Care at home: the importance of help and care

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Imagine you are a journalist interviewing two very dedicated ladies who have put their heart and soul into building an exemplary, everyday network for people with dementia and their relatives for eleven (!) years. Suddenly you get the news that the article has to be completely rewritten. This is because services have recently been massively reduced and jobs have been cut in the municipality, where a large number of older people live. The jobs of the two ladies fell victim to the red pencil.

Municipal budgets are coming under pressure and savings have to be made – I am well aware of that. But anyone who cuts back on services for older people and their family carers, of all people, is saving at the completely wrong end. This takes pressure off families and is politically and economically short-sighted. A commentary by editor Anja Herberth – in light of current events.

We’re on a collision course with reality

In my practice, I talk to many people from the social economy, I research and interview people about dementia and the like, what older people and their (caring) relatives need. Places in care homes are rare, but often they are not needed. Above all, people need support to be able to live as independently as possible in their own four walls for as long as possible. What has been built up here regionally is very valuable.

Because when I talk to politicians, it becomes clear that despite the increasing need for care services, savings are being made wherever possible. After all, demographic change is in full swing: according to the OEC, the continuous increase in the working-age population will stop in 2025 and it will begin to decline.

Being able to stay at home is therefore not only the wish of many people – anything else is simply no longer affordable. And there aren’t any qualified staff for that either. On the contrary: Nursing homes are often only partially occupied because the required staff-to-resident ratio cannot be met due to a shortage of qualified personnel.

I am all the more baffled when support programs for older people and their family caregivers are scrapped. If more care needs to be provided at home, then at the very least, help is needed to organize it. To provide families with guidance on how to tackle this challenge. This is because families often feel completely at a loss; hardly anyone is prepared. That is also the reason why these cuts are so easy to make: No one has any idea that these benefits are essential for families.

What such programs do – and why they are irreplaceable

Where it works, municipalities are joining forces with associations, GPs, pharmacies, care homes, administration, building yards and volunteers. Brugge (Belgium) is not just a picturesque tourist magnet – the city shows how to build an age- and dementia-friendly city: interdisciplinary cooperation produces practical solutions that have an immediate impact.

An important component is the training of the entire municipal environment: from the sales force to banks, retail and catering to the building yard and waterworks, employees are made aware of how to deal with older people and those suffering from dementia. Even bus drivers are involved to ensure that those affected get off safely at the right stop; stores find unbureaucratic solutions if payment is no longer possible. Particularly relieving: regular day/half-day care so that relatives can catch their breath, attend appointments or simply recharge their batteries.

The result: Safety, dignity, and practicality—right where life happens. Looking for more ideas? Seating with higher seats in public spaces (to make it easier to stand up); cultural programs designed to help people with dementia participate naturally (e.g., special museum tours); easily accessible information sessions; and even special cooking classes for people with swallowing difficulties. Im Gegenteil: Pflegeheime sind oft nur teilweise ausgelastet, weil das vorgeschriebene Betreuungsverhältnis aufgrund des Mangels an qualifiziertem Personal nicht eingehalten werden kann.All das hat für die Betroffenen und ihre Angehörigen spürbare positive Effekte im Alltag.

This system is not only jointly funded by the states and municipalities; volunteers also make a significant contribution. This combination of professional coordination and volunteer support makes communities more resilient—and takes some of the strain off professional care providers and the budget.

Care affects us all: We all have parents, grandparents. If people are left alone with the challenge of care, this has a deep impact on the family structure. The reputation of politics is already very poor, and the governments in Germany and Austria are unpopular—and leaving people to fend for themselves isn’t going to make things any better. My opinion: We shouldn’t be surprised by the rise of radical political fringe groups. The challenges facing families are growing, yet they are left to find solutions on their own.

Why these cuts are “madness”

If coordination and key support services are eliminated, the network falls apart: low-threshold services become scarce or disappear entirely, volunteers lose their points of contact, and the families affected lose access to participation and respite care programs. The result is a noticeable decline in the daily lives of those affected and a silent shift in costs to other parts of the system.

Many municipalities are facing the same constraints: There is a lack of money, funding programs are costly in terms of bureaucracy and project management, and in some places even existing activities are being scrapped out of necessity. What brings short-term savings in care, however, generates higher costs in the system in the medium term. The (more expensive) nursing homes are overloaded, the necessary outpatient or semi-outpatient structures for support at home are not available to a sufficient extent. Hospital admissions are increasing and relatives are burning out.

The savings are hitting exactly the wrong targets. The services keep people well at home for longer, i.e. exactly where they want to live – and where care can be organized in the most sustainable and cost-effective way. Advice as early as possible, low-threshold relief and an age- and dementia-friendly environment reduce risks, stabilize families and avoid expensive escalations.
These cuts undermine the multiplier effects and existing levers that make regions dementia- and age-friendly. The burden of care falls on the shoulders of individuals, who gradually burn out. If cuts are made here, we will also lose system knowledge that cannot be replaced overnight.
Unplanned savings demotivate volunteering and partnerships. Volunteering needs coordinated structures, support and recognition. If these structures are dismantled, the network will fray – volunteering will not step in “by itself”.
The cost savings obscure the demographic reality. Even today, there is a shortage of skilled workers and accessible services. Cutting costs now will only make the shortage worse tomorrow—with all the consequences that entails for safety, health, and quality of life.

What local authorities should do now – instead of cutting back

Ensuring coordination: The role that ties together networks, training programs, volunteer work, and services is essential to the system. Without them, the building blocks that help people live at home for as long as possible fall apart.
Prioritize everyday life on site: Seating, safe routes, cultural events, information evenings and day care are small levers with a big impact – be sure to keep them.
Strengthen volunteer work: Good coordination (today there are more than just Excel lists for this!) plus training and reimbursement of expenses are investments in regional stability, not “nice-to-haves”.
Connecting business and services of general interest: Integrating banks, retail, gastronomy and transport into training courses – this is relatively inexpensive, but creates tangible accessibility in everyday life.
Agree on predictable financing: Set up country-community models and (where appropriate) subsidies in such a way that reliability is created – instead of ad hoc savings that destroy structures.

Especially when budgets are tight, intelligent priorities are needed – not the red pencil for those who have the least lobbying power. Services that ensure independence, safety and relief in everyday life are core tasks of public services, not dispensable luxuries. Anyone who cuts them produces follow-up costs and human suffering. Those who protect them keep their community liveable and fit for the future. Or to put it more clearly: cuts in support for older people and their carers are madness.

Yours, Anja Herberth / Editor

Email: anja@sbc.co.at