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

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.