Ageing in place: how to evaluate current practices following long-term care reforms

Governments worldwide are investing in ageing in place-that is, policies and programmes that enable older adults to remain in their homes and communities irrespective of income level or functional ability. However, there have been few concerted evaluation efforts to keep up with these reforms. Drawing on country examples from the Netherlands, Norway, and Japan, this Personal View identifies three recurring reform tensions: decentralisation versus coordination, personal versus collective responsibility, and cost containment versus investment. Each reform tension produces unintended consequences that evaluations can detect, prompting midcourse corrections. Importantly, existing evaluation frameworks remain narrowly focused on care expenditure, missing the wider societal consequences of reforms. These frameworks also overlook structural inequities that shape who can and cannot age in place with dignity. We therefore propose an integrated, equity-stratified framework to assess whether ageing in place reforms achieve their stated goals or instead widen the disparities they purport to address.