# Impact of the 2015 Dutch Long‐Term Care Reform on Nursing Home Use and Access for People With Dementia

## TL;DR

A 2015 Dutch care reform aimed to keep older people with dementia at home but led to fewer nursing home admissions and longer waiting lists, raising concerns about their health and caregiver burden.

## Contribution

This study provides population-level evidence of unintended consequences of aging-in-place policies on nursing home access for people with dementia.

## Key findings

- The 2015 reform was linked to a 39% drop in nursing home admissions for older people with dementia.
- Waiting lists for nursing home care increased by 15.9% after the reform.
- Fewer admissions and longer waiting lists suggest institutional capacity did not match the persistent need for care.

## Abstract

In 2015, the Netherlands implemented long‐term care (LTC) reforms to promote aging‐in‐place, potentially impacting nursing home (NH) access for older individuals with dementia. This study examines how the reform affected NH admission rates and waiting list prevalence for this population.

We performed interrupted time series analyses to evaluate trends in NH admissions (2011–2019, Statistics Netherlands) and waiting list prevalence (2013–2018, National Healthcare Institute) before and after the 2015 LTC reform. Incidence rate ratios (IRR) were calculated for monthly NH admission rates and waiting list prevalence.

Among 270,706 older people with dementia, the reform was negatively associated with NH admission rates (IRR 0.610 [0.547–0.681]), halting the pre‐reform decline and stabilizing the post‐reform trend (IRR 1.001 [0.999–1.002]). The reform was positively associated with NH waiting list prevalence (IRR 1.159 [1.048–1.282]).

Among older Dutch people with dementia, the 2015 Dutch LTC reform was associated with fewer NH admissions and longer waiting lists. While stabilization of the NH admissions may reflect prioritization of persons with dementia within stricter eligibility criteria, the concurrent rise in waiting list prevalence suggests that institutional capacity did not keep pace with persistent need. As a result, many older people with dementia remain longer in the community, raising concerns regarding their health and safety as well as the burden on their informal caregivers.

Key points◦The 2015 Dutch long‐term care reform promoted aging‐in‐place by limiting nursing home access to only those with severe care needs.◦The reform was associated with declines in nursing home admissions and increases in waiting lists among older adults with dementia.◦These outcomes reveal an unintended consequence of aging‐in‐place policies, that is, that of prolonged residence in a community of older persons with dementia.
Why does this paper matter?◦This study provides population‐level evidence on the unintended effects of long‐term care reforms designed to promote aging‐in‐place. While such policies aim to support autonomy and reduce use of institutional care, the findings show reduced admissions and longer waiting lists among people with dementia. These results highlight the need for long‐term care strategies that ensure timely access to appropriate care for those who need high levels of support.

Key points◦The 2015 Dutch long‐term care reform promoted aging‐in‐place by limiting nursing home access to only those with severe care needs.◦The reform was associated with declines in nursing home admissions and increases in waiting lists among older adults with dementia.◦These outcomes reveal an unintended consequence of aging‐in‐place policies, that is, that of prolonged residence in a community of older persons with dementia.

The 2015 Dutch long‐term care reform promoted aging‐in‐place by limiting nursing home access to only those with severe care needs.

The reform was associated with declines in nursing home admissions and increases in waiting lists among older adults with dementia.

These outcomes reveal an unintended consequence of aging‐in‐place policies, that is, that of prolonged residence in a community of older persons with dementia.

Why does this paper matter?◦This study provides population‐level evidence on the unintended effects of long‐term care reforms designed to promote aging‐in‐place. While such policies aim to support autonomy and reduce use of institutional care, the findings show reduced admissions and longer waiting lists among people with dementia. These results highlight the need for long‐term care strategies that ensure timely access to appropriate care for those who need high levels of support.

This study provides population‐level evidence on the unintended effects of long‐term care reforms designed to promote aging‐in‐place. While such policies aim to support autonomy and reduce use of institutional care, the findings show reduced admissions and longer waiting lists among people with dementia. These results highlight the need for long‐term care strategies that ensure timely access to appropriate care for those who need high levels of support.