Evaluating ageing-in-place reforms Developing policy assessment tools and understanding care preferences of older adults and informal caregivers in the Netherlands

The rapid ageing of the world population and corresponding rising long-term care (LTC) demand and costs are pressuring the LTC systems. Many countries, including the Netherlands, have responded by promoting ageing in place (AIP) as a cost-saving alternative to institutional care, encouraging older adults to remain at home with support of informal caregivers. While AIP is often presented as a cost-saving solution aligned with older adults’ preferences, it is important to assess whether this policy ideal is being fulfilled and what its societal implications are.
This thesis develops a system-level framework for evaluating AIP reform policies, combining a review of the international literature on performance indicators used for AIP reform evaluation with a Delphi study involving Dutch AIP experts. This process produced a consensus-based set of actionable performance indicators covering health system inputs, service delivery, and outcomes such as caregiver burden, and health inequalities.
Complementing this system-level perspective, individual-level AIP preferences are explored through mixed-methodologies, with particular attention for underrepresented groups, including persons with dementia and persons with a migration background. These studies reveal shared needs, such as informal support, formal care, social activities, and help navigating the healthcare system, alongside the need for culturally sensitive care. This evidence informs future Discrete Choice Experiments to help quantify AIP preferences.
Together, the findings of this thesis highlight that equitable AIP policy requires evaluation frameworks that combine robust performance indicators with a deeper understanding of the diverse and evolving preferences of older adults and informal caregivers.