doubted for a second whether he would go into elderly care, he says. ‘It has to do with vulnerability. People are always happy with you,’ he says while one of the other residents starts to slide the shuffleboard stones over the shuffleboard.

‘Elderly care still has to deal with the stigma of 'washing people and putting on stockings,' Oosterhof sighs, ‘while that is such a small part of your daily work.’ Most of his working day consists of observation, consultation and conversations, with colleagues and clients. ‘I always wonder what health is,’ he says. ‘Do I treat someone because I know they will benefit from it or do I listen to the client, who wants something different? As a healthcare professional, I know which path is best to take, but you also have to take into account what the manager of the home thinks about it. The challenge is to work it out together.’

Doing it together

'Doing it together': these words are often used during the conversations. Grietje Kooistra also emphasizes how important 'doing things together' is in elderly care. She not only refers to participation in treatment, but also to the social challenges. ‘Homes for the elderly took care of many of the problems we are currently facing: housing for the elderly, fluidity in the housing market and combating loneliness.’ This is why it is important to think carefully about how you organize elderly care. She points around her. ‘Not only are people being cared for here, but there is also a health square that the whole neighbourhood can use, research is being done and people are being trained. This means that there is a connection with the immediate environment and with the people who will be doing the work in the future. We're in it together.’

‘There are more and more elderly people, who are also getting older,’ adds Hans Drenth. ‘And that is presented as if a tsunami of misery is coming our way.’ He is silent for a moment. ‘Actually, that surprises me enormously. It just depends on how you feel about it. Working with the elderly has enriched my life tremendously.’ Then he says passionately: ‘We all want to grow old and you also want to be treated well and with respect when you do grow old. We just have to get elderly care out of the corner of shame.’ He and Grietje nod in agreement. In the meantime, the shuffleboards fly through the shuffleboard and the lady who was so dissatisfied with her painted planter looks curiously at the photo that has been taken of her.

ZuidOostZorg and the Hanze work together on the transition of elderly care

In order to be able to continue to provide good care to vulnerable elderly people in the future, a new generation of care workers must be trained. Research is also needed at the intersection of care, welfare, forms of treatment and technology. That is why ZuidOostZorg works in interprofessional learning communities, in which researchers and students from the Hanze and healthcare professionals from ZuidOostzorg learn from and with each other. Hanze students will work at ZuidOostZorg in a place where they are seen and heard and where they themselves make a difference by working on issues from the daily practice.