Aukje de Vries' Diary Day 13

Queen Beatrix celebrates her 71st birthday. I do not see many flags in the streets. We officially celebrate the Queen’s birthday on April 30th, which was her mother’s birthday. It was the first official decision of her reign to retain April 30th as the national holiday. A very good idea, because the day is always celebrated with many outdoor activities. Today is very cold and windy but sunny, which is nice. Not a day for outdoor games.

I have just received Anbo’s monthly magazine for its members. It looks nice, but if I had not been alerted to the fact that it was going to be renewed, I am not so sure I would have noticed. I always look for policy news first. This time they tell what they did to try and convince politicians that extra co-payments for long-term care in care homes to be levied on the assets of people who have more than just a rather small amount in the bank should not be introduced. They have really done what they could, I am glad to know and they are very proud they have been successful. But….what Parliament has decided instead: an extra levy on the income of people with assets seems to me just as bad. I have seen only scarce information plus a letter from the Junior Minister to Parliament about the two proposals and this information was incomplete and unclear to me, so I should not jump to conclusions, but I cannot suppress a certain suspicion that the seniors’ organisations have been fooled by Parliament. Anyway, many older people in care homes will have to pay even more than before.

A friend from Rotterdam and I were going to go out for a walk in the countryside on Sunday, but the weather forecast is bad: very strong easterly winds, low temperatures and possibly snow. We decide not to go. This leaves me some extra time to catch up with house work, personal administration and phone calls.

Aukje de Vries' Diary Day 12

Last night I have read the Ministry’s paper on long-term care once more and have taken notes of the issues, which Anbo might raise. It does not take me long to write down 12 points about which Anbo can voice an opinion or raise a question.

I listen to the radio a lot, to a news station when I am doing things with my hands and classical music when I work and need to think. This morning I hear three consecutive news bulletins with disquieting news. The first one tells us that the pension funds have published figures about their financial position. They have incurred dramatic losses on the stock market and the interest rates seem to have been lowered for them (this puzzles me: banks offer their private clients higher interest rates). Anyway, they must face the difficulties and look for solutions, which could be higher premiums for those who are still at work and lower pensions for the pensioners. My pension fund is called by name as one with serious problems.An hour later the news is more definite: the premiums are going to be raised and the pensions lowered, an hour later it is explained that this may not happen immediately, there will be deliberations first, and the pension funds ask permission to take some extra time than the law allows to redress the situation, so that they do not yet have to take these drastic measures. This is really a scare. Under normal circumstances pensions are raised in proportion to inflation. For 2009 pensions ought to have been increased by 3%. Pension funds are not obliged to do this, they only raise pensions when they can afford it. In December we were informed that we will not get the raise in 2009, but lowering pensions is something I have never heard about in The Netherlands. So far our government has kept assuring us that the Dutch economy is in better shape than that of most other countries, but now it seems only a matter of time before the crisis will hit us also very hard.

There is a second news issue which interests me very much, and which also comes back in the news all day and at night on TV. This is about Mea Vita a huge home care organisation. It serves about 100,000 clients and has 20,000 employees. This organisation has been created only a few years ago by a merger of four already sizeable organisations in different parts of the country. It is also the largest organisation in The Hague. This is where LF has worked. Mea Vita has been in the news before because of financial problems, but now the Junior Minister in charge of long-term care, has written a letter to Parliament describing the situation. The financial problems are acute. The Junior Minister wants to ensure that care can be continued. The financial management has become too complicated because of the mergers and because the organisation has made different contracts with no less than 65 municipalities. This has been brought about by a recent change in the national policy, which has taken home help (house work) out of the long-term care package, and decentralised it to the municipalities. They organise tenders, every municipality with its own conditions, and that explains how there can be so many different contracts. The Junior Minister proposes that the merger will be undone in order to make structures more transparant. This must be scary news for the 20,000 clients of Mea Vita.

Esther has invited me for dinner. She has lit the open fire and has prepared a traditional dish that I never manage to make properly. We chat about everyday topics, because we talk with each other almost every day. Our cats and stray cat Janus are among the subjects we discuss at length. Janus is a Great Problem to us, about which I will tell more later.We conclude we need a cat psychologist (if such an expert exists) to help us understand the feline mind.

Aukje de Vries' Diary Day 11

This is a day in which I will not have time to do much writing. In the morning I go and see a friend who lives not very far from me and whom I know from the time we were students. We have not seen each other for a long time so we exchange news on a variety of things. Before I know it, it is late. The weather is very cold and grey, so I do not make a detour in order to have some extra exercise but go straight home.

In the afternoon I have a meeting at Liz’s house. She knows through her church several people who have worked in the care sector and who, like us, worry about recent developments. We have heard that in some places a new organisation has become active: it is called neighbourhood care. They bring the district nurse back to the neighbourhood and the nurse works with a small team of workers who are allowed to do many tasks, not like in the large organisations where the work is completely divided up into small tasks and care recipients get many visits of different workers every day for the various tasks that need to be done. In the end it is much more efficient to have more tasks done by one worker, even if this worker is doing some tasks for which she is overqualified. Can we get the district nurse back in our neighbourhood?

I only know one of the persons invited by Liz. The ones who are new to me are two nurses, one of whom has retired only two years ago (LF), the other (TR), I believe slightly longer ago and she obviously has also been a client of home care herself. There is also the community worker of the church (AL), whose task it is to build bridges between the church and the community. The person I know (LD) has been the director of a residential home for older people. (I want the persons in this diary to be as unidentifiable as possible, because they do not get a chance to authorise my texts. Therefore I do not use their real names. I have given my friends new first names but for the persons I “work with” I will use their initials, in order to make it a bit easier for me to remember who is who in real life.)

We introduce ourselves and very soon we exchange experiences, mostly cases where things have gone wrong. Stuff for your diary, Liz says, but it is too much. I’ll just mention one thing that is bizarre, but it is rather typical of the way in which many home care organisations work.LF tells us that in her organisation the workers all have electronic cards. When they get to the house of a client they have to check in on an electronic device that is given to the client, and they have to check out when they leave. Clients are told they have to put the device outside the house on the doorpost. The worker checks in before she enters the house and checks out after she has closed the door behind her. This way the time the worker needs to take off her coat and to put it on at the end of her visit will be counted as working time, that needs to be paid to the organisation.

How should we proceed as neighbourhood group and who have to be involved? The GPs for sure. There must be about ten of them in this area. Who else?? We are not sure, but we have some telephone numbers. One belongs to the new national organisation. TR has tried to call this number, but so far without success. I have found a local number on the internet. We decide the best thing is to try and call the local number first. The phone is answered by a lady who is quite enthusiastic that we want neighbourhood care and suggests we have a meeting. We try to find a date and we find one next week. Unfortunately for us Liz will then be about to leave for her 2 months trip abroad so she will not be with us. The organisation is based at a hairdresser’s saloon close by, but they do not have enough room to receive 5 of us. I invite them to my house.

Here we go, Liz says, women at work. We do not talk long but get down to business. I notice that we have laughed a lot. This is exciting!

Aukje de Vries' Diary Day 10

Our long-term care system was, once upon a time, very good. It is no longer. I hear from friends and relations dreadful stories about people not getting the care they are entitled to, problems with assessments, co-payments that are very high and lots more.

The paper of the Ministry is not about that. It is about the AWBZ, the Act which regulates long-term care. The paper is written in English. Over the years there have been many alterations, the long-term care system is not very logical any more and structures and institutional relations are very complicated. Even in Dutch it is difficult to write a coherent and understandable paper about the workings of the AWBZ, let alone in a foreign language. I don’t know how good the paper was in Dutch, but I notice that the translator does not know the jargon. S/He often uses the term “implementing bodies” but my impression is, that this refers to several different agencies. There are phrases that are completely incomprehensible to me. If I do not even understand it, how can people from other countries understand this, let alone discuss about it? What is interesting is, that the AGE paper (which is very much to the point) hardly refers to the Ministry’s paper. I guess that its authors have used the knowledge they had from other sources.

In the mean time Anbo, my seniors’ organisation, has also asked me to give comments. I decide to do two things: one is to write a paper with my own, personal observations, because I realise that there are some issues that particularly worry me but that an organisation, speaking on behalf of all members, can never include in its commentary. In the second place I will write comments of a more general nature that can be used by Anbo.

Last night I have already made a rough outline of what I want to say in the first paper. I have a go at it and I get all excited while writing, there is so much I want to say. I have to look up some data because I want to be as precise as possible on some issues. I decide to keep working and have dinner a little later than usual.

Just after I have gone to the kitchen a friend from Amsterdam calls. She likes to know how my trip to London went and I tell her. She has already had her dinner, but I haven’t and I am hungry, so we don’t talk too long. I tell her about the commentary I am writing and about the diary. She thinks this will be quite a strain and says: I thought you were going to live a more relaxing life….. She is right.

After dinner and a quick glance at newspaper headlines I go back to my study. I give up going to a meeting of the Association of Dutch University Women and continue writing. It goes well. After midnight the first paper is ready and I send it off to AGE and copy Anbo in. Six pages of text in English, hopefully more comprehensible than the Ministry’s paper. Let me summarise very briefly what my points are.

The government tells us that we should rely more on informal carers. In most cases they are family members. But I happen to have no family members at all. Because of all the bureaucracy it is practically impossible to work the system and get sufficient care without carers. Has the government thought of people like me?

I have described four cases about which I heard over the last 6 weeks, where care did not work or was no longer affordable. I comment on the fact that home help (house work) has been taken out of the long-term care insurance and is now the responsibility of municipalities. What once was integrated care has been disintegrated again, it creates a lot of confusion for users. I criticise the assessment procedure. It is supposed to be independent but is completely steered by the (local) government’s guidelines. I try to figure out what the co-payments are that users of home care and institutional care have to make. I discover a very amazing fact on the website of an organisation called Per Saldo. This website presents data which suggest that people with an income of roughly € 20.000 a year or more have to pay more for home care than the actual value of the care they receive. They had better arrange their home care privately. This is unbelievable!

I criticise the quality of care (there is a lot of what we call “stopwatch care” which means that each worker is told precisely what tasks she must do and how many minutes she is allowed to use for each task) and I discuss the bureaucracy and the costs of it. I also touch on euthanasia of which I hope it will be easier to get when my final days approach.It is late when I go to bed and I cannot unwind. I don’t sleep well.

Aukje de Vries' Diary Day 9

I begin the day with a dentist’s appointment, the first of a long series. I am there for an hour and leave the practice with a funny feeling in my head. When I get home I first hang around and watch some TV before I feel well enough to go upstairs to my study and do some work.I have to write the minutes of last Friday’s teleconference and to do some of the tasks that we decided on. I start with it and then want to look at some of the papers of the General Assembly last November to which we referred in the teleconference. I used them while preparing the agenda and realised at the time that the file (neatly sorted out in a blue folder) contained some papers which I did not have on my computer and of which I had no other copy. So I thought I’d better be careful. I look for the folder but it is not there. Not on my desk, not in the filing cabinet, not in the piles of paper that sit on a couch, not in the document boxes, not in the piles in the book case. Because I have cleared my desk last week I wonder whether by any chance they are among the papers I want to throw away. These are downstairs in three huge piles, waiting to be collected. I go through them No luck. I look in all the same places once again. I try to think if they can be anywhere else in the house, I look in the living room. No blue folder, no papers. It drives me crazy. This is not possible. But the file is gone. I lose about two hours and finally get back to my minutes. I also check my email and find an interesting message. It comes from AGE, the European Older People’s Platform. They are invited by the European Commission to participate in a peer review of long-term care in The Netherlands. There is a basic paper by the Dutch Ministry of Health explaining Dutch long-term care, there is a draft commentary by AGE and there is some info about the procedure.AGE asks its members to comment on the papers. This is my chance!! I have great misgivings about what the government has done to long-term care over the past few years. I have sent letters to newspapers but they have not been published, I have sent a message to my seniors’ organisation, but I did not get much feedback, so this is an opportunity to make my opinion heard. I’ll read the stuff tonight so that I can start writing tomorrow. I’ll have to change my priorities.

Aukje de Vries' Diary Day 8

Quiet day today. In the afternoon I look at my e-mail and surf on the internet, trying to find out about income taxes in 2009. January 23rd is pay day for many pensioners. I will receive the amounts I am entitled to on my bank account. When there are changes in the amount the pension fund sends us a notice. Like many other pensioners I receive my pension from no less than 4 different sources: my state pension, two occupational pensions and what I get from an insurance I have concluded myself, because in my first job my employer thought it was not necessary for a young woman to build up pension rights. You will get married, he said, and then your husband will take care of you. At that time my old age was too far off and I accepted his proposal. I shouldn’t have, but I had not yet thought through my new position of employee.

I find the tax rates on the internet and to my surprise I also find the information I was looking for about the premium of the long-term care insurance (LTCI). It is 12.15% over an income up to a limit of € 31,589. This means that I will have to pay about € 320 a month for the LTCI. The amount I pay into the LTCI is not specified on the notice of my major occupational pension. It is included in the amount for taxes and another social security scheme. Together with the premium for the health care insurance, which amounts to € 279 a month, I will have to pay in all € 599 a month for health care and long-term care. That is as long as I do not use any care. As soon as I get medical or long-term care ((ltc) I will have to pay. For health care there are deductibles up to an amount of € 155 a year. Not all health care is taken into consideration for deductibles. I can go to the GP and the fee will not be a deductible. The underlying principle is that people will think twice before they use the medical services. At the time this rule was discussed in Parliament one of the MPs was a GP. He convinced his fellow parliamentarians that people ought to be able to go to their GP without financial impediments. In the Netherlands the GP is the gatekeeper of health care. In order to go to a specialist we have to get a referral from our GP. Therefore it is not logical that we are punished financially for a visit to a specialist. It is rather the GP’s decision than our own. The deductibles do not work the way they are meant to, they only mean users of health care are charged another € 155 for medical services.

For ltc we have to make co-payments. It is nearly impossible to find out how much we have to pay because the rates are calculated per individual, related to age, household composition and income from wages/pensions and assets. I will not go into this now, I’ll leave it for later (maybe).

Aukje de Vries' Diary Day 7

There is an answer on my e-mail about the “chipcard” ( the electronic public transport card).I am referred back to the various public transport companies. Since my first e-mail enquiry did not lead me anywhere useful, I try the telephone. It is Saturday morning. Customer service of the local transport company in The Hague: not available on Saturday. Dutch rail: not available on Saturday. Rotterdam local transport company: yes, they are there. They do not know if I can charge my card in The Hague. They think I have to come to Rotterdam if I want to do this, unless I will do it via the internet. I pay as little as possible by computer because we keep hearing about hackers and fraud and older people being victims because they do not have the proper protection. So I’ll have to wait until I get to Rotterdam, to charge my card.

Aukje de Vries' Diary Day 6

Busy day. Among others: teleconference in the morning and a meeting with friends/neighbours in the afternoon. Besides, my cleaning lady comes in the morning.The teleconference goes well and does not last too long, but because there is so much on the agenda we omit some items that we should have discussed. The conference leaves me with lots of work to be done. I have not yet finished clearing my desk and current files, so I decide to give priority to that before going to the meeting at Esther’s home. Esther lives in the same street as I, three houses down the block. Over the past years we have become close friends and we are actually the first port of call for each other, to exchange experiences, to ask for advice or support. We are in a similar situation, living on our own. Esther has been divorced but has no children, I have never been married. Esther has a brother, whom she does not see very often and I have no brothers or sisters, so both of us must rely on friends. Further down the street there are two other women, more or less our age, who live there by themselves as well. Liz, who is a widow and who has two daughters, one of whom has emigrated to New Zealand and Jacqui, who like me, has never been married (as far as I know) and has been a school principal. Liz and Jacqui also have very frequent contacts and help each other wherever they can, just like Esther and myself. Both Liz and Jacqui are active watchers of what happens in our street and our neighbourhood. Liz, trained as a lawyer, is also very active in her church and knows very many local people. Since our government keeps telling us that we have to rely more on volunteers and informal care, we have decided to meet once every few months with the four of us, getting to know each other better so that we will be able to help each other more easily when the necessity arises. This is an implicit understanding, not formalised in any way.

Jacqui has just had a hip replacement. She tells us about her experiences. Both Esther and Liz have had both hips replaced, so they know exactly what Jacqui is going through. Liz has helped Jacqui after her discharge from hospital. We discuss several issues, such as experiences we have come across of people who need home care but do not get it.We also wonder about the new electronic card that we will have to use to pay for all public transport: train, tram, subway and busses throughout the country. The government and transport companies who develop this card have run into many difficulties and its introduction has been deferred time after time. Rotterdam is the first city in the country where at the end of this month the card will become the only means to pay for the subway. The card must be on sale in Rotterdam, but how will we get it? One of us knows that the rail pass that we have (and which gives seniors a reduction) can be used electronically, but then we still do not know how we can charge it. Because of a newspaper ad which I saw a few days ago I have looked at the website of our local transport company, but that has not been very helpful. So I have sent them an e-mail asking for information. I have not yet received an answer. Liz tells about her coming trip to New Zealand, where she will visit her daughter and son in law and will take a tour and we discuss our cats. Esther and I used to have cats but they died several years ago. Last year we both adopted a new cat.

George, Esther’s cat was more or less forced on her. She had pity on him, because his owners did not take good care of him and he was often out on the street at night asking to be let in at her door. The owners finally asked her to take him. My cat (Tigger) at first only came to visit me in the summer when the doors to my garden were open. When he visited me more and more frequently I found out where he belonged but it turned out he had left home a year ago and did absolutely not want to go back there. The owner regretted this but she agreed it would be best for the cat if he would stay with me. It had not been my intention either to take a new cat, but once it was there….Cats are nice company! Liz has inherited the cat of the daughter who emigrated. Jacqui and two other neighbours, living closer to Liz than Esther and I will take turns taking care of Liz’s cat. We leave Esther’s house after a pleasant and relaxing afternoon.

Aukje de Vries' Diary Day 6

Busy day. Among others: teleconference in the morning and a meeting with friends/neighbours in the afternoon. Besides, my cleaning lady comes in the morning.The teleconference goes well and does not last too long, but because there is so much on the agenda we omit some items that we should have discussed. The conference leaves me with lots of work to be done. I have not yet finished clearing my desk and current files, so I decide to give priority to that before going to the meeting at Esther’s home. Esther lives in the same street as I, three houses down the block. Over the past years we have become close friends and we are actually the first port of call for each other, to exchange experiences, to ask for advice or support. We are in a similar situation, living on our own. Esther has been divorced but has no children, I have never been married. Esther has a brother, whom she does not see very often and I have no brothers or sisters, so both of us must rely on friends. Further down the street there are two other women, more or less our age, who live there by themselves as well. Liz, who is a widow and who has two daughters, one of whom has emigrated to New Zealand and Jacqui, who like me, has never been married (as far as I know) and has been a school principal. Liz and Jacqui also have very frequent contacts and help each other wherever they can, just like Esther and myself. Both Liz and Jacqui are active watchers of what happens in our street and our neighbourhood. Liz, trained as a lawyer, is also very active in her church and knows very many local people. Since our government keeps telling us that we have to rely more on volunteers and informal care, we have decided to meet once every few months with the four of us, getting to know each other better so that we will be able to help each other more easily when the necessity arises. This is an implicit understanding, not formalised in any way.

Jacqui has just had a hip replacement. She tells us about her experiences. Both Esther and Liz have had both hips replaced, so they know exactly what Jacqui is going through. Liz has helped Jacqui after her discharge from hospital. We discuss several issues, such as experiences we have come across of people who need home care but do not get it.We also wonder about the new electronic card that we will have to use to pay for all public transport: train, tram, subway and busses throughout the country. The government and transport companies who develop this card have run into many difficulties and its introduction has been deferred time after time. Rotterdam is the first city in the country where at the end of this month the card will become the only means to pay for the subway. The card must be on sale in Rotterdam, but how will we get it? One of us knows that the rail pass that we have (and which gives seniors a reduction) can be used electronically, but then we still do not know how we can charge it. Because of a newspaper ad which I saw a few days ago I have looked at the website of our local transport company, but that has not been very helpful. So I have sent them an e-mail asking for information. I have not yet received an answer. Liz tells about her coming trip to New Zealand, where she will visit her daughter and son in law and will take a tour and we discuss our cats. Esther and I used to have cats but they died several years ago. Last year we both adopted a new cat.

George, Esther’s cat was more or less forced on her. She had pity on him, because his owners did not take good care of him and he was often out on the street at night asking to be let in at her door. The owners finally asked her to take him. My cat (Tigger) at first only came to visit me in the summer when the doors to my garden were open. When he visited me more and more frequently I found out where he belonged but it turned out he had left home a year ago and did absolutely not want to go back there. The owner regretted this but she agreed it would be best for the cat if he would stay with me. It had not been my intention either to take a new cat, but once it was there….Cats are nice company! Liz has inherited the cat of the daughter who emigrated. Jacqui and two other neighbours, living closer to Liz than Esther and I will take turns taking care of Liz’s cat. We leave Esther’s house after a pleasant and relaxing afternoon.

Aukje de Vries' Diary Day 5

Yesterday, after I had closed my diary I went out for my daily exercise, not expecting anything special to happen in the rest of the day. Surprise. Close to my home in the middle of the street I saw a purse. I picked it up. A beautiful black leather purse. Contents: a € 10 note, some change, a seniors’ public transport card plus two bank cards. I decided to go home again and see what the best course of action would be. On the bank cards I found a name. It was the name of a woman and gave both her husband’s and her maiden name.

I looked up the name in the phone directory. Six entries with her husband’s name, two of them not too far from where I live. I decided to give them a ring. Both of them had an answering machine, so I left a message, saying that I had found something, without further specifications. I did not want to try and contact the other people mentioned in the phone directory, but instead called the police. I had the number of our local police station, but this number was no longer in use. I had to call a central number. Police in the neighbourhood? Not here.

I called the central number, gave the details of what I had found and the police functionary advised me to take it to the police station. This is at quite a distance and I have no car, so this was not an attractive proposition. The police woman said she asked me to do so because otherwise I might get some strange characters at my door. I told her I had not given any details to the two people I had phoned but that I was unwilling to come to the police station. She accepted that and took down all my details (more than I thought she needed, including my date of birth, but she said this was needed for registration!). I finally went out for my walk and after my return I got a phone call. It was the person who had lost the purse. I asked her some questions to make sure she was the right person and agreed that she would come and pick it up. A little later she appeared. A well groomed, upperclassy woman, approximately my age, who must spend a fortune on her hairdo. She did not seem excited at all. It occurred to me that she might have had my phone call before she had noticed that she had lost the purse, but this was not the case. When she had noticed she had immediately called her banks to block the cards, and when she had learned the purse had been found she had tried to unblock them again, but the banks could not do this immediately. She seemed quite irritated. After a lukewarm thank you she left with the purse. No flowers for the finder.

Spent practically all of toady clearing my desk and sorting out all the papers I have accumulated in more than a year because of my involvement in several organisations in different capacities. It is amazing how much information one gets using the internet. It often feels like more than I can reasonably cope with.

Aukje de Vries' Diary Day 4

Other than a Health Care Insurance we also have a Long-Term Care Insurance. We call the scheme AWBZ, but I will call it here LTCI (= long-term care insurance). For a while this scheme has been very comprehensive and because of the LTCI and the other health care insurance The Netherlands ranked with the Scandinavian countries among the best in Europe re health care. But in recent years the government has made drastic changes and our long-term care system is now in my opinion an absolute mess. I will tell more about this later.At this point I want to find out what premium I have to pay for the LTCI. This premium is also taken out of my pension before I receive it. I looked for information on the internet but again, I could not find it. The premium is decided annually, so it may be different this year than last year. The day before yesterday I also asked the agency which is supposed to inform us about government measures what the premium is for the LTCI and this morning there was an answer: like last year it is 12.15%. But this answer is incomplete: there is no information on the maximum amount over which this percentage is due. If that amount is higher than it was last year people with a higher income have to pay more. So I write again and ask for this additional information.

I receive regular newsletters about health- and long-term care on the internet and this morning readers are asked to give a reaction to a question related to bringing hospitals under a market regime. I write that as a user I am against market principles in care, because in the long run it will drive up prices and I am unwilling to pay for the far too high salaries of top functionaries or the profits of entrepreneurs in health care.

Aukje de Vries' Diary Day 3

This morning I received a telephone call from a civil servant from the Ministry of Health. I did not recognise her name and had no idea why she might call me, but she sounded as if she had a “bad news” message. After a few sentences I understood that she called me in my capacity of secretary of a network of older women. We had written to the Minister some 9 months ago about a new system of subsidisation which was then being developed and that would exclude our organisation because the requirements for receiving money are such that we cannot but also do not want to meet them. We are not a membership organisation but a small network, with formal legal status, that tries to make the voice of older women heard, but for other organisations than membership organisations there is no room in the new system. Both the organisations of older people and the women’s organisations seem to ignore older women and we want to change that, but we do not want to become a membership organisation that competes with the many already existing organisations. She tells me she is sorry the Ministry has not answered our letter, they were too busy developing the new system. She advises me to contact PGO, the agency to which the task to subsidise organisations of patients, handicapped persons and older persons has been outsourced. Of course we have already done so. Basically her message is that she cannot do anything for us. Probably the Ministry could have done something at the time we wrote our letter, like designate a small amount of money for organisations which work according to different principles than codified by the Ministry. Her reaction is a bit blank, when I suggest this. When I ask her for which division in the Ministry she works (in case we might want to contact her), she says M and C. This stands for Market and Consumers. I blow my top. I am against market principles in health and long-term care.

Aukje de Vries' Diary Day 2

Answered some e-mails this morning and did some work to prepare for a teleconference that we will have coming Friday with the members of the Executive Committee of a new European organisation that we have recently set up. In Brussels there are many umbrella organisations representing citizens with special interests such as women, older people handicapped people, homeless people, people on low incomes etc. They make their voice heard to the European Commission and the European Parliament. We now also want a special organisation representing (informal) carers. I put “informal” between parentheses, because carers themselves don’t want to be called informal, but without that extra word people may think I am talking about paid carers, which is not the case. This is about unpaid carers, mostly family members. It is quite a struggle to get such an organisation set up and finding financial support.

Today seems to be called “Blue Monday” the most depressing day of the year. The weather is deplorable indeed. It clears up a bit in the afternoon. I go out for a walk, which I try to do every day. I live in The Hague not too far from the North Sea. By the time I reach the beach it rains again and I take a bus home.

I spend some time trying to find out what my contribution to the mandatory Health Care Insurance Scheme is going to be this year. I had expected it would be easy to find this on the internet, but no. I had to finally send an e-mail to the organisation that is supposed to provide such information on government schemes and they gave me the link where I could find the answer. It turns out that in 2009 I will have to pay 4.8% over my state pension (called AOW) and 6.9% over my occupational pension. Should I have an annual income that is higher than €32,369* I do not have to pay over the amount above the €32,369.

This means that I will have to pay about € 165 a month for the basic package of the health insurance, which will be taken out of my pensions before they are paid to me. But this is not all. Our health care insurance has been privatised and the insurance companies are supposed to compete. They also charge a premium directly to their clients and their prices vary, but not to a great extent. Most of them charge an amount around € 1000.- a year. In my case my insurance company charges me € 87,75 a month. All insurance companies are obliged to provide the basic package of health care to all their clients. The government decides annually on the contents of this basic package. Insurance companies cannot refuse to accept people for the basic package, no matter how bad their condition is. This requirement is acceptable to the insurance companies because the government also pays them out of the monies that are levied on our income (in the case of pensioners the 4.8% and the 6.9%). The insurers receive amounts that are related to the characteristics of their clients. If they have very many older or handicapped persons they get more money from the government.

The basic package for which we are all insured in The Netherlands is said to comprise about 90% of all health care. Some essential treatments such as dental care are not included, and what is important for many older persons: physiotherapy is only included for very few treatments. So all insurance companies have additional insurance policies for what is not included in the basic package, and it is here that they can make a profit. They can refuse the “bad risks”, they can include in their packages whatever they like and decide on the price. My additional insurance costs € 26,25 a month, so in all I pay € 114.- monthly to the insurance company. Together with the premiums taken out of my pension for the health care insurance it adds up to € 279 a month.


* € 1.- equals at this moment approximately US $ 1,29

Aukje de Vries' Diary Day 1

Came back from London yesterday. Today I try to catch up with e-mail, newspapers laundry, shopping and such things. Sunday is a day with many interesting TV broadcasts. That means my time for other things is limited. In the morning I always watch the Andrew Marr show, bringing me up to date about what goes on in the UK. Will they talk about the third runway for the Heathrow Airport? The newspapers in London were full of it. Yes, they do, but what is much more interesting is an interview with a 91 year old author, Diana Athil, who has just published a new book about ageing, entitled: Somewhere towards the end. The interviewer asks her about her career and she says that she has had a lot of good luck in her life. She did not mind ageing: she has enjoyed later life. One of the positive aspects of getting old is that one does not mind what others say, one can be oneself. Asked how she came to write this book she told she had been asked to do it and she considered this as an opportunity not to be missed. Her philosophy had always been to grasp opportunities when they present themselves and she considered this as such an opportunity. She had enjoyed writing it tremendously, because she likes writing and hopes to be able to continue. Is there a parallel in it for me? I consider being asked to write a diary which tells about ageing in The Netherlands and how active seniors cope with the many changes in social and other conditions as a challenge and an opportunity, which will make me even more aware and eager to find out of the many processes which influence the lives of older people. I’ll have to do some investigating here and there and probably will have to explain how social and other policies work in this country. They can be quite complicated but I will have to find ways to make them understandable for people from other countries. I’ll give it a try and see how it works!