Meeting the urgent need for care in nursing homes

Keystone

Who will take care of all the seniors in the future? Not only is Switzerland facing an explosion of its 65+ population, but about half of the nursing home staff needed to tend to the elderly will also retire over the next 15 years.

It’s mid-February – Valentine’s Day, to be exact – and a dozen seniors sit at a table strewn with chocolate hearts. A middle-aged staff member is testing their memories.

“Do you remember what gifts you gave when you were in love?” she asks, looking around the table. She addresses the group members one by one.

For most of the retirees, the answers come slowly, after reflection.

“A trip. To Paris?” says one person. 

“A golden ring with a diamond in it,” says another.

“Flowers – from my neighbour’s garden,” one of the women answers mischievously.

This group meets every Friday at Domicil Baumgarten, a nursing home just outside of Bern. The group members are not yet residents; they are here for social stimulation, or to give their families a break from caregiving. It’s a sort of day camp, offering memory training, exercise class, arts and crafts, and lunch for people with physical and mental limitations who want to remain at home as long as possible.

Coping with increasing demand

Only around 25 places for residents become free at Baumgarten each year, says the home’s director, Kurt Wegmüller. The home has an occupancy rate of 98% and there are 300 people on the waiting list for the independent living section. He doesn’t maintain a list for nursing care, because the places are generally required at short notice.

Currently, the average age of residents entering one of the 21 homes run by Domicil, the largest provider in canton Bern, is 85, and the average stay is three and a half years. The company has around 1,500 residents – 500 of whom live relatively independently and 1,000 needing nursing or dementia care.

The demand for places in retirement and nursing homes is only going to increase. A 2009 study by the Swiss Health Observatory estimated that the number of over-65s will rise by 66% between 2005 and 2030 and the number over 80 will double. Joining the ranks of the over-65s will be about half of the health professionals currently working in nursing and retirement homes.

And they won’t be replaced easily, even though there’s no shortage of people interested in nursing careers.

Educating future nurses

The third most popular apprenticeship chosen by teenagers in Switzerland (primarily girls, but the number of boys is increasing) is a relatively new, entry-level nursing position which can serve as a basis for an advanced-level nursing degree. The Inselspital, Bern University Hospital, receives 300 queries for the 40 new apprenticeships it offers each year. But Henriette Schmid, head of education and training, points out that an applicant’s motivation, skills, language abilities, and expectations for the profession also must be taken into account. Interest alone isn’t enough, she says.

Interest in nursing doesn’t necessarily translate into new workers for nursing homes, either. “There’s a tendency for young people to gravitate toward hospitals, whereas people with life experience tend perhaps toward long-term care,” says Domicil CEO Heinz Hänni.

Schmid, who also worked as a nurse, agrees. “When I think back to when I was 20, I was interested in medical technology, in surgery. And perhaps it’s normal, that when you’re young you don’t necessarily want to be confronted with age and chronic disease.”

Retaining personnel

As a result, it’s all the more important that qualified nurses receive incentives to stay in the profession. Although nursing is mentally, psychologically and physically demanding, says Schmid, it’s possible to retain employees if the working atmosphere is good and appreciation is shown for work performed.

Domicil devotes considerable effort to rewarding its employees. The company offers five weeks of vacation per year at hiring, six weeks with age 45, and a generous retirement plan. More important is the focus on creating a positive working environment, according to Hänni.

High job satisfaction is a potential selling point for Swiss nursing homes looking for workers. A 2013 study by the University of Basel, surveying more than 5,000 professionals at nursing homes across the country, found that the quality of care in the institutions was high, and nursing personnel generally liked their jobs.

“If you asked me, ‘Would you do it all again?’ I’d say “Yes, absolutely,” Schmid says.

But lack of time to perform tasks, high workload, and insufficient personnel contribute to job stress. “If  jobs are cut and the level of work stays the same, or increases, then after a while you lose the good employees,” says Schmid.

Learning from each other

One advantage of the University of Basel’s SHURP study is that the participating nursing homes can benefit from each other’s experience, says lead author René Schwendimann. In a database they can see their own results and compare them with the results of other sites. And in a series of meetings, the study authors “discussed with the participants how they interpret the results. What are their approaches to overcome difficulties, or what are their best practices?” According to Schwendimann,  “already this sitting together, this discussing with several different nursing homes, creates this atmosphere, an informal venue to come into discussion with each other, and out of that they may collaborate.”

Importance of foreign labour

More than 90% of nursing home directors surveyed in the Basel study reported that recruiting nursing staff was difficult. Nursing homes will need new approaches to find and keep workers – especially in light of the vote on February 9 to re-introduce quotas for citizens coming from the European Union.

In a statement released on February 20, the Swiss Conference of Cantonal Healthcare Directors warned that if the number of foreign workers is restricted, hospitals and nursing homes in Switzerland won’t be able to provide the same level of service.

About one in four of Domicil’s 1350 employees is a foreigner. That’s in line with the number of foreign workers in other major sectors of the Swiss economy.

“It’s not because we choose foreigners over Swiss,” says Hänni. “It’s because we don’t find Swiss for the jobs.”

But human resources director  Franziska Honegger says she expects the company will be able to get the quotas the company needs for foreign staff, even if the administrative process “becomes much, much more complicated”.

Domicil already uses a variety of strategies to recruit personnel. The company has an employee referral programme, provides special support to people returning to the workforce, offers 141 apprenticeships, and works with partners in EU countries to recruit workers. The company also took part in a programme to recruit workers from non-EU countries, says Honegger, but “it was very difficult to get permits for them”.

Innovation

Meeting the needs of the ageing population will require innovation on a variety of levels, according to Sabina De Geest, one of the authors of the Basel study. New approaches are needed in nursing education, in nursing homes, in clinical settings, in cooperation with hospitals and with family doctors, and in research. This could be anything from designing senior-friendly furniture to asking nursing home residents about their needs.

There should be much more connection, exchange, and brainstorming between the different disciplines, De Geest says.

The main thing to remember, however, is that “it’s a very basic human experience, growing old and becoming more dependent.” In caring for the elderly “you can’t have technology be the main solution. In the end it will be nursing care.”