The Interview | Paul Derhaeg - 'Small, single elderly facilities have a hard time surviving'

This spring saw the publication of the fifth edition of the report Networks in private non-profit and private-commercial residential care for the elderly, an initiative of Paul Derhaeg. In this report, this retired employee of welfare and prevention organization Idewe brings a detailed overview of the entire Flemish residential care offer for the elderly.

Text | Koen Mortelmans

"Within the commercial assignments of my former employer, a ready view of the evolutions in elderly facilities - and other customer segments - was a must. It quickly became clear to me that residential care centers from along the way no longer had to be approached as stand-alone entities but - in a growing number of cases - as groupings and clusters of several separate initiatives and facilities. For an external prevention service like Idewe, it was useful to get a clear view of this development. It took some time before I could fully devote myself to the necessary search. My retirement was an opportune time for this."

Derhaeg left out the public sector until now. "My focus was mainly on networking in Flanders. Brussels and Wallonia were only discussed indirectly, with the background being that private commercial groups in particular are expanding their territory throughout Belgium - and even across national borders." The latest report inventories 121 groups.

Continuous updating

Previously, neither care umbrella organizations nor professional organizations had ventured to survey networking in the residential care sector. Institutions that are involved in care for the elderly, such as Zorgnet-Icuro and the Agency for Care and Health, have already expressed their appreciation. "It is both a kind of reference work (what is there now?) and an impetus for continuous updating (what is changing?). I am thinking of including the public sector in the next edition as well as extending the inventory to the whole of Belgium," Derhaeg said. "It takes a lot of energy and time to find out what evolutions are happening on a daily basis. Especially in the commercial sector, things often change: not only takeovers of residential care centers, but also mergers and absorptions between commercial umbrella organizations. I gather current information in many cases by researching on the Internet, through media reports and through contacts with agencies and responses from individuals and organizations who are involved and/or interested in this matter on a daily basis."

"Networks are not a new phenomena. Already in previous centuries, religious orders and congregations, as part of their mission, built numerous facilities for education and care of the sick, elderly and disabled. These were managed from an umbrella structure. Local councils set up "benevolent offices" and "civil houses of worship" within the boundaries of their city or town in the context of poor relief. Guilds and later the sickness funds - as part of their mandate for 'mutual aid' - contributed to a range of facilities in the care of the sick and the elderly."

Motives for networking

According to Derhaeg, four motives underlie today's networking. "First is the establishment of a broader policy in welfare and health care. This extends beyond elderly care. Then there is the drive for efficiency. This can translate into, for example, the joint purchasing of services and goods, the appointment of a single directorate for multiple initiatives, the preparation of meals from a single delivery point or the provision of temporary logistical assistance in emergencies." There is also the need to cope with the increasing complexity of regulations on management and operation, he says. "Instead of each residential care center having an entire staff to provide the necessary expertise, a structure is then created in which several staff members work to serve the residential care centers affiliated with the network. Another possibility is to provide an exchange facility in which the expertise already present or yet to be recruited is pooled. This is spread across the group's various residential care centers. At cost or by exchange, any member of the (de facto or de jure) network can call upon it. Finally, there may be commercial considerations to develop and/or take over as many residential facilities as possible and operate them in-house for profit."

Increasing share of for-profit sector

"During the past decades, enormous growth has been achieved in the residential care sector from commercial initiative. Rapidly growing programming figures, to which the traditional players were unable to respond adequately due to a variety of circumstances, increased the opportunities for commercial sector deployment. Over the period 2013-2020, the share of total places offered in the nonprofit and public sectors decreased by 3.5 and 4.9%, respectively, to 42.9 and 30.1% of total residential care places. Within the public sector, an important shift is visible, from PCSWs as initiators to care companies, associations of public law. This is offset by the growth of the commercial profit WC by 71%, from 1,962 to 9,141 places. With this, the commercial sector now accounts for 27% of the total supply, up from 18.7% in 2013. It is possible that this expansion has since stopped, given the slowdown in growth two years ago and the stagnation last year."

With increasing economies of scale through networks of residential care centers, coupled with attached initiatives such as assisted living and short-stay homes, small, single facilities will have a hard time surviving, Derhaeg believes. "Keeping in mind that the current corona crisis will lead to additional conditions regarding prevention, safety and infrastructure."

Interested parties may request the report from [email protected]. Suggestions, additions and corrections are also welcome at this email address.