Neglect of elderly deepens as Dutch care system faces growing strain
The Dutch elderly care system is under mounting pressure, with tens of thousands of seniors falling through the cracks between independent living and institutional care, AD reports. Doctors, researchers, and care leaders warn of a growing number of elderly patients arriving at hospitals in neglected condition—victims of a healthcare structure that lacks a middle ground.
“We regularly have angry families in front of us,” clinical geriatrician Esther Cornegé-Blokland told AD. “They ask why we’re not solving the problem—‘it can’t go on like this at home.’ But we need that hospital bed for others, and there’s no place available elsewhere. I’d like to see it differently too. This affects me, and I’m worried.”
Cornegé-Blokland, chair of the Dutch Association for Clinical Geriatrics, described multiple cases of elderly patients arriving in deeply neglected states. One man in his 80s was brought to her clinic after a fall. “The entire hallway smelled of him. He was severely neglected,” she said. The man reeked of urine and sweat, was drinking heavily, and had early-stage dementia. In another case, a man arrived at the emergency department with flies in his hair. One man in his 70s had been hospitalized seven times, as his family could no longer care for him and no appropriate living arrangement could be found.
According to Cornegé-Blokland, 15 percent of elderly hospital patients are too frail to return home, yet no nursing home beds are available for them. More than a quarter are sent home anyway, despite medical staff knowing it’s not safe. The cycle continues: older people fall, are hospitalized, return home, and fall again. “The disappearance of traditional residential care homes since 2014 and the policy shift to aging in place play a major role,” she said.
A recent nationwide survey by Panel Inzicht revealed that 64 percent of Dutch respondents believe residential care homes should return. Among those aged 65 and over, not a single respondent opposed the idea.
The Dutch government is now exploring whether to reintroduce residential care homes through new policy evaluations. Health Minister Fleur Agema, a vocal proponent of the idea during her time as a Tweede Kamer member, has pushed for this reassessment.
The original system of “bejaardenhuizen” (residential care homes) was launched in 1963 to address severe housing shortages in the post-war Netherlands. The idea was that moving seniors into dedicated homes would free up houses for young families. Cultural shifts also made it less common for older relatives to live with their children.
“At that time, you didn’t have to be in poor health to move in,” Atie Schipaanboord of seniors’ advocacy group ANBO-PCOB said to AD. “My grandparents were still vital, not even 70, and moved into a bejaardenhuis just after retirement.” She recalled her grandfather playing billiards and her grandmother socializing over coffee. Meals came through a hatch in the door, and there was a sense of routine and community.
Still, she questioned whether today’s seniors would accept that model. “You don’t really think the current generation wants to live like that, do you?”
ANBO-PCOB’s own research confirms that while many older adults support the idea of reintroducing care homes, few actually want to live in one.
Between 2002 and 2007, then-State Secretary Clémence Ross-Van Dorp laid the groundwork for aging in place. “People wanted it themselves,” she said. “We looked at what was needed to make that possible.”
But Ross-Van Dorp cautioned against nostalgia. “I worked at a care home where my aunt was the director. There was a lot of loneliness too. Many residents no longer had visitors.” She also noted that most buildings were outdated, with small rooms.
In 2012, the government formally decided that elderly people with low care needs would no longer qualify for residential care. The policy aligned with the supposed wishes of the elderly, but also served as a budget cut.
“We understood the philosophy,” Pieter Hermsen, now a senior executive at Vivent in Den Bosch, told AD. “But we already foresaw a housing shortage.” As thousands of care home units disappeared, elderly people remained in larger homes, reducing housing mobility for young families. Some old facilities were converted into nursing homes; others were demolished. “Now there’s another housing crisis. Many elderly people live alone in large homes, and nothing’s moving,” Hermsen said.
Inge Borghuis, director at Amstelring and a longtime elderly care professional, agreed: “The decision to close care homes was made too recklessly, without sufficient long-term planning. Now we’re seeing the consequences.”
While home care teams travel from door to door to help with dressing, bathing, and medication, many elderly people live in inaccessible buildings—such as apartments on the third floor without elevators. Sometimes spouses are too old to assist, or adult children live far away. Staff shortages also mean not everyone gets the help they need.
“There were many stories from home care workers about people who couldn't care for themselves,” Karim Skalli, a board member at FNV, told AD. “Yet they received fewer care hours because of budget cuts.”
Budget reductions also affected community centers, which once provided the social element of care homes. “That’s a huge loss,” Borghuis told AD. “You want to build community. People are more likely to help each other if they know one another.”
Those without a strong social network often suffer most. “We see people who speak to a nurse at 11 a.m., and that’s the only human contact they’ll have that day,” Hermsen added.
Researcher Marlies Bär from Erasmus University Rotterdam found that hospitalizations increase when nursing home placements are delayed. “Of every 100 people who have to wait an extra month for a nursing home spot, three end up in the hospital,” Bär told AD. “They often receive home care, but it’s not enough to protect them from hospitalization.”
Noud Engelen of the Council of the Elderly said housing quality directly affects health. “If you live in a supportive environment with access to caregivers, timely medication, proper meals, and some social contact, you automatically need less care,” he explained to AD. Engelen, also a geriatric psychologist, has seen the toll on those left behind. “People become depressed, psychotic, confused, wandering the streets.”
He urged policymakers to witness the situation firsthand: “Spend a week on home visits. Many people simply can’t manage. When society no longer helps, we reach a point that shouldn’t exist in the Netherlands.”
Still, not everyone supports a return to traditional care homes. “Not all elderly people want to live together. They want choices, not an all-inclusive setup like the old care homes,” said Borghuis.
Instead, there’s growing interest in a “modern care home” concept—secure housing with on-site care, social spaces, and local amenities like supermarkets. Some projects are already underway, including mixed housing developments where seniors and families live side by side.
“The function of a care home still matters, but the old model doesn’t,” Hermsen told AD. “We need a modern version, focused on neighborhoods, community, and connection.”
But that won’t happen overnight. Experts agree that the government has acted too slowly and too little. Tens of thousands of specialized senior housing units are needed. “We need a sense of urgency,” Borghuis told AD. “We need a clear vision for elderly housing and we must accelerate. We should’ve started yesterday.”
