25 February 2020 - Newsletter

ZOOM ON BELGIUM Belgium and the ageing challenge

Belgium is no exception to the rule : its population is ageing fast. By 2025, it will have to support a much higher number of very old and potentially dependent people. How is Belgium preparing to face this challenge ?

Belgium currently has 2.2 million people aged 65 and older. In 2030 they will be 2.6M and in 2050 3.1M. This increase is significant but the increase of 85 and older population will be even greater: 330.000 today, 370.000 in 2030… 716.000 in 2050. The share of people aged 85 and older will evolve from 3% of total population today to 6% in 2050 . Belgium is therefore no exception to the trend of the old continent: the ageing of its population is inexorable and it will considerably increase the number of elderlies who may need care at home or in residential institutions.

Today Belgium has 1.500 nursing homes with about 150.000 beds, not homogeneously distributed between the regions (see map below). In the coming years, additional beds will have to be created to cover future demand: an average of 1.389 creations per year are planned for the 2018-25 period in Flanders and nearly 12.000 creations by 2030 in Wallonia. However, in the Brussels region, which is sufficiently equipped today, supply will not change in the short term.

Structure of the belgian nursing homes market

Nevertheless, to support this growth, an important work must be done to attract professionals in the sector. Like France, Belgium is facing vocation crisis for caregivers and nurses professions. The operators have taken up the subject and are working with the government, in particular to create an intermediate professional category (logistics aids) in order to make the profession of caregivers in retirement homes more attractive. The financing of these professionals remains to be defined, because in Belgium too, financial issues are central. And in Belgium too, the model actually needs to be reviewed.


The funding for support and care provided by institutions for the elderly is composed by 2 main elements: the daily price charged to residents (with possible contribution from the State or insurance), which covers accommodation and catering; a dependency and care contribution, allocated by the regions to finance care and medical equipment as well as qualified caregivers, which varies according to the average level of dependency of residents.

This public funding is based on various mechanisms, among which: the daily rate intended for healthcare services, calculated by an estimation of the real healthcare costs, taking into account the dependence of residents, evaluated with the KATZ scale. The government then funds (only in Brussels and Wallonia), via a separate channel, the additional cost of social agreements borne by nursing homes regarding salaried staff. Finally, nurses in institutions who have a professional title of geriatric nurse, or a professional qualification of geriatric nurse, or nurse with specific expertise in palliative care, can claim an additional annual premium, funded by the government.

This system seems quite complete but in reality, it doesn’t cover all of the costs, particularly those which aren’t directly linked to care but to logistics and personal assistance (see the Filip Weyers’ interview). Beyond that, it is towards a more complete model of organization and financing that Belgium should converge, in order to facilitate recruitment in professions which are becoming tense given the exploding needs. Hence, the proactive strategy of Armonea and its professional federation to co-build and suggest this new model to the authorities.

1. Source : StatBel – Perspectives de la population 1991 – 2071

In Belgium, a distinction is made between nursing homes (MR) and nursing and cure homes (MRS). Both are aimed at dependent elderly people, but the former (47% of places) help with their daily tasks and provide care for people who can no longer live alone at home; the second, said to be medical, (50% of places) also welcome highly dependent people, but who require heavy care. To illustrate, the MR is not under the legal obligation to set up a palliative function, contrary to the MRS.

There are also “day centers” (3% of places), generally integrated into the MR.

These 3 types of structures constitute the medico-social sector for elderly. The panorama is completed by home services, temporary centres and senior residences.
2. Source : INAMI

Interview :
COO of Armonea – Colisée group Belgium
In what terms is the ageing issue currently debated in Belgium ?

Filip WEYERS : The debate is naturally oriented toward nursing homes and the discussions are similar to those taking place in France. From an emotional point of view, people prefer staying at home as long as possible.

The government has chosen to focus on personal homes and provides specific funding. However, this system is limited in terms of organization, because the nurses, for example, can’t exceed a certain number of acts per day.

What are the main challenges to come ?

F.W. : We are going through a period of conjectural tension on nurses’ recruitment. The nurses’ training program has just been extended from 3 to 4 years long in Belgium. We didn’t receive any new graduated nurses in 2019 and we have seen a decrease in training registrations due to this longer duration of studies. The biggest issue right now is to overcome this temporary deficit and, in the longer term, to enhance the profession in order to retain staff.

For this purpose, it is necessary to show that these positions in rest homes make sense and that they require greater versatility than specialized hospital units.

We also have to make the nursing assistant profession evolve. We are working on it with the federation and the government. For example, we know that the nursing assistants do tasks they don’t necessarily have to do and that don’t require nursing technical expertise. We are working therefore with the government on how to introduce a new professional category: “logistics aid”, partly in charge of hotel services and partly elderly care. Subsequently, we’ll have to find how to integrate them into the funding process.

Recruiting and retaining nursing staff, while working with the academic world in order to build new training programs and new professions: this is our roadmap !

In this context, what are the actions of Armonea Colisee in Belgium ?

F.W. : The last year has been very interesting. We have managed to integrate Armonea into the Colisee Group in a harmonious way and now we are learning from each other in order to improve together. Last year, we adopted the Colisee partnership approach and our occupancy rate went from 88% to 94%. This year, the idea is to go even further in this networking approach.

In the past, the director or the staff members weren’t leaving their establishment a lot. Now, they go out to meet social services, hospitals and all potential prescribers. This is a positive development that will allow us to see how to use this network to continue our expansion and reach new collaborators.

Also, we are developing a digitalization plan at the European level. MyArmonea, for example, a private social network that allows families, residents and teams to communicate in real time is implemented in all our nursing homes now.

And last but not least: we are working on a new care approach in Belgium, in collaboration with The Antwerp University and we are developing the Armonea Campus, that aims to become the European COLISEE training center for the nursing professions. It’s a very exciting agenda !