Housing, community and care: restructuring the architecture of long-term care in ageing societies
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As populations age and care needs become more complex, housing is emerging as a critical component of long-term care policy. The Netherlands is developing new forms of clustered and care-supportive housing to help older adults remain independent for longer while addressing the growing gap between ordinary housing and institutional care.
Across Europe, demographic ageing has fundamentally challenged the institutional and financial architecture of modern care and welfare states. While increasing life expectancy represents one of humanity's greatest achievements, it has radically transformed the epidemiological landscape of care demand. Care systems are no longer preoccupied primarily with episodes of acute illness, but are instead confronted with prolonged trajectories of dependency, complex and chronic multimorbidity such as dementia.
The Netherlands provides a compelling lens through which to examine this structural transformation. Having spent decades expanding a comprehensive, publicly financed institutional care model, known by the historic residential care (nursing homes), Dutch policy has progressively pivoted toward 'ageing in place' and community-based support. However, as recent strategic evaluations underscore, the contemporary challenge is no longer merely facilitating independent living in ordinary homes, but deliberately engineering the residential, social, and governance infrastructure necessary to sustain populations once they reside outside traditional institutions.
The demographic necessity and the structural 'missing middle'
The motion for integrating housing policy with long-term care reform is driven by undeniable demographic pressures. Projections indicate that the number of individuals living with dementia in the Netherlands will surge from approximately 310,000 today to over 500,000 by 2040, while inpatient nursing-home capacity remains capped at roughly 130,000 places through at least 2030. This widening divergence between growing complex needs and frozen institutional capacity means that increasing numbers of vulnerable older adults will inevitably age outside traditional facilities.
This reality has exposed a critical structural vulnerability: the 'missing middle'. Many older adults experience early cognitive decline, increasing frailty, or reduced capacity for self-management, making independent living without support increasingly challenging. At the same time, their needs are not severe enough to qualify for nursing-home care under the Dutch Long-term Care Act (Wlz). To address this gap, national frameworks such as the Programme for Living, Support and Care for the Elderly (WOZO) and the Main Agreement on Elderly Care (HLO) established a target to realise 290,000 suitable senior homes by 2030. This comprehensive target encompasses 170,000 zero-step accessible dwellings, 80,000 clustered housing units, and 40,000 care-suitable homes, with half of these developments strategically anchored within the social rental sector.
A taxonomy of supportive housing types
To accommodate this need, contemporary policy relies on a differentiated portfolio of housing concepts that bridge the chasm between ordinary homes and institutional care.
- Zero-step dwellings: representing a foundational baseline within a national housing stock of approximately 7.7 million homes. These units are fully accessible from both interior and exterior approaches without threshold barriers.
- Clustered housing forms: grounded in zero-step complexes featuring indoor or proximate meeting spaces (within roughly 100 meters). These environments foster mutual support and social cohesion without recreating clinical institutional models.
- Care-suitable homes: specialised dwellings designed according to Dutch accessibility, adaptability, and care-supportive housing standards, with spatial configurations that facilitate professional home care delivery. These homes provide wheelchair accessibility, generous circulation space, accessible bathrooms, and, where applicable, stretcher-lift access to facilitate professional care provision.
- Thuishuizen: small-scale communal senior living arrangements (such as those in the city Woerden) where single older adults maintain private independent apartments while sharing expansive communal living rooms and gardens managed by local volunteer foundations, prioritising social connection and well-being over built-in professional care.
- Thuisplusflats and Wonen met een Plus: high-density residential complexes (for example SociaalHart Ommoord in Rotterdam) accommodating hundreds of older residents with mixed care needs, anchored by professional social managers and integrated Housing-Welfare-Care (WWZ) teams that deliver 'dotted' Full Home Care Packages (VPT gespikkeld).
- Duo-wonen: an intergenerational model where older homeowners partition their private residences, renting space to younger tenants under structured reciprocity agreements and matching protocols.
Housing as strategic care infrastructure
In modern long-term care policy for older adults, housing is no longer treated as a mere real estate commodity; it is gradually becoming an integral component of care infrastructure. Traditional residential care homes historically bundled housing, safety, supervision, and social interaction into a single environment. As older adults remain in ordinary neighbourhoods longer, these vital functions become decentralised.
Clustered living arrangements and care-suitable homes act as vital architectural bridges. By grouping accessible zero-step homes around shared spaces, these models allow professional home care such as the Full Home Care Package (VPT) to be delivered efficiently and safely across a concentrated resident group. Furthermore, administrative models like the preferred care provider assign a single integrated care team to a residential complex, ensuring streamlined communication, reliable 24/7 support, and optimised workforce deployment.
Not a 'Nursing Home 2.0'
A common misconception of the current Full Home Care Package (VPT) is that it tends to replicate an institutional nursing home inside an individual's private apartment. In practice, successful Dutch models (such as Thuisplusflats and mixed residential complexes) operate on a fundamentally different philosophy. As outlined in national policy and implementation guidelines, these clustered arrangements are explicitly not a nursing home 2.0, but a living environment where independent living is central.
Within these settings, care is delivered via 'dotted' Full Home Care Packages (VPT gespikkeld), distributed across the entire complex while allowing people with and without care needs to live together. This enables mutual support, informal care, and social cohesion to flourish organically alongside professional care provision.
Formal care and informal community networks
VPT and home-based support are therefore deployed across a concentrated, mixed-population residential complex with the assumption that formal care and informal community networks reinforce one another:
- Mutual support: residents within these environments engage in reciprocal daily assistance, performing small services for one another, sharing social rituals, and looking out for neighbours.
- Absorption of everyday tasks: informal neighbourhood networks and community structures handle lighter support requests – such as practical errands, grocery shopping, companionship, and daily check-ins – which correspond to vital Instrumental Activities of Daily Living (IADLs).
- Optimised professional roles: by allowing informal community networks to absorb lighter support needs, professional care teams operating within the complex can focus efficiently on complex medical tasks and intensive personal care.
- Integrated care teams: administrative models like the preferred care provider assign a single integrated care team (often collaborating directly with housing corporations and welfare organisations) to a residential complex, ensuring seamless communication, reliable 24/7 support, and tailored workforce deployment.
Necessity of social infrastructure and governance
While physical housing provides the structural container for care, building a sustainable living environment requires robust social infrastructure. A recurring assumption in earlier ageing-in-place policies is that supportive, caring communities would emerge spontaneously once older adults were placed in shared environments. Field research synthesised in publications such as Zorgzaam wonen is geen toeval proves otherwise; community formation is an active, deliberate process.
Sustaining these environments depends heavily on professional social managers who coordinate daily interactions, bridge formal and informal networks, and foster reciprocal support. Furthermore, because these models rely on mixed resident populations – blending individuals with and without care needs – their long-term success requires cross-domain governance. Municipalities must align public housing programmes with social support statutes, while housing corporations and healthcare providers must coordinate on flexible allocation policies, digital home automation, and shared property management.
Successful community-building governance
Key insights regarding successful community-building governance include:
- Professional social management: social managers and community coordinators play an indispensable role in bridging neighbours, mitigating loneliness, and establishing daily rhythms of reciprocity.
- Mixed resident populations: integrating older adults with and without care needs – alongside intergenerational models – fosters mutual support and prevents institutional isolation.
- Intentional allocation and matching: successful models utilise careful intake procedures such as motivational interviews and introductory gatherings to ensure that incoming residents share a mutual willingness to contribute to the social fabric of the community.
- Deliberate governance: social cohesion relies heavily on shared physical assets, such as accessible communal living rooms that serve as the beating heart of a complex and invite broader neighbourhood engagement.
- The heart of the complex: communal living rooms serve as focal points for social interaction, accessibility, and neighbourhood integration, inviting both residents and wider community members across the threshold.
Conclusion
The Dutch experience suggests that the future challenge in long-term care is no longer primarily the reform of care systems, but the creation of the conditions under which care can be organised beyond institutions. Demographic ageing, rising prevalence of dementia, and persistent workforce shortages increasingly limit the capacity of institution-centred models to absorb future demand. In response, housing, community support and care provision are becoming interconnected components of a broader support system rather than separate policy domains.
The key policy question is therefore not whether older adults should remain independent for longer. That transition is already underway. The more pressing question is whether societies can create residential environments, social networks and governance capable of sustaining independence when support needs become more complex. The Netherlands' ongoing efforts to develop clustered housing, strengthen community capacity and address the gap between ordinary housing and institutional care illustrate both the opportunities and the unresolved challenges of this transition. For ageing societies, the central lesson is clear: the sustainability of future care systems will depend not only on healthcare capacity, but also on the quality of the housing and social infrastructures in which ageing takes place.