Caring about Health Care

The heath care sector in the Netherlands isn’t what it used to be. That has become readily apparent at ‘Vredenoord’, an Adventist nursing home and residential care facility. Despite some administrative and financial challenges, though, their situation is relatively good when compared with other institutions. ‘We’re like a marathon runner: we keep on going until we reach the finish line.’

Text by Lydia Lijkendijk

Vredenoord has a stubborn Board of Directors, consisting of Paula Koeweiden‒Cane Tuppen. She first took on this role in 2002, when she was still the Treasurer of the Netherlands Union Conference, and the job became official in 2004. She is also Vredenoord’s site manager. Next summer she will be retiring. ‘I’m already past my expiration date,’ she says. Koeweiden (68) has a management team and a Board of Trustees to fall back on, but she often stands alone against the brushfire currently encircling the health care industry. Officially she lives in Woudenberg, but most days (and nights) you will find her in Vredenoord. When she is home, she’s often working for Vredenoord. ‘We’re too small for a full-time Board of Directors, but you do need someone onsite to manage all the employees. My advice? Once I leave, turn the job into a full-time site manager, with two or three days of board work a week for strategic affairs.’

End of the Line

Despite the hectic nature of her work, Koeweiden feels she has a very good job. ‘My work comes with variety. It’s never boring. I get to talk to doctors, carers, residents, families, volunteers, and colleagues. I work with people who are on their way out of this life, and who want to close their eyes in peace. We’re there as people look back, relax, and see that they’ve lived a good life. Nothing is more beautiful.’ Vredenoord helps those who are in the final phase of their lives, and for many this care home is the end of the line.

‘When I first got here things were different,’ says Koeweiden. ‘In 2002 we were just an old age home. People came to live here when they turned 65. It was like a holiday resort. We had catered meals, and twice a year we would take road trips. The fun would never end. I even had the time to have good conversations with people and really get to know them, because they were here for a long time. Now the youngest people we admit are 85, and most already have dementia. Often they pass away within a year and a half. I have a very different relationship with these residents. Their fight is up before they arrive. We’re not an old age home any more, but increasingly a nursing home.’


When asked what concerns her most about the health care field, Koeweiden says: ‘Within a three year period the government has doubled the intensiveness of our workload, despite the fact that some of our personnel are still only elderly helpers and carers. How are they meant to take care of the patients that need intensive care?’ Extra training isn’t always the solution, not least because some can’t take on extra training. ‘Well-trained staff are extremely difficult to find. In the Netherlands, in the degree programs – no one has enough trained carers and nurses. The struggle to find sufficiently and suitably qualified staff is the hardest part of my job. I need to work very closely with the education system, for instance, so we can offer condensed training programmes for carers and nurses in geriatrics.’

As far as Koeweiden is concerned, refugees seeking employment are welcome to help fill this gap. ‘Our staff and volunteers come from all different countries. We don’t discriminate – though the language barrier can be a big issue. We’re fighting competing care centres for people. I try to be creative in recruiting, but if that doesn’t work I’m not afraid to get my own hands dirty. I’m not a trained nurse, but I can certainly make beds and collect laundry.’

Administrative Burdens

The increasing administrative requirements for care homes are another source of pressure. ‘Every little paper cup of butter has to be stickered and checked,’ Koeweiden sighs. ‘We spend a huge amount of money on things that have nothing to do with health care. Our staff has protested some of these changes in The Hague, and Actiz, the health care providers’ union where we are members, is at the table with the politicians. We’re going to have to wait until the shore turns the ship, though, or until the politicians wake up. Something has to change, though. We can’t go on like this for much longer.’

‘The idea of a participatory society, where people live independently for longer with the help of friends and family, sounds good. But it’s a cutback. 75-year-old ‘children’, sometimes with the help of volunteers, end up caring for parents well past 90. That situation can easily lead to the wrong medication or the wrong kind of care, and sooner or later someone in the Netherlands is going to kill someone with care.’ Koeweiden makes a hand gesture that indicates how she feels about this: completely bonkers. It’s also a great source of worry, because the problems this causes for Vredenoord end up on her plate. ‘All these things make up the low points of my work.’

Financially Sound

These recent developments in health care offer enormous challenges for homes like Vredenoord, not only in their daily work, but also on a financial level. Koeweiden: ‘health insurance companies and healthcare offices have the budget, but for years they haven’t been paying the fees necessary to offer the elderly proper care. If that doesn’t change, the state of care will continue to deteriorate.’

For a brief period, behind the scenes at Vredenoord staff considered a merger to improve the facility’s scale and financial position. Once plans were nearly complete, however, they were put on hold. ‘It didn’t feel right,’ Koeweiden says firmly. ‘We no longer had any trust in their director, and were afraid our vision would be lost if we merged into another organisation.’ The delay became permanent in February 2016, when the healthcare office decided that Vredenoord’s numbers were hopeful enough for it to stay open on its own.

It was meant to be, thinks Koeweiden, who notes that Vredenoord often performs better than other care homes. ‘Our accountant tells me that we’re above average. In the beginning we were in the red, but now our finances show an upward trend. We have no vacancies. I’m thrilled that we’re in the black, and that we’ve been blessed with the chance to keep working as a small, independent care home. How is it even possible! We’re like a marathon runner: we keep on going until we reach the finish line, even if it takes the last of our strength.’

With Distinction

Vredenoord’s ordered finances are not the only thing that separates it from other care homes. It has a warm atmosphere, with lots of laughter among the residents, staff, and volunteers, and love for each other is considered very important. ‘We work from an Adventist perspective. We love God, and love our neighbour as ourselves. We give people genuine attention, and we help them with all the skills we have. No deskbound leaders here – our leaders work in teams with the rest of us. They’re in touch with the staff and the residents, and that only improves the quality of the care we can offer.’

You will also find quality in the meals at Vredenoord, because Koeweiden feels that fresh cooking is important. Spiritual sustenance is also a priority, in the form of morning and evening vespers, Sabbath school on Friday evenings, and a church service on Sabbath morning. Naturally there are also prayers before meals. ‘Most people here are believers, and enjoy the emphasis on religion.’

Hendrik Groen

Would Paula Koeweiden want to come to Vredenoord herself, as the final stop on her earthly journey? ‘I’d find that difficult now, because I know everyone,’ she says. ‘But it will probably be a good twenty years before I need to think about it. I would rather live in my own home, but if that became impossible I would definitely want to go to Vredenoord, and not somewhere else.’

When asked, she says she hasn’t read The Secret Diary of Hendrik Groen, 83¼ Years Old, a bestelling book that tells the humorous story of a man’s life in an old age home. ‘I’m always busy with my required reading for work,’ Koeweiden admits. At this point fans of Hendrik Groen would contest that his attempts to make something of life should always be on the list of required reading – specifically for Boards of Directors in health care, but really for everyone.


Huis ter Heide’s residential care home, Vredenoord, provides housing, care, and wellbeing according to the needs and wishes of its residents. These services are built on a Protestant foundation, stemming from the beliefs of the Seventh-day Adventist Church. Vredenoord’s target audience is elderly Adventists, and other older people who have respect for, or feel drawn to, the norms and values that this way of life inspires.

The home has around 100 residents. The 42 apartments in Intermezzo, which have space for around 56 residents, are not officially a part of Vredenoord. These are owned by a housing association, though Vredenoord manages the waiting list. Vredenoord is part of a no-smoking zone, which includes Intermezzo.

Work at Vredenoord

Vredenoord warmly welcomes young people who are interested in a nursing career, or who are interested in receiving training in health care. The home has opportunities for nurses (level 4), carers (3IG), and live-in assistants. Do you have (or want) training in one of these areas? Visit for more information, or contact Paula Koeweiden at (030) 693 1665 or is the official website of the Seventh-day Adventist church

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