Recent reforms in Dutch long-term care have brought about a transition from publicly financed care to unpaid care. This means that older people in the Netherlands have a greater responsibility to try and arrange care themselves or with the help of their family before turning to publicly financed care. By making an international comparison, we will put the Dutch long-term care system into a European perspective.
About the authors
Debbie Verbeek-Oudijk, Isolde Woittiez, Evelien Eggink & Lisa Putman are affiliated with the Netherlands Institute for Social Research and conduct research into long-term care.
Translation: Angelique van Vondelen
Reforms in Dutch long-term care are aimed at enabling older people with disabilities, who need support with daily living activities over a prolonged period of time, to live independently as long as possible with the help and support of their own social network. By comparing the Dutch situation to that of other European countries, we get a grasp of where Dutch long-term care stands in Europe. We compare the Netherlands with fifteen other European countries (Verbeek-Oudijk et al., 2014). In this way we can study a wide range of different care systems. We use data from the 2011 Survey of Health, Ageing and Retirement in Europe (SHARE) about the care situation of people who are over 50 and who live independently . This means that we focus on home care, which includes domestic help, but also nursing facilities and care services that are delivered at home. We do not take into account residential care.
When people grow older, they will need more care. The ageing of the population in the Netherlands is still in its infancy. It is to be expected that the ageing of the population reaches its peak around the year 2040. By that time, the percentage of older people in the Netherlands will equal the European average.
Impairments also play a role with respect to the need for long-term care. These include both physical impairments (for instance in daily living activities such as personal hygiene, preparing a meal or mobility) and psychological impairments (feeling depressed) or cognitive impairments (memory loss). Of all the people over 50 in the Netherlands, 55% have impairments and about 10% suffer from severe impairments (Figure 1). This percentage is less than average, which is also the case in Northern-Europe and Switzerland. Poland, Spain, Portugal and Hungary however, show a much higher percentage of people with impairments.
When it comes to providing support to older people in need of help, family members – partners or children - seem to be the most obvious persons. However, they are not always in a position to offer this support. For instance, when the partner of the person in need of care also has health impairments. Or when the children have fulltime jobs, do not live close enough to their parents or need to look after their own small children. In this respect, almost 70% of the Dutch population over 50 have access to a family network which is not inhibited from giving support (Figure 2). This percentage is higher than in almost any of the other countries. Even though there is no impediment for the members in the family network to provide care and support, this is not a guarantee that they will actually do so. The family network in the Netherlands mainly consists of the partner of the person who is in need of care. This makes the network fragile, as the partner in question could become dependent on care as well. What is more, unpaid caregivers are often overburdened already (Oudijk et al., 2010). It is therefore important not to expect too much of the reforms in Dutch long-term care with respect to the potential of the family network.
The over 50s who are in need of care will receive either paid or unpaid care. Paid care consists of publicly financed care, but also of private care arrangements. On estimate, 64% of the Dutch people over 50 receive paid and/ or unpaid long term care; this more or less equals the average of all the countries in our study (Figure 3). The use of paid care in the Netherlands is about 10% – which is above the average (7.5%) – and equals that in Northern and Central-European countries. However, the use of unpaid care in the Netherlands is relatively low – just over 60% – especially when compared to most Southern and Eastern European countries. A relatively large number of people in the Netherlands receive both paid and unpaid care. This suggests that these forms of care are complementary in this country. In other countries, such as Germany, people generally receive either one or the other form of care and it seems that here paid care can be replaced by unpaid care.
The quality of Dutch public care is high (Biró, 2013). However, the growing tendency to resort to unpaid care seems to involve a risk: this could become detrimental to the high quality of the present Dutch public care. A good interaction between paid and unpaid caregivers is therefore essential.