Utilisation of nursing home care before and after the 2015 Dutch national reform: an interrupted time series analysis

The Netherlands introduced abrupt, large-scale, long-term care (LTC) reforms in 2015 that promoted ageing-in-place. However, there has been no comprehensive population-level study evaluating how these reforms have impacted nursing home (NH) utilisation. This study examines the association between the 2015 reforms with national monthly rates of NH admissions and survival time amongst newly admitted older adults.

We analysed population data from Statistics Netherlands (2011-2019), conducting an interrupted time-series analysis to compare monthly NH admission rates before and after the 2015 reforms amongst adults aged 65 and older (N = 402 350). A Cox proportional hazards model was used to assess the reform's impact on mortality risk amongst newly admitted residents.

The adjusted NH admission rate before the reform was 88.80 per 100 000 older adults (95% CI (confidence interval): 82.36-95.83), compared to 69.82 per 100 000 after the reform (95% CI: 65.91-73.78), indicating a significant reduction (incident rate ratio: 0.80, 95% CI: 0.74-0.86). Over a 3-year follow-up, the average survival time for those admitted after the reform was 608 days (95% CI: 608.72-610.74), compared to 622.52 days (95% CI: 620.59-624.45) for those admitted before the reform. The reform was associated with a slightly increased mortality risk (hazard ratio: 1.05, 95% CI: 1.02-1.07).

The 2015 Dutch LTC reform is associated with a reduction in national NH admissions and a decrease in average survival time of 2 weeks.