Reform sheltered housing


Sheltered housing was originally conceived as a temporary solution for people with a psychological / psychosocial background. Housing and getting help with their problems is central, with attention being paid to stabilization and self-reliance.

The intention is that this person can eventually go on their own within a few months to several years. But this seems to work out differently in practice.

The problems

People are increasingly hearing about dissatisfaction with sheltered housing and everything related to it. Residents speaking up, media reporting about it, and even official statements from city councils and agencies underscore a development of discontent that is prevalent.

There is a battle for the limited information that comes out. On the one hand, people who live in sheltered praise and, on the other hand, hate people who live in a shelter to the very core of their bodies. It is striking that there is no gray area. The intention is that this person can eventually go on their own within a few months to several years. But this seems to work out differently in practice.

Some more important reasons for reform are

First of all, we have to look at when these people enter sheltered housing. Precisely from the moment that with outpatient counseling (= live away from home + care) it no longer works and intramural care (= live-in + care) is necessary to come to sheltered housing.

However, the reality is different. The vast majority of people in sheltered housing have never had an outpatient care history. It is used in practice as an intermediate step between treatment institutions and living on your own.

The aspect of stabilization is actually not necessary because the practitioners have already taken care of it. Otherwise, you will be deemed too poor for sheltered housing. Self-reliance is credible, but there are no universal criteria for what is considered self-reliance.

In short, there is still a lot to be done here. But then we are not there yet. Because the dissatisfaction really starts with the performance of activities of protected housing (or the lack of it).

Protected housing projects are often run by care institutions. These care institutions receive money on the basis of the indication of the client they accept (the so-called care weight package). On paper, there are decent amounts of hours that everyone can expect to be sufficient. In practice, it is at most a fraction of these hours. It is not uncommon for only 10% to be given for which 100% is paid.

Nor does it help that healthcare institutions do not have to account for their hours as this director said. It is perhaps even more painful that both the complaints committee and the judge have concluded that this makes the care uncontrollable.

Ultimately, everyone is the victim of this and the client is probably the most. He who needs the most care is in a system that on paper provides that care, but in practice turns out to be a fraction.

In the Netherlands, we all contribute to healthcare costs according to capacity by means of a solidarity system. After all, some people need more help and longer than others. However, in some parts of the care industry, including sheltered housing, there is no obligation to achieve results under the guidance, so that the guidance is indemnified to do whatever they want, regardless of whether this benefits the client.

And this leads to annual rising health care costs while performance is not improving. This has an eroding effect on social funds that can only be raised with a continuously higher tax burden.

In a fragmented industry, the lack of clear criteria on top of a decentralized government policy is a toxic cocktail in which the question is how well a client will ultimately end up with sheltered housing. There is disagreement about the definition of “house-tree-bug” and this division often also results in quarrels between the client and guidance.

A holistic or comprehensive approach provides direction and purpose. A goal that can be answered very simply with “yes or no”, provided it is formulated SMART.

Another twisted phenomenon is that the care institution first actively recruits clients with all kinds of promises that they can help the client to find out after a few months that it is too difficult. This does not necessarily have to be wrong (read best efforts obligation), but where the blame is placed it will go wrong.

The care institutions suddenly change and suddenly feel that it is the client’s fault that they cannot help him (is blamed for “not cooperating with the care”), which puts the client with his back to the wall. On the other hand, the client cannot suddenly change the request for help because a disability does not change from one day to the next.

That would be the same as coming to a hospital and asking to be treated with heart complaints, but the hospital refuses you because they have decided that they have only trained pulmonologists on purpose. If such a thing were to exist in the Netherlands, then all hell would break out, but with sheltered housing, this would happen, and then wouldn’t it break out?

In short, healthcare institutions distort who is responsible for taking center stage. On paper, this is the client, but in practice, business conditions take precedence over the client’s individual request for help and if you do not fit in, you have to disappear.

The idea of ​​combining these two sounds like a golden combination on paper, but again the practice turns out to be different. In the light of the above topic, something very unpleasant happens when a healthcare institution stops care. The client is then kicked out on the street.

This is problematic because on the one hand sheltered housing is responsible for everything about the life of the client and on the other hand the relationships have deteriorated to such an extent that nothing is being arranged for the client. After all, who is helping his enemy?

Homelessness is now a major problem for people without disabilities, let alone for people who are dealing with a disability on top of that. The system that should actually help these people facilitates that this vulnerable group is threatened with death. It smacks of a process of extinction, but instead of processes, lives are the victim.

Protected housing is a temporary solution. In short, it comes to an end and a good end comes with a warm transfer. But what’s a good warm transfer? Opinions differ about this and there is also a conflict of interest because a protected home will always want to make the transfer with as little effort as possible and it is not important whether the client ends well afterward.

The continuation of care (so-called aftercare) is often wafer-thin, whereby clients are thrown in the deep end just like that. No attention is paid to the fact that PGB (Personal Budget)) can be requested in addition to the ZIN (Care In Kind) to create a transition period in which the client is given the opportunity to find, get to know, and better understand his own care provider. work before the move takes place. The care provider then moves along and from that moment on becomes the primary point of contact for the client.

The solution

Based on the above points, the protected housing system is rattling on all sides. It would be good to turn the entire system inside out to see where all the bottlenecks are. Our above points are a good springboard to start digging from there.

The conclusion

The idea behind sheltered housing is noble. However, how it is carried out now (or the lack thereof) creates more problems than solutions and makes people’s lives hopeless. Society pays big money to help people who need help, not to have them hidden away.

G: Reform Sheltered Housing


Time: 7 hour15s15

Written by: Mariëlle Pax & Robert Velhorst.