Context
As the Netherlands is facing many issues related to the sustainability of healthcare, the Dutch government introduced a long-term transition program, which includes the Cross-Sectoral Care Agreement (IZA) and other healthcare agreements such as the Healthy and Active Living Agreement (GALA) and Housing, Support and Care for Older People (WOZO) in an effort to tackle some of these challenges. In this policy analysis we further elaborate on the WOZO agreement.
In 2022, the Dutch government introduced the WOZO program together with 40 stakeholders in long-term care (including umbrella organizations of patients, health insurers, municipalities, home care providers and healthcare professionals). The WOZO is a policy program on housing, support and care for older people lasting five years in total (Programma Wonen, Ondersteuning en Zorg voor Ouderen). This program focuses on the long-term perspective of long-term care, consisting of a set of measures, initiatives and projects aimed at making it future-proof. The Dutch cabinet has allocated approximately 1.5 billion euro to support this plan. The first evaluation of this program was published in December 2024.
Impetus
Due to an aging population with more chronic conditions and increasing life span, the demand for healthcare is increasing. However, the number of people working in healthcare and the number of informal caregivers is not growing at the same pace. Without appropriate changes to how long-term care is organized, a shortage is anticipated in the near future. Therefore, reorganization to optimize the use of available resources while ensuring high quality of care is essential.
Main purpose of the reform
The aim of the WOZO is to reform care for older people with a strong focus on self-reliance. The norm will be to “take care of yourself if possible, at home if possible and digitally if possible”.
Content
In more detail, the WOZO is centred on enabling older people to be as self-reliant as possible by (re)learning skills if necessary, staying fit, using assistive devices and receiving support from their environment. The program prioritizes delivering care digitally whenever possible and encouraging people to live at home unless no longer feasible.
The WOZO program is structured around five action points, each divided into multiple subthemes:
- Growing old together vitally in a suitable environment. This point focuses on stimulating people to think about their future, promoting cohabitation of younger and older people and knowledge development on and increasing reablement.
- Strong basic care for older people entails improving the collaboration between healthcare and the social domain and strengthening primary care.
- Appropriate long-term care for individuals who require continuous and intensive care. This care needs to fit their needs by for example developing a personal healthcare plan with a cross-sectoral approach.
- Housing and care for older people focuses on creating sufficient housing in an environment that fits their needs. For each municipality, it is calculated how many houses need to be built.
- Labour market and innovation directed towards keeping healthcare workers in the sector. With the help of technological and social innovations, healthcare workers will be deployed in the most efficient way to take care of older people.
Implementation steps taken/outcomes to date
Within WOZO, there have been initiatives for housing of older people, an awareness program for older people to assess their wishes for future housing and a study to gain insight into the decision to relocate by older people. Furthermore, incentive programmes have been set up to subsidize housing initiatives for older people. Assessing the effect of WOZO is challenging for several reasons. First, its changes align with a broader societal shift, making it difficult to isolate WOZO’s effects only. Secondly, many projects have not been fully implemented yet as they require collaboration between various stakeholders, such as healthcare providers and municipalities, which is a complex process. The involvement of the social domain could also be improved.
Additionally, the current healthcare structure does not fully support the optimal use of WOZO. The Dutch Healthcare Authority (NZa) has noted the following: To be able to finance initiatives structurally, the Long-term Care Act (Wlz) needs to be restructured: the core aims of WOZO “by yourself if possible, at home if possible and digitally if possible” need to be specified further. The old budget regime – nursing homes received a budget per client - needs to be changed. The newly introduced financial separation of housing and care is a challenge for institutions that have long-lasting commitments for their buildings. Future actions foreseen by the Ministry of Health are broadening the movement, integrating it into the Sectoral Care Agreement, collecting challenges and options for improvement and focusing on reablement and options to strengthen people living at home.