A demographic tidal wave looms. By 2040, one in four Dutch residents will be over 65. The same “silver tsunami” is building in much of the developed world, including the United States. And it will strain the budgets and test the ingenuity of nations. Here in the Netherlands, a social welfare state roughly twice the size of Massachusetts, leaders have been planning for this graying of society for a half century. Drawing on public funds, a sense of shared responsibility, and compulsory insurance premiums paid throughout their working lives, those born in the post-World War II baby boom take for granted that they’ll have the home and nursing care they need as they age.
“It’s pretty much undebated,” said Bram Wouterse, assistant professor in health economics at Erasmus University in Rotterdam. “People know that when you get old, the government will provide good care.”
In the United States, it’s a far different story. The question of who will take care of older Americans, and who will foot the bill, keep many awake at night. A scathing report in April from the National Academies of Sciences described the US long-term care system as “ineffective, inefficient, [and] fragmented.” The wealthiest can afford quality care; those with less money must navigate a Byzantine system that forces them to spend down their savings to get a nursing home bed.
And despite that increasingly glaring gap, there is little chance this picture will change any time soon. The cost would be vast. Older Americans are projected to account for more than 20 percent of the US population within two decades, but addressing their needs in a sweeping fashion would require a political will that is not yet visible.
Still, the example set by the Netherlands is intriguing — and chastening.
A visit to this nation of 17 million, jutting into the North Sea, offers a look at a society grappling seriously with the struggles and costs of aging. Like their American counterparts, the Dutch face not only a rapidly growing older population but also a worsening shortage of elder care workers. Those trends are fueling anxieties on both sides of the Atlantic. But in the Netherlands, there’s an age-friendly game plan, bolstered by a broad consensus that older people deserve to get the care they need, and that they shouldn’t feel isolated or warehoused.
The Dutch use the word solidariteit, or solidarity, to describe their commitment to older residents. The Netherlands was the first country in Europe to introduce a mandatory long-term care system in 1968. It has updated and refined its plan several times since, holding to its vision of universal care even as it relies more on managed competition between nonprofit providers and insurers to control costs. The most recent overhaul, in 2015, aims to help residents age in place.
People want to stay at home, said Theo van Uum, director of long-term care at the Dutch Ministry of Health, Welfare, and Sport in The Hague. That new emphasis also anticipates and seeks to ease the growing weight of nursing home care on the national coffers.
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