ageing in the netherlands - pwc · 2015-06-03 · reed business bv, p.o. box 152, 1000 ad...

Public Sector

Ageing in the Netherlands

Gertjan BaarsAnneke Offereins

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© Reed Business, Amsterdam 2010© PricewaterhouseCoopers, Amsterdam 2010

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ISBN 978 90 352 3167 2NUR 882

Ageing in the NetherlandsThe point of view of decision-makers in the public sector

Ageing tomorrow, innovation today

Gertjan BaarsAnneke Offereins

PricewaterhouseCoopers 3

Preface

With the baby boom generation moving into retirement from 2011 onwards, Dutch societywill soon start to show the effects of population ageing. Whereas the causes of populationageing can be deduced logically, its effects and their urgency and severity are often subjectto many different interpretations. We can, however, be sure that decision-makers in theDutch public sector will be facing some daunting challenges. On the one hand, social andadministrative responsibilities oblige them to develop a vision on ageing. On the other, theywill be confronted with changes in the demand for public services, changes in theirproduction capacity and having to develop new forms of service delivery.

Within the next few years, significant changes can be expected in sectors such ashealthcare, local government, education, housing, justice and law enforcement. Pensionfunds and insurance companies will also be affected.

In our experience, discussion on the subject of ageing tends to be fairly one-dimensional.More often than not, decision-makers tend to focus on how ageing might affect their ownorganisation in terms of knowledge drain and loss of production volume, or how they canprepare for an ageing workforce. Surprisingly, there is not much discourse on how ageing isgoing to change society as a whole and what this will entail for the future tasks public sectororganisations will be asked to perform and the products and services they will be required toprovide.

In order to verify our observations and make a positive contribution to population ageingawareness, we asked Dutch decision-makers for their points of view on this issue. Using thethought model we have developed, we interviewed nineteen leading decision-makers fromvarious sectors on their insights, experiences and concerns with regard to population ageingand dejuvenation.

These sessions produced a lot of fresh concepts and reflections, as well as a call to allconcerned to step up to the plate and act upon ideas that have been circulating for quitesome time. Above all, the interviews provided food for thought, which is why we would like toshare them with you, the reader, by means of this booklet.

We would like to thank all interviewees and PwC staff who contributed to this booklet.On behalf of the PwC Ageing Taskforce, we wish you happy reading.

Gertjan Baars and Anneke OffereinsFebruary 2010


Contents

Preface 5

Introduction 10

1 Housing corporations 12“The care sector talks about ‘occupants’, whereas senior citizens tend to think ofthemselves as ‘residents’”. 13Peter Boerenfijn’s point of view

“People make their own choices about where they want to live, we are all individualconsumers.” 16Ton Selten’s point of view

2 Healthcare 20“Among ethnic groups, ageing might result in an interesting shift in demand patterns.”21Petra van Dam’s point of view

“The demand for geriatric care and disabled care is converging.” 24Ton Capsers and Alfons Klarenbeek’s point of view

“Care organisations need to think about how they want to position themselves in themarket: do they want to adopt a discount or a high-street format?” 26Albert Arp’s point of view

“We should no longer think in terms of living longer, but in terms of growing oldhealthily.” 29Huibert Pols’ point of view

3 Local and regional governments 32“Ageing can be compared to climate change and swine flu in the sense that everyoneknows it’s coming, but people are slow to swing into action.” 33Herman Sietsma’s point of view

“The challenges municipalities will be facing are going to require a lot of creativity.” 36Ralph Pans’ point of view

“Self-reliance is destroyed once municipalities start pampering their citizens.” 39Frans Mencke’s point of view

6 PricewaterhouseCoopers

4 Justice, law enforcement and safety 42“Ageing should be a more prominent issue within the Rotterdam Rijnmond SecurityRegion.” 43Don Berghuijs’ point of view

“Projections estimate that half of our current staff pool will have left the service bythe year 2017.” 45Leon Kuijs’ point of view

“Expectations are we won’t have to make significant alterations to our service

delivery concepts to serve the ageing target group.” 48Hans van der Vlist’ point of view

5 Health insurance companies and pension funds 50“Ageing is going to cause labour shortages.” 51Martin van Rijn’s point of view

“When it comes to care, part of the responsibility and initiative should be handed backto the public.” 53Roger van Boxtel’s point of view

“GPs will continue to play an important role in the community, but they will have tostart concentrating on their core tasks.” 56Martin Bontje’s point of view

“Staff shortage problems in the care sector are not yet acute.” 59Jeroen van Breda Vriesman’s point of view

6 Education 62“When it comes to staff recruitment, we are already having to look abroad more andmore often.” 63Dymph van den Boom’s point of view

“Ageing will create an ever growing demand for care-related training programmes.” 66Hermien Hendrikx and Simone Blenk’s

“For the education sector, one of the most pressing aspects of ageing is the factthat young people are increasingly moving away from rural areas.” 69Pieter Boekhoud’s point of view

Final words: the future has already begun 71

About the authors 75


Introduction

We all know the Dutch population is ageing.Better healthcare, improved working conditionsand shorter working hours have been increasinglife expectancy ever since the 1920s. Anotherimportant factor is the steep decline in birthssince the early 1970s. As a result, the number ofover-65s is rising while the working agepopulation is slowly declining. When ageingreaches its peak in the mid 2030s, the old agedependency ratio ((i.e. the proportion of citizensaged 65 or over to citizens of working age) isexpected to rise to between 42 and 46 percent(as compared to 24,5 percent in 2010).

An integral approach

During our discussions with public sector organisations,we have often observed a tendency to look at the ageingissue from a rather narrow point of view. Whereasdecision-makers often identify staff shortages andknowledge drain as significant effects of ageing, they arefailing to ask some related, equally important questions.How is client demand going to change and how can weprepare for this by adjusting our products and services?What opportunities does this present? How will ageingaffect our service delivery? How should we plan ourproduction capacity and what will it take to keepproduction volume up?

In order to elucidate the connections between thesevarious issues and place them in a coherent framework,PricewaterhouseCoopers has developed a model centredaround three key questions:

1. How is the market going to develop, i.e. how are(potential) care consumers’ supply and demandpatterns going to change?

2. What changes will have to be made to the wayproduction capacity is organised and whatopportunities are there to optimise and innovate?

3. Which new service provision concepts can beemployed to cater to (potential) care consumers’changing demands and requirements?

What: Market shifts in demand and supplypatterns

The precise effects of an increasingly elderly populationare hard to estimate. One of the few certainties is thatmost elderly citizens will have more time to spend onleisure activities after partially or completely retiring fromthe labour process. They often do volunteer work. Asthey no longer have dependent children, the position theyoccupy in society is fundamentally different, and theiraverage disposable income has been increasing steadilyover the years. Growing up in an era of economic growthmight has accustomed the near future generation ofpensioners to continuous financial improvement, but theyhave been around long enough to fully appreciate thisdevelopment. Pensioners are also becoming moreassertive and self-reliant, but nonetheless old ageinvariably comes with some physical and/or mentalimpairments.

Major shifts can also be seen in the young population.Today’s and tomorrow’s youths count on optimumsupport and having access to facilities such as IT to helpthem cope with the demands of a 24-hour economy.


HOW?Organisingproductioncapacity

WHO?Innovating

service deliveryconcepts

WHAT?Market shiftsin demandand supply

patterns

They were born in a time of affluence and seeminglyendless possibilities. Unaware of the effort that went intocreating it, they may find their standard of livingthreatened by population ageing and its mountingpressure on collective resources. This pressure will affectthe patterns of demand of the young and the old alike. Itmay even result in loss of intergenerational solidarity,which would present public sector organisations with theenormous challenge of having to find a suitable solution.

How: innovating service delivery concepts

Ageing may act as catalyst for innovating service deliveryconcepts to respond optimally to the changing wants andneeds of clients. With demand changing in nature andvolume and production volumes dropping, organisationsare forced to change and smarten up their work methods.Some existing work processes may even need to beabandoned altogether. Organisations should invest inmodernisation and innovation of products and services,such as the use of IT to make service delivery moreproactive and individually tailored. Examples are theimplementation of e-health in the care sector and theautomatic remission of certain municipal taxes.

We have found the most promising opportunities forproviding suitable and custom-made solutions lie inpromoting extensive and long-term partnerships betweenservice providers such as housing corporations, careinstitutions, educational institutes and governmentagencies.

Who: organising production capacity

Research shows that from 2011 onwards, a growingnumber of workers will be moving into retirement. Thisleaves a smaller number of people to do a possibly evenbigger job. Dejuvenation is expected to result in labourshortages that will put additional pressure on labourpotential. As staff members leave the workforce, valuableknowledge about products, processes and services maydrain away. These developments will be visiblethroughout the public sector as a whole. Work in thepublic sector tends to be relatively labour intensive, withcare and education being the first examples to come tomind. This means new insights are required on staffingpolicies, methods of knowledge retention and ways inwhich organisations prepare for changing patterns ofdemand.

Analysis model as interview formatThe three questions What? How? and Who? form acomprehensive, easy-reference analysis model by meansof which the ageing issue can be mapped out. Themodel also provided the template for the interviews weconducted. Making use of the What? How? Who? format,we asked decision-makers to present their points of viewon the effects of ageing.

The result is a cross-section of visions on ageing from ahost of sectors within the public service delivery domain:care, education, local government, law enforcement,justice, public safety and housing.


1 Housing corporations

“The care sector talks about‘occupants’, whereas seniorcitizens tend to think ofthemselves as ‘residents’”.

Peter Boerenfijn’s point of view


In the past, Boerenfijn explains, people who turned 65used to apply to their local councils for a place in aretirement home. A few years later, a room was assignedto them, and they would be taken care of for the rest oftheir lives. Those days, Boerenfijn feels, are over: “Seniorcitizens of the future no longer want to be fussed over”.Pensioners of the future want more luxury and are notkeen on moving into a cramped 25 square meter space.Unfortunately, 25 square meters is still the room size onwhich Dutch financial regulations (AWBZ) are based.Boerenfijn feels this is wrong. This is why Habion nolonger constructs care homes with these relatively smallrooms. Instead, it has opted for residential facilities with

75 square meter apartments to which care can bedelivered when required. In doing this, Habion has let goof the minimum subsidy standards stipulated by AWBZ.

This is not the only aspect of AWBZ that is not futurepensioner proof, Boerenfijn argues. “The care sector talksabout ‘occupants’, whereas senior citizens thinks ofthemselves as ‘residents’. People just want to live in theirhomes and be taken seriously.” The latter commentrefers to the practice of fitting care homes with glasspanel doors to allow nursing staff to check - and in manycases enter - a resident’s room. It goes without sayingthat senior citizens value their privacy as much as anyoneand would therefore prefer to have a lockable,non-transparent front door. Future retirement homes willproject a different image than today’s: they will no longerbe ‘care homes’, but residential buildings with carefacilities. Boerenfijn also denounces what he calls “thestale smell of Brussel sprouts, broccoli and fish”associated with retirement homes. By the year 2026these types of facilities will be outdated.

Boerenfijn thinks the AWBZ section on housing has littlemerit. “Why would over-65s suddenly be unable to paytheir rent? This is, after all, why we have housing benefits.”


Habion - Peter Boerenfijn

Habion is a nation-wide housing corporation that specialises inhousing for the elderly. Habion board’s consists of a single boardmember, Mr. P. (Peter) Boerenfijn) MRE, who has occupied thisposition since 2008. Prior to this, Boerenfijn was managing directorat Aedes, an umbrella association for housing corporations in theNetherlands.

Boerenfijn says a broader range of comfort and luxurypackages is beginning to emerge. Elderly people nolonger want a one-size-fits-all arrangement. This meansthere should be greater variation in the types ofresidences that are being built. The senior citizens of thefuture will have a higher disposable income and areaccustomed to a higher standard of living. Habionaccommodates this by building quality homes that areable to meet future demand. At present, Habion isoffering rent reductions to people with limited means. Infuture this will be compensated by chargingmarket-driven prices.

How: Innovating service delivery concepts

The wants and needs of future senior citizens haveprompted Habion to make different choices. Habion isbuilding relatively large apartments centred around aso-called residential service zone. “Services are there forthose who require them”, Boerenfijn explain. “Theyinclude care, but meal services and hair stylists are alsoon hand.” It is vital that these apartments are part of avibrant residential community. Informal care will becomevery important to prevent elderly people from becomingsocially isolated.

Senior dwellings should be ready for care delivery, butthis does not mean that every home should bestandard-fitted with special facilities. As an example,Boerenfijn mentions the grab rails that have beeninstalled in all care home toilets, whether the residents inquestion need them or not. Habion instead proposes tomake toilets grab rail-ready, so they can be easilyinstalled if and when they are required. Boerenfijn thinksthat making these kinds of small, practical alterations isvery important. He compares this concept to practices inthe car industry: “The plugs are there, they only need tobe plugged in.”

Boerenfijn foresees an important role for joint venturesbetween care institutions and housing corporations. Hefeels both types of organisations tend to be hampered byinstitutional thinking and would benefit from the formationof an intermediary organisation. “A kind of liaison, anamusement park manager if you will, who listens to whatthe client wants and is not hindered by the careorganisation/housing corporation machine.” Thisintermediary body should have a decisive say in mattersthat concern both organisations. Habion is a firm believerin private entrepreneurship and mentions so-called carehotels as a textbook example of thinking outside theinstitutional box.

According to Boerenfijn, collaboration is key and shouldextend beyond care institutes. “In the future, pharmacieswill disappear and medicines will be sent by mail. Thismakes TNT (the Dutch postal service) an attractivepartner.” This also goes for Sodexo, a food and facilitiesmanagement service, as almost every residentialcomplex will want to have their own grand café.Boerenfijn is less enthusiastic about mergers betweencorporations and care institutions. This would only resultin new institutional machines, which is the very thingBoerenfijn wants to get rid of. Partnerships are important,but service provision should stay small-scale, local andeasily accessible to clients.

Who: Organising production capacity

The average age of Habion employees is 46. Boerenfijnthinks this may pose a potential quantitative problem in20 years time. While Habion employees themselves willnot venture out on service calls, Habion will in the futurebe taking on the role of service organisation: “If someonecalls us about a leaky tap, we will call a local plumber tofix the problem.” The housing corporation has theadvantage of operating nation-wide and to some degreeit already operates as a service organisation.


Habion’s workforce consists of three groups: employeeswith 25 years of service, employees with 10-12 years ofservice and those who have been in service for less than3 years. The group that has been in service the longestrepresents a lot of valuable knowledge. Boerenfijn makesuse of these senior employees to hand down knowledgeto junior members of staff. “Older employees often comeup with practical solutions, which they share with junioremployees who tend to do things by the book.”

As various studies and media reports have shown, jobsatisfaction among home care employees is declining asa result of the growing number of regulations. A possiblesolution would be for care institutes to make use ofself-employed care workers, Boerenfijn says. Theseself-employed carers are assigned a certain number ofclients and are free to determine on an individual basiswhich tasks need to be carried out. The care sector iscurrently experimenting with this work method. However,a prerequisite for making it a success is making sureemployees are indeed willing and able to work in thismanner.

Senior citizens prefer having a trusted face to directpotential queries and complaints to. Boerenfijn ischarmed by the notion of instituting a caretaker. Anintermediary body (between care institute and housingcorporation) could in this respect act as client liaison.

“It is a fallacy to think that we should combat staffshortages in the care sector by hiring more staff”,Boerenfijn says. Many (future) over-65s want to have anactive role in society. These people can perform some ofthe necessary care tasks by providing informal care,which would contribute significantly to solving staffshortages. Only in nursing care, which comprises only afraction of total care provision, the staff shortage problemwill persist: “We should not burden over-65s with havingto care for over-85s with Alzheimer’s.” Scale increasewould be one way of dealing with the problem in thenursing sector. Boerenfijn expects that this scale increasein care will make its way to the heart of communities,rather than being ‘tucked away behind a row of trees’ likebefore.

Habion expects that technological developments willallow a decreasing number of people to carry out thesame amount of work. The corporation is alreadyincorporating home automation in some of its newhomes. The trend towards providing care in localcommunities will also cause the demand for staff to drop.“Many people will no longer have to be taken to hospitalby ambulance.”


“People make their own choicesabout where they want to live, weare all individual consumers.”

Ton Selten’s point of view


Selten feels that housing corporations can be expectedto look beyond their own housing stock and examinesupply and demand patterns from a broader perspective.The correlation between these patterns on a regionallevel can provide a starting point for the strategicdecisions housing associations have to make. From thisviewpoint, the merits of entering into partnerships withother parties are obvious. As a staunch proponent ofcollaboration, Selten has initiated several suchcollaborations. Lefier’s very origins can be traced back tothe observation that three corporations combined can domore to further the development of the Groningen andDrenthe provinces than they could possibly do on theirown.

Selten does not view population ageing as a problem, butfocuses instead on the effects it will have on people’sliving conditions and the level of resources in theso-called ‘undivided region’ in which Lefier operates.

Lefier not only looks at the housing stock it should becreating 10 or 15 years from now, but bases its work on alifestyle vision geared to the possibilities the ruralnortheast of the Netherlands has to offer to potentialresidents. According to Selten, the region’s strengths liein space and peacefulness, low land prices and the factthat it seems far removed from the hubbub of the highlyurbanised Randstad area.

That does not alter the fact that the combined effects ofageing and dejuvenation (young people are moving awayto the cities) will have consequences for Lefier. Themost significant effect is pressure on the value of thecorporation’s real estate. Selten: “I don’t quite understandwhy ageing should result in falling house prices. Thedejuvenation aspect I get, but not the ageing aspect.Won’t those people just want to stay and live in thatarea? Real estate value is one of the important pillars ofour corporation’s financial continuity. We need it to beable to make socially relevant investments.” For the sakeof public interest, Selten argues, housing associations


Lefier - Ton Selten

A.W.M. (Ton) Selten (Arnhem, 1953) is the chairman of Lefier, ahousing corporation in the cities of Groningen, Hoogezand,Stadskanaal, Borger-Odoorn and Emmen. He and three other boardmembers form the board of directors of this ambitious corporation.

In 1983 Selten graduated from the University of Groningen as asociologist. During his studies, he had become an active member ofvarious neighbourhood committees in Groningen's urban renewalareas, and in 1981 he started his career as a welfare worker inStadskanaal. In 1987 he joined housing corporation ECW, aprecursor to Wooncom, which merged with other housingcorporations to form Lefier in 2009.

Throughout the years, Selten has occupied several board positions inthe field of politics, labour, childcare, care for the mentally disabledand, currently, chess. He is also on the board of FWAW (Working onHousing Fund), Stichting Leergeld (Tuition Fee Foundation) andMKB-Emmen (an Emmen-based lobby organisation for small andmedium sized companies) and he is the chairman of two steeringgroups formed by housing corporations operating in the northernpart of the Netherlands.

should ensure that their real estate portfolio is not tooone-dimensional.

Achieving a balanced real estate portfolio was the mostimportant motivation behind the Lefier merger. TheWooncom and Volksbelang corporations were alreadyengaged in talks, but analysis of their joint portfoliosshowed that they would be vulnerable to the effects ofthe population drop taking place in both their areas. Theirhousing stock could be described as being more of thesame in a similar market.

In order to reduce vulnerability, the Groningen-basedhousing association In became involved in the merger.The urban Assen-Groningen axis is viewed as a Northerngrowth area, boasting two cities with an obvious appealto young people. Adding a strong partner in Groningenwould therefore help spread the risk. Selten: “If it rains inone area, the sun might just come out in another. Allresidents will benefit from this merger. The capitalWooncom has acquired in the past can be used to attractfunds for investing in Groningen and Hoogezand. Thecapital thus acquired can in the future be used to investin areas with shrinking populations, where Wooncomowns a lot of property.” Simultaneously, Lefier is seekingto collaborate with municipalities, social organisationsand other housing associations based in the northernprovinces to work on harmonising the supply of socialfacilities. This is what the term ‘undivided region’ standsfor.

“We use the term undivided region because municipalitiesrely on one another. Let’s say a city has a train stationand a theatre. These facilities will not only be used by citydwellers, but by people from the surrounding villages aswell. Vice versa, day trippers from the city visit thesevillages to enjoy the pastoral setting. Similarly, thecontours of the region are outlined by housing careersand relocation movements.” According to Selten, thechallenge lies in convincing municipal executives thatregional collaboration is crucial. “The undivided regiondoes not have its own governing body and the province’s

hands are tied if municipalities are unwilling toparticipate.”

Selten knows from experience it is hard to motivatemunicipalities to adopt the notion of an undivided region,as the following example demonstrates. A number ofmunicipalities in the eastern part of the Groningenprovince are planning on building 4,000 new dwellings inthe coming years, but studies have shown that only 300homes are needed. Several municipalities got togetherand reached a compromise that involved the constructionof 2,100 houses. “Although these municipalities are wellaware of the fact that the demand for housing isn’t thathigh, all of them feel the required 300 houses should bebuilt in their municipality.” The end result is adisproportionately large number of new homes. TheGroningen province is pleased that the numbers havebeen brought down from 4,000 to 2,100, but does nothave the authority to step in and reduce them evenfurther. Fortunately, things may not be as bad as theyseem. It is unlikely the number of houses on paper areactually going to be built. They reflect projections thatwere formulated and laid down in zoning schemes yearsago.

The area in which Lefier operates is already seeing a dropin real estate value. The municipality of Delfzijl (whereLefier does not own property) is a prime example, withdozens (and at one point even hundreds) of vacanthomes. The resulting capital destruction is twofold: firstthese houses had to be built and now they will bedemolished before they are even occupied.This negatively affects the house prices and the quality oflife in these areas. Selten therefore calls upon all partiesinvolved to take a more demand-driven approach tospending social capital.

“Provinces such as Drenthe and Groningen appeal tosenior citizens who want to escape the crowds. They arepeaceful, offer many possibilities for recreation and landprices are low. Young people, on the other hand, likevitality and diversity. It will be very hard to hang to them,particularly in view of the fact that higher education


institutes in this region have a limited curriculum. Maybewe should not even try to hang on to the young. Althoughmany senior citizens nowadays stay completelyself-reliant for a very long time, they will at one point intheir lives become dependent on care. When thishappens, it is important to bring care to people’s homes.Every village could offer some form of assisted living,provided there is sufficient demand for such schemes. Ifthis is not the case, facilities will not be put to optimumuse and social capital is wasted. This is why you mustmake sure there is no oversupply of facilities. This canonly be achieved by organising highly specialised orspecific facilities at a higher level.”


In view of the notion of the undivided region, it would bedesirable to bundle facilities, e.g. establishing a RegionalEducation Centre, a regional hospital and welfarefacilities in one area. Creating smart link-ups with majortransportation hubs is also very important: accessibilityhas to be planned and organised. Other areas within theundivided region (i.e. outlying villages) should have asound transportation network and some type of primarycare facility. This facility should be able to answerquestions on care, welfare, local government or housingrelated issues directly or make referrals. In order toachieve this, Lefier has collaborated with municipalities,care institutions and welfare organisations to launch avocational training scheme. After completing theirtraining, employees of the participating organisationshave more insight into how other organisations work,allowing them to operate on a more integral,demand-oriented basis from their local support facilities.

Senior citizens who are toying with the idea of headingnorth to find tranquillity and low prices do offer someopportunities for entrepreneurs and others parties. Seniorcitizens have a keen interest in culture, but Selten feelsthe region’s cultural offerings are at present rathernarrow. Also, the expanding geriatric care sector willcreate jobs and may help bring down relatively high youth

unemployment rates in some parts of the region. Trainingwill, however, be required. “Maybe senior citizens will beworking for a longer period of time. Society is flexible andcapable of absorbing changes. Let populationdevelopment be the guiding principle, and employment issure to fall in line.”

It is unlikely that parties in the undivided region such ashome care organisations, hospitals, (public)transportation companies, welfare organisations,education institutes, housing associations, businessesand municipalities are going to join forces of their ownaccord. There is no coordination and no governing bodyfor these parties. “At some point, organisations will haveto start getting together and make sure they get on thesame page,” Selten says. This is why Lefier andVNO-NCW (Confederation of Netherlands Industry andEmployers) scheduled a meeting between largecompanies and social organisations, during which itbecame clear that all parties appreciated the issues thatare at stake. Collaboration and focus are paramount. “Asupra-municipal approach would suit the scale of theproblems.”

According to Selten, consultation between these partiesshould result in a social debate on a unified direction anda joint strategy. Subsequently, a programme may bedeveloped that is sanctioned by the provinces, preferablyin such a way that it binds municipalities to its stipulations.

Selten: “People make their own choices about wherethey want to live. We are all individual consumers.” Inpractice it is still hard for Lefier to think of senior citizensas individual consumers. It is crucial to remember thattomorrow’s generations of senior citizens will be morehighly educated than today’s and have more disposableincome. They will no longer allow others to make theirchoices for them. Lefier will have to learn how to dealwith these outspoken senior citizens, particularly whenthey do not yet depend on care. Consumers will be muchmore critical. “On a micro level, this is an enormous task.Senior citizens will display a wide range of lifestyles and


housing preferences. Generalisations won’t cut it. This isan issue we still need to explore.”


“Approximately half of Lefier’s maintenance workers areover 50. A significant portion of those will leave the labourforce in the near future”, Selten notes. This raises thequestion of whether Lefier will be able to call uponsufficient technical staff in the years to come. This alsogoes for the building firms Lefier collaborates with. Theytoo will have to maintain a sufficiently large and qualifiedstaff pool in order to fulfil their obligations to the housingassociation.

This is why several northern housing associations havejoint forces with Regional Education Centres and theFundeon knowledge centre. As part of theirage-conscious policy, housing corporations are settingaside construction assignments in order to set up studentconstruction sites and additional apprenticeships andwork experience posts. During these apprenticeships,older generations educate the young on professionalskills through a journeyman-student approach.

Selten is enthusiastic about this approach, which allowsolder employees to become or remain productive acrossvarious sectors. This means more can be achieved on alarger scale. This is a good thing, because senioremployees represent a wealth of knowledge that can bepassed on to younger generations.


2 Healthcare

“Among ethnic groups, ageingmight result in an interesting shiftin demand patterns.”

Petra van Dam’s point of view


In Amsterdam, Arkin’s main area of operation,demographic shifts present a picture that seems to differfrom the rest of the country. In part, this is the result ofhousing and economic policies and the fact that the cityis home to two universities. The large number of residentswith an ethnic background also contributes to Amsterdamhaving a relatively young population. Projections say thatin 2012 approximately 12 percent of the population willbe 65 or over.

Remarkably, Arkin’s client base has seen the proportionof clients over 65 drop in the past few years. On the onehand, this can be explained by changes in the pattern ofdemand, with an expanding client group of people under

the age of 65. On the other hand, it may be caused bysupply pattern developments. It is possible more clientsare being treated by primary care facilities or new careproviders.

At present, approximately half of Amsterdam’sinhabitants are of ethnic origin. Among residents of 65 orover, 74 percent are of non-ethnic origin and 13 percenthave a non-western background. Projections estimatethat in 2030 these percentages will be 58 percent and 30percent respectively.

These demographic developments have an effect ondemand patterns in the field of psychiatry and drugcounselling. Population ageing will lead to shifts in thesepatterns. One of the most pronounced will be a risingdemand for somatic care. Van Dam thinks care providersshould adapt to these changes in care demand. To meetthe population’s changing care needs and requirements,adjustments should be made to care programmes,housing, work locations and the location of (outpatient)clinics.

The relatively large proportion of seniors of ethnic originamong the ageing local population reveals an interestingshift in care demand. Health-related problems tend to


Arkin - Petra van Dam

Drs. M.E. (Petra) van Dam has been on the board of Arkin sinceSeptember of 2008. Arkin was established on 1 September 2008 asa merger between JellinekMentrum and AMC de Meren. Arkinprovides drug treatment and mental healthcare services inAmsterdam and Gooi & Vechtstreek, ranging from prevention toforensic psychiatry. Arkin employs over 3,600 employees at 43regional locations, plus three locations outside the region. By the endof 2009, the merger partners combined were treating or providingcare for some 25,000 clients.

differ among ethnic groups, with depression, for instance,being much more prevalent among people with a Dutch,non-ethnic background. How care demand will developamong the second and third generation of people with anethnic, non-western background is hard to predict.

So far, scientific research into these differences in carerequirement has been fairly limited. Not much is knownabout demand development among the differentgenerations of ethnic groups. It is possible that secondgeneration senior citizens with an ethnic backgroundexperience problems that are much more similar tonon-ethnic seniors. Shifts in care demand requireadjustments to care offerings. Van Dam stresses theimportance of training institutes. They should respond tothese changes as best they can to make sure newgenerations of care providers are familiar with evolvingcare demand. Input from the various target groups isindispensable. The special consultation hour for elderlyChinese women is a textbook example of how careofferings can be modified to fit demand.


In the future, the use of new technologies will be playingan important role in mental health care and addictiontreatment. Various forms of counselling are alreadyavailable online. Their application should always beintegrated with face-to-face treatment, however. Onlinetreatment always has to be linked to the case file in someway and tie in with the treatment process as a whole. Toprovide optimum services, e-health and face-to-faceconsulting should be integrated. This allows socialworkers’ productivity to increase and care to be tailoredto individual needs.

The application of online treatment has led to someinteresting outcomes. Online, clients prove to be far moreopen than they would have been in face to faceencounters with care workers. Van Dam explains: “TheInternet encourages clients to display a greater degree ofcandour in sharing their experiences.” Online counselling

has the added benefit of allowing a more flexibleorganisation of care, because it can be delivered moreeasily and to any location. But, as Van Dam says,“appointment times should be more rigorously managed,because neither carers nor clients want or can afford towait long for the other party to log on.” The introductionof care via the Internet has signified a change in the typeof contact care workers have with their clients.Understandably, there has been some apprehension.How will the lack of non-verbal cues affect the quality ofservice and what will be the effect of clients’ greateropenness? Arkin expects an increase in the number ofscreen-to-screen treatments and a more important rolefor IT in the care industry. This will in turn allow a relativereduction in the number of face-to-face patientencounters.

Ageing will also necessitate changes to housing andhome design. An increase in somatic comorbidity willrequire specially adapted facilities. Standards ofhospitality will also have to be geared to new clientgroups. Clients want to be able to feel welcome and atease when meeting care providers and they are justifiedin expecting ever higher standards of service.


The number of Arkin employees in the 45-58 age bracketis three percent higher than the Dutch average. Studiesamong Arkin employeers have shown that older membersof staff do not experience more work-related pressurethan younger staff and continue to develop within theorganisation. Van Dam indicates attention should be paidto retention policies to prevent employees from leavingthe organisation.

In order to hang on to employees, Arkin offers professionaltraining schemes and promotes internal mobility. Theorganisation also maintains close ties with educationalinstitutions to recruit new staff. In order to make theirtraining future-proof, these training institutes shouldbecome better attuned to what is happening in the field.


Arkin is participating in a local Education and CarePlatform to improve the compatibility of training with workfloor practices. Furthermore, the mental healthorganisations GGZ are working together at makingagreements on a collective employment agreement andtraining schemes for staff members. Arkin feelscompetition on the labour market is becoming morefierce, especially with regard to recruiting highlyspecialised care workers. Employers no longer shy awayfrom offering competitive salaries and the battle forpersonnel is often fought and won by virtue of relativelyminor differences in employment terms. One mightwonder whether all this will really help keep futureemployees motivated. Research shows that the newgeneration of care professionals find having an interestingjob, nice colleagues and pleasant working conditionsmuch more important than earning a high salary.Discontinuity in professional staff will have an adverseeffect on the quality of care across the sector.

In the future, Arkin will have to find alternative methods toretain employees. Van Dam expects to make headwaywith this issue by changing the way the work isorganised, for instance by allowing employees to opt fordifferent rota systems, more flexible work hours and avariety of contract types.



“The demand for geriatric careand disabled care is converging.”

Ton Caspers and Alfons Klarenbeek’s point of view


Over the past fifty years, the life expectancy of peoplewith a moderate to severe mental impairment has beengoing up, from approximately 30 a few decades ago to60 today. Caspers indicates that people with a mentalhandicap tend to age more quickly than the averageperson. This ageing process comes with associateddiseases such as Alzheimer’s and cancer and progressesmore rapidly. This typically makes the care processshorter but more intensive than normal. Unlike home careand nursing, population ageing initially does not seem tohave a significant effect on the number of older clients indisabled care. Casper explains: “The influx of clientsremains relatively stable. Many clients spend their lives ina care institute or assisted living facility, which they moveto on average at the age of 20-24. They usually stay inthese facilities until they reach old age.” In addition, it isvery hard to put an exact number on the influx of clients,which according to Caspers is the result of variousdevelopments. “On the one hand, the trend of care as

societal responsibility seems to lead to a drop inintramural care. On the other hand, changes in laws andregulations have resulted in a transfer of clients frompsychiatric to disabled care. New target groups areemerging. The number of young people with minormental impairments is growing, leading to an overallgrowth in the number of clients. There is also an increasein clients from an ethnic background.” The latter targetgroup has shown a remarkable trend: young ethnicclients tend to make use of day care centres and daytimeactivity schemes until they reach maturity, after whichthey leave the care institute system and are cared for byrelatives (with or without the aid of a personal carebudget). Finally, there are various geographical changes.“In the past, clients came from all over the country.Nowadays, most clients come from the region in whichthe facility is located.” These developments combinedmake it hard to accurately predict the influx of newclients.

Amerpoort not only deals with the recipients of disabledcare, but with their families as well. One of the strikingresults of ageing is that the informal care for relatives withmental handicaps is beginning to shift from parents tosiblings, as the former are getting too old to perform theircare duties. Younger generations usually have their owntake on how things should be handled and they tend todo things their own way.

Amerpoort - Ton Caspers(board of managers) and AlfonsKlarenbeek

Amerpoort’s management board consists of asingle board member, drs. A.M. (Ton) Caspers,who has occupied the position since 1999.A. (Alfons) Klarenbeek is a policy officer withAmerpoort who has been working on thepopulation ageing issue. Amerpoort offersassisted living services to people with mentaldisabilities and answers their questions ondaytime activities, leisure activities and housing.Amerpoort’s area of operation includes theprovinces of Flevoland, Utrecht and part ofNorth-Holland.


There are many shifts in the care supply. Whereasdisabled clients used to live in large, often relativelysecluded complexes, they now typically live insmall-scale assisted living communities that are verymuch part of society. It should be noted this only goes forclients with minor to moderate mental impairments;people with severe mental disabilities usually live in careinstitutes. Particularly for younger clients there are manyspecial small-scale housing and care concepts, such asthe Thomas Homes and several private initiatives.Caspers wonders what will happen to these clients whenthey get older. “It is possible that this category willeventually end up in larger, more sheltered housingfacilities.”

In the future, Caspers sees possibilities for partnershipswith the nursing and (home) care sector. “Preferably,clients should be able to live in their local region. This canbe realised by collaborating with the nursing and (home)care sector.” According to Caspers, geriatric anddisabled care demand are converging. Regional careprovision can be improved by sharing capacity andresources. “This will ultimately evolve into a networkorganisation”, Caspers explains. “Individual careproviders cannot by themselves provide housing andcare concepts for all these different categories: theyoung, the old, the slightly impaired and the severelydisabled.” Intensifying collaboration within the care chainwould also result in a more diverse care supply. “It isimportant for clients to have options. We shouldaccommodate this by building both small-scale grouphomes and large-scale residential facilities.” In order torealise this, Amerpoort has formed partnerships withhousing associations and nursing and care organisations.


To ensure a sufficiently large and competent staff pool,care providers should effectively position themselves inthe labour market. “When it comes to labour potential,quality, not quantity, is the key”, Casper says. “You haveto be able to find the right people and bind them to yourorganisation.” For now, Caspers does not think ageingwill prove to be a major stumbling block for staffrecruitment. In this respect, the disabled care sectorseems to differ from (home) care and nursing. “The influxof clients is fairly constant and most of our staff tend tostay in service for a long time. The diversity of positionsand activities in the disabled care sector allows forgreater flexibility and a wide range of career options.When certain tasks become too physically demanding forolder employees to carry out, they can transfer tophysically less demanding positions such as ambulantcare. Things tend to work themselves out.” Caspers doesnot expect implementing IT or technologies like homeautomation and labour-saving techniques to make amajor contribution to improving labour productivity. Hefeels optimum working conditions are much moreimportant. “Give employees the regulatory space tostructure their work in an efficient manner. This will alsohelp ensure optimum care provision.”

In order to promote the steady rejuvenation of theworkforce, Amerpoort maintains close ties with schoolsand offers training positions to students. In addition, theorganisation tries to attract workers from the (home) careand nursing sector. “Ours is an attractive sector to workin. This shows when we are recruiting new staff. Weappeal to people from a wide variety of carebackgrounds.” In this respect, collaboration betweenfellow care organisations is an important means foroptimising labour market exposure for the sector as awhole.


“Care organisations need to thinkabout how they want to positionthemselves in the market: do theywant to adopt a discount or ahigh-street format?”

Albert Arp’s point of view


Many care organisations formulate a strategic focus thatcovers a three to five year period. In order to settle on asound strategic course and determine which choices theorganisation should be making, it is essential to grasp theimplications of long-term care developments. How willthese developments affect real estate and buildingpolicies? “This means you are basically talking about atwenty to twenty-five year time span”, Arp explains. Hesays his organisation is trying to get a handle on this, withprevalent diseases and people’s habits and lifestylesbeing determining factors. The effects of ageing on allthese segments can be mapped out by making

product/market combinations. Arp expects that marketdynamics will have an increasing role to play in caresupply and demand patterns. “Clients will have a greatersay in the types of products and services that areavailable to them.”

In the future, care consumers who are reliant on care(5-10 percent of over-60s) will no longer be the mostsignificant target group among the over-60s. A section ofthe market is starting to aim its attention at the group ofhealthy over-60s, the so-called coming consumers.These healthy seniors want to be able to choose from arange of products and services offered to them by anarray of providers. Arp expects that the care sector willincreasingly start focussing on people’s lifestyles and onfinding ways of tuning into them. “To get insight into theneeds and requirements of target groups, care providersshould divide them into segments, draw up client profilesand, similar to what the private sector is already doing,adapt their care offerings accordingly”, Arp says. “Careorganisations need to think about how they want toposition themselves in the market. Do they want to adopta discount or a high-street format? Choices will inevitablyhave to be made.


Beweging 3.0 - Albert Arp

Drs. A.C. (Albert) Arp serves on the board of Beweging 3.0, a careorganisation in the Eemland region that engages in a wide range ofhousing, care and welfare-related activities aimed specifically atclients in their third phase of life. It meets its clients’ needs andrequirements by providing care, assistance and social support, aswell as suitable housing concepts and services. Beweging 3.0employs over 3,800 professionals, making it one of the largestemployers in the Eemland region.

Projections say that ageing will lead to a noticeable rise incare demand, but as result of dramatic staff shortagesproduct volume will not be able to keep up. Manyorganisations are probably already having troublemaintaining production volume. Arp expects thatcompetition on the labour market is going to be stiff.


In order to meet the growing demand for care, careinstitutions should look for new methods of serviceprovision that are much more efficient and broader inscope. In collaboration with other large careorganisations, Beweging 3.0 is looking into thepossibilities of making use of telecare. “Remote carepromises a large service volume at relatively low cost”,Arp explains. “But since regular financing schemes suchas the Exceptional Medical Expenses Act will not befooting the bill, an adequate business case is needed toprove this service delivery concept is indeed viable.”Modernisation of the care sector seems to be a hard nutto crack. According to Arp, there are two main reasonsfor this: “On the one hand, not enough resources arebeing set aside to invest in innovation. On the other hand,innovation has not yet gained momentum for want ofvision. The leadership and courage needed to makeinnovation a success seem to be lacking.”

This touches upon a new issue. “Every citizen has theright to receive care, but how are we going to beproviding it in the future and, more importantly, how arewe going to finance it? The central government will haveto make some choices, because the current way offinancing is not going to suffice when care demandrises.” With regard to future financing, Arp is thinking ofhybrid systems combining public and private financing.He also thinks care organisations might have to considerestablishing alternative legal entities, such as new formsof shareholdership. “Geriatric care is currently at animpasse. Right now, there is still no sign of modernisationor innovation at sector level”, Arp says.

In order to become a catalyst for change, Beweging 3.0wants to act as regional frontrunner in innovation andimprovement. This is why the organisation is workingvigorously on a variety of social issues, such as openingup the labour market to people with an ethnicbackground. Beweging 3.0 is also actively seekingpartnerships with other parties (such as municipalitiesand the Ministry of Social Affairs).


According to Arp, a lot of work remains to be done onimproving geriatric care, which would lead to significantcost reductions. “Seventy percent of geriatric careservices can be standardised. Processes can bestreamlined and designed in a more efficient way,overhead can be drastically reduced. The remaining thirtypercent of care services are tailored to the individual andshould be paid for through additional health insuranceschemes. It goes without saying that the target group’sneeds and requirements should be mapped out in detailon the basis of a sound business case. Arp can see a lotof benefits in scale and volume increase. “As adecision-maker, you need to carefully consider whattypes of activities your organisation should be engaged inand which activities can be outsource to others. Onlythen can you reap the benefits of a larger scale ofoperations.” Arp, who used to work in consultancy beforeembarking on a career in care, acknowledges the factthat the healthcare sector is not yet ready to take abusiness-like approach to care, but does observe a morecorporate approach to management. “Decision-makersare beginning to take into account the expected output oftheir strategic decisions.” Partly due to the economicdownturn, solvency and funding are becoming majorissues.

For employers, it is crucial to distinguish themselves fromthe competition. They have to become employers ofchoice and make themselves attractive to potentialemployees. “Organisations are fishing in a small pond.


Therefore, it is important not to focus exclusively on thecare sector, but to direct efforts at attracting staff fromother sectors as well.” Arp: “The current economy is aneconomy of perception. People want to work for anorganisation because they feel proud to be part of it.”Many care workers tend to work for the sameorganisation for a very long time, moving up the careerladder until they reach a management position; a trendthat Arp describes as “football players evolving intocoaches”. Not all employees are going to thrive in a morebusiness-like environment, however. “You need to investin the employees that do make the grade, so that theymay develop into a solid middle management layer thatpropels the entire organisation forward.”

How can care organisations retain and recruit employeesin a strained labour market? Hiring self-employed staffmay seem like a good solution, but self-employedworkers carry the risk of not being as loyal or willing tocommit themselves to any one particular organisation.Turn employees into shareholders, or stakeholders at thevery least”, Arp suggests, “but remember this will onlyhave an effect if these workers get an actual say in thedecision-making process.”

According to Arp, these processes take time to come tofruition. “Changes to the ‘hard’ side of organisations maytake one, maybe two years to implement, but realisingdesired changes to the ‘soft’ side may take up tobetween three to five years.”


“We should no longer think interms of living longer, but in termsof growing old healthily.”

Huibert Pols’ point of view


Population ageing brings to the fore several issues, oneof them being the accessibility and affordability of care.The rising number of geriatric citizens is likely to put anincreasing amount of pressure on intergenerationalsolidarity. According to Pols, this should be the subject ofprofound social debate. He feels healthcare reforms arenecessary to ensure that care remains accessible to all inthe years to come. In his view, this should entail a systemwith some type of basic universal care and additionalcare that clients can opt for at a premium. Pols expectsthe future care arena to be much more tailored toindividual needs, with clients taking responsibility for theirown health and taking charge of their own care

processes. “Personalised medicine will be a widelyaccepted notion in the future.”

Pols does not view ageing as a burden, but rather as achallenge. Tomorrow’s senior citizens will have a higherdisposable income than today’s and they will displaydifferent wants and needs. Pols has dubbed this group ofwealthy seniors the silver economy. This silver economycreates opportunities for developing specific careproducts and services. “Not only will there be moresenior citizens, but seniors will also live longer”, Polsexplains. “For every week a weekend.” This also meansthat the elderly will be relying on care for a longer periodof time. “Fifty to sixty percent of people over the age ofseventy have two or more medical conditions”, Pols says.He feels the current disease management model aimedat living longer should be discarded in favour of a qualityof life model aimed at growing old healthily. “By startingthis approach early, through exercise and healthy eating,many people will be able to stay in good health for alonger period of time. Prevention offers a lot ofopportunities.”


Erasmus Medical Centre - Huibert Pols

Prof.dr. H.A.P. (Huibert) Pols is the vice-chairman and dean ofErasmus Medical Centre. Pol went to medical school in Rotterdam.Prior to occupying the post of dean and vice-chairman on EMC'sboard of directors, he served as head of the Internal Medicinedepartment. Pols helped establish Ti-GO, a platform for geriatrichealth.


In order to optimally gear care offerings to clients’ needs,we will first have to do some research into what theseneeds actually are. “Ti-GO makes use of senior citizens’focus groups to assess their requirements and determinewhether these can be met by our proposed solutions. Inthis way, we are working together with seniors atdeveloping products and services.” Collaboration isparamount, Pols explains, because there seems to be agap between users and providers. “Eighty percent ofappliances that are developed specifically for elderlyusers are never actually used because they do notcorrespond with their personal needs.” He elaborates:“Today’s senior citizens are used to establishing apersonal bond with their care providers. They valuepersonal contact and it will take time for them to get usedto other forms of communication.”

It remains to be seen whether labour-saving technologiesor innovations will deliver the desired results. “You canimplement all kinds of home automation such as falldetectors, but as long as there is no system in place toprocess the data and take appropriate action, thepractical use of these technologies is virtually nil.”

Many innovations are yet to see large-scale introduction.According to Pols, this is the result of a lack ofconsensus on the standards these innovations have tomeet and a lack of centralised coordination at national orregional level.


Due to the rising demand for care and diminishing labourpotential, new solutions will have to be found to maintainproduction capacity. Pols feels that keeping seniorcitizens actively involved in the labour process andpushing back the retirement age may help increaselabour potential. “For some senior employees, this maymean having to take a step back on the career ladder,returning to a position they occupied when they wereyounger.” According to Pols, this idea has met with majorreservations, mostly because people fear losing thesocial prestige their former position commanded.Nevertheless, the question we ask over-65s should nolonger be ‘when are you going to retire?’, but ‘what areyou going to be doing next?’. This requires a change inmentality.”

According to Pols, information and communicationtechnology can play an important part in enlargingproduction capacity. This means we have to take a freshlook at the care process and come up with a different setof answers. Technological developments may helpdecrease the number of medical check-ups becausepatients will be able to contribute to their care process athome. This does, however, require a degree ofresponsibility and self-reliance on the part of the patient.

Efficiency improvements can also be realised by alteringthe way care processes are organised. Pols feels labourproductivity in hospitals can be increased by improvinginfrastructure. Standards have to be developed to designprocesses in a more efficient way. Reassigning tasks(e.g. delegating duties from physicians to nursepractitioners) may also be a possible solution. Pols feelsthere is still much to be gained in this respect.


3 Local and regionalgovernments

“Ageing can be compared toclimate change and swine flu inthe sense that everyone knows it’scoming, but people are slow toswing into action.”

Herman Sietsma’s point of view


“At the moment, ageing is not a priority item on theprovincial agenda”, Sietsma says. Population ageing is,however, going to affect the province in numerous waysand occasionally it is a topic for discussion in theprovincial domain.

The province of Utrecht will have a grace period beforethe consequences of population ageing start to becomeapparent, but this does not mean there will be noproblems. Sietsma explains: “Utrecht is currentlyexperiencing a growth spurt, with many young peopleand families being drawn to the province.

These groups tend to favour the (larger) cities, however,which means the consequences of ageing will strike thesmaller towns and villages first.”

Partly due to the Lodders report, many provinces feel thatthey should primarily concern themselves with tasks inthe physical rather than the social environment. As aresult, provinces are increasingly reluctant to carry outsocial and cultural tasks, feeling these are primarilymunicipal responsibilities. In the recent executiveagreement, the number of social tasks for provinces hasbeen reduced, mostly due to budget cuts. Currentspearheads of provincial policy are regional development,road construction, infrastructure and the environment.This means social issues are not included in provinces’primary set of tasks.

Sietsma is adamant, however, that ageing should notforce the province to withdraw from the social domainaltogether: “Constitution-wise, provinces are openhouseholds. They are entitled to take on the tasks theydeem necessary. A province is a community onto itself.When ageing results in the closure of facilities in smallcommunities, such as shops and care institutions, aconnective provincial policy may be essential.


Province of Utrecht - Herman Sietsma MPA

Drs. H.H. (Herman) Sietsma is the provincial clerk and general headof the official apparatus of the province of Utrecht, acting as liaisonbetween the Provincial Executive and the civil service. Sietsmaserves as chairman on the board of directors and in this capacitycarries final responsibility for the provincial civil service apparatus.

Ageing may thus shift the provincial focus back to dealingwith certain social tasks.”

Sietsma explains: “The quality of care diminishes due tolack of social cohesion and the trend of giving marketdynamics free reign. Ironically, the need for care in asociety that is both ageing and losing cohesion will growexponentially. We may no longer be able to take forgranted that care resources (care institutions and informalcare resources) are evenly distributed across the countryand among population groups. According to Sietsma, thebiggest challenge lies in answering the followingquestion: “Are we capable of safeguarding a society thatupholds human values, combats social isolation andallows all its citizens to participate?”

Small communities have already indicated they wouldbenefit from a provincial policy on communities. This is,for instance, why a local library programme has recentlybeen launched. At supra-municipal level, the (central)government will probably need to expand its role in careand education, two sectors which have thus far beenoperating without much government involvement. Thisrequires a significant cultural change.

Ageing will also present the province with somechallenges with regard to spatial planning. The provinceof Utrecht is dynamic and relatively rich in areas ofnatural beauty, and is committed to preserving theseassets as they meet important social needs. There is alsoa large demand for housing. “There seems to be awidening chasm between social needs (social cohesionand the young population’s demand for housing) and thelimits to home construction. We need to balance thedemand for new dwellings with the quality of life asenvisioned by the province. Changing social needs willmake supra-local frameworks more important”.

In Utrecht, the ageing problem is a little less pronouncedthan in other provinces and as a result, ageing-relatedpolicies are as yet not as decisive as they could be:“Ageing can be compared to climate change and swineflu in the sense that everyone knows it is coming, but

people are slow to swing into action.” At present, policyand spatial planning documents sometimes briefly touchupon the population ageing issue, but Sietsma does notrule out a future need for specific provincialageing-related policies that view the various problems asaspects of ageing rather than the other way around.

Regardless of its rather privileged position, Utrecht has inthe last few years launched several pilot projects withregard to ageing-related problems, most of them in thefield of regional development. The province has, forinstance, ‘adopted’ several neighbourhoods with a viewto making them more ‘life phase proof’, financiallysupporting community projects for incorporating theconcept of home automation in the designs for the newVeenendaal-Oost district and the redevelopment of theOndiep district in Utrecht. “In this way, Utrecht showsthat it is aware of the need to adapt products andservices to meet changing social demand. The role of theprovince lies mostly in facilitating this process andcreating the right preconditions.” Sietsma also seessharing knowledge gained from pilot projects like theseas an important provincial task.


Sietsma indicates that there seems to be a downside toemploying technology. “Closing down service points andreplacing them with online services may run contrary tosociety’s needs. Society relies on social cohesion tocombat phenomena such as social isolation.” The roleprovinces can play in this issue is limited, according toSietsma. “Citizens rarely deal with provinces apart fromapplying for certain permits. Their municipality is their firstpoint of contact; provinces merely create the frameworkand conditions within which municipalities operate.”

Provinces do concern themselves with measures to gearpublic service delivery to changing demand, however,albeit in a more indirect way. The province of Utrechtpromotes initiatives such as age-proof housing, whichallows senior citizens to live independently for an


extended period by giving them access to external andin-home resources. “For provinces, changes in servicedelivery concepts should focus mostly on erecting asound supra-local framework and creating the rightconditions by allocating the appropriate funds.”


According to Sietsma, raising the retirement age to 67 isgoing to be an important and virtually inevitableramification of ageing. This change will lead to anincrease in labour potential, causing a large group ofpeople to remain productive rather than merelyconsumptive for a longer period of time. Despite unionresistance, it is only a matter of time before measures likethese will have to be implemented. “Early retirementschemes that allowed workers to retire at the age of 57used to be fairly common, but now the concept isvirtually inconceivable. The argument that olderemployees cost more than younger staff no longer seemsvalid.” Increasingly, employers are beginning toappreciate the knowledge and experience that olderemployees bring.

In the fairly recent past, the province of Utrecht hasexperienced an outflux of older civil servants. Thevacancies they left behind have been filled by youngerstaff. It has never been difficult for the province to recruityoung personnel, due to the region’s appeal to thisparticular target group. Also, the province maintains closeties with both the University of Applied Sciences (HU) andthe University of Utrecht (UU). The province benefits fromthese institutions’ innovative capacity and has littletrouble in recruiting talented, highly educated graduates.Nonetheless, the province of Utrecht devotes a lot ofenergy to keeping its new recruits motivated to makesure they stay in service. Utrecht has to safeguard itslabour potential across the board. “But luckily”, Sietsmasays, “Utrecht occupies a rather favourable positioncompared to other provinces: there are no large greyclouds overhead.”


“The challenges municipalities willbe facing are going to require a lotof creativity.”

Ralph Pans’ point of view


“It is important to view ageing in relation to municipal andregional dejuvenation”, Pans starts off by saying. “Whenyoung people are moving away, the age dependencyratio goes up. Young people’s activities are therefore akey factor in assessing the effects of demographicdevelopments on municipalities.” That approximately halfof municipalities will be experiencing negative growth inthe coming twenty years is a given, but the ramificationsof this development will vary across the board.Particularly municipalities and regions with shrinkingpopulations will be facing major challenges, but as Pansexplains, this is not necessarily a problem. “The speedwith which these developments take place is equallyimportant. Gradual developments can be

accommodated, whereas sudden changes are muchharder to absorb.” Because there are significantdifferences between municipalities, the notion of finding aone-size-fits-all solution should be abandoned.

The consequences of demographic development arelegion. The average composition of families will changeand increasingly the housing supply will fall short of thechanging requirements. In small communities, communitycentres and schools may be forced to close their doors.Shrinking populations give rise to various urban renewaland development issues. In some cities, homes may evenhave to be demolished. “The challenges municipalitieswill be facing are going to require a lot of creativity”, Pansstates. The issues at hand are invariably complex andcostly to solve and there are no standard solutions.Instead, the answer may be found in specificarrangements and tapping into new forms of financingother than overstretched municipal funds. Some of thesefinancing schemes may be transnational, especially inregions bordering neighbouring countries. Pans feels thatthe central government, provincial governments and theAssociation of Netherlands municipalities (VNG) have animportant supportive role in bringing this about.


Association of Netherlands municipalities -Ralph Pans

Mr. R.J.J.M. (Ralph) Pans is the chairman of the Association ofNetherlands Municipalities’ (VNG). Prior to that, he held the positionof Secretary-General for the Ministry of Transport, Public Works andWater Management. Pans also served as mayor of the town ofRosmalen and alderman of the town of Zaanstad. As therepresentative of all Dutch municipalities, VNG promotes anddiscusses the association's interests with government bodies suchas provincial governments, Parliament and the Cabinet.

Ageing is going to affect municipalities in a variety ofways. In municipalities with relatively large elderlypopulations, the pressure on vulnerable groups is goingto mount. There will be a growing need for volunteers andstrong social cohesion. Municipalities have a major roleto play when it comes to getting people involved. One ofthe instruments at their disposal is the Social Support Act(Wmo). As result of population ageing, the demand forWmo-related services is going to change in nature andvolume, pushing municipal budgets to and over theirlimits. Municipalities should take precautions.

Demographic changes may also force local governmentsto adopt a different view on other facilities, such as localshops and community centres. In order to enhance theircommunities’ appeal, local governments will increasinglyhave to take local and regional strengths as startingpoints. “Municipalities will have to ask themselves somekey questions. What are our strengths? Which qualitiesdo we aspire to? How can we keep the town attractive?”,Pans explains. “Municipal strategies should addressthese questions. Ageing does not have to be a problem ifthere is a clear strategy in place, one that does justice toboth the quality of the town and the needs of itsresidents.” In the future, regional partnerships are goingto become ever more important. Working together withother (neighbouring) municipalities should be based onconsultation rather than competition. If a town has manynice boutiques, its neighbour should not try to steal itslimelight by also promoting itself as a town with niceboutiques. There are still some important steps to betaken before municipalities get to this stage, however.


In order to meet changing demand, municipalities shouldget their households in order, particular with regard to IT.“Ongoing computerisation, such as linking various basicregistration databases and taking a life event-orientedapproach, gives a boost to service delivery development.This so-called self-service concept allows citizens accessto an increasing number of products and services without

the need for direct civil servant involvement. Designing asound infrastructure behind the (digital) service desk is akey factor in developing smarter work methods, but oneshould keep in mind that a local government cannotrefuse service to any of its citizens. There will always beIT illiterate clients. This means municipalities will alwaysbe required to make their services available throughmultiple channels.”


Dutch municipalities will be facing a massive outflux ofolder civil servants. These vacancies will need to be filledto maintain quantitative capacity. “Ageing will result in agreater demand for staff. On the one hand, the outflux ofretiring civil servants will have to be absorbed and on theother, municipalities will be asked to display morecreativity and innovative capacity. Municipalities will haveto recruit creative thinkers”, Pans argues. Despite the factthat the economic downturn has resulted in an ample buttemporary supply of qualified staff, VNG has recentlylaunched the Local Employers project. “The aim of theLocal Employers project is to promote municipalities asemployers of choice”, Pans explains. “There areadvantages to working for a municipality, such asattractive job benefits and working conditions. There isstill, however, much to be gained by enhancingmunicipalities’ recruitment efforts, but this requires adifferent approach to being an employer. Municipalbodies should take note of the different work methodsfuture staff will be employing, e.g. flexible workschedules, flexible work locations and alternative workprocesses. Municipalities should, in short, be able tomeet the needs of the young working population.According to Pans, setting up supra-municipal trainingschemes and staff pools should be an integral part ofthis. The question remains whether this will suffice tomeet the quantitative demand for staff. Innovation andmanagement efficiency improvements will also berequired.


Creative and innovative minds should be recruited toenable municipalities to develop smarter work methodsand step up their collaborative efforts, but Pans feels aculture change is needed to make this possible. “Scaleincrease through collaborating with other municipalitiesand government bodies has many benefits, withoutnecessarily culminating in a municipal merger.Municipalities are slow to realise that their autonomy liesin the content of their policies rather than in how theyorganise their business processes.” Although Pans doesnot discount the possibility of further public/privatepartnerships with regard to forming staffing pools, forinstance, he feels the time is not yet ripe. “Such forms ofcollaboration need to be well thought-out. It is paramountthat the foundations are secure and municipalities havetheir own affairs in order. In this respect, municipalitiesstill have a long way to go.”

Besides the managerial aspect, there is also ademocratic aspect to municipal policy. At the moment,many local councils are ageing. The typical local councilmember is white, male, highly educated and over fifty. “Inview of the ‘getting people involved’ concept,municipalities should develop long-term strategies torecruit young people into local politics to ensure thatcouncils remain a valid representation of society.”


“Self-reliance is destroyed oncemunicipalities start pamperingtheir citizens.”

Frans Mencke’s point of view


In view of the ageing issue, it is important to ensure atown’s appeal and be sensitive to what the populationwants. “In Hoorn we recently had a public debate onwhat kind of town we wanted to be”, Mencke says.“It turns out our residents want a lively city thataccommodates the young and the old alike, even if thismeans they have to put up with some public nuisance asa result.” The municipality is receptive to these signs, butalso has to take into account regional interests. Menckeexplains: “Because of the facilities they have to offer,regional urban centres are very appealing, particularly inareas experiencing population decline. As a result, citiesrun the risk of draining the surrounding villages, which isa shame as this would eat away at the quality of the

region as a whole. Therefore, regional urban centresshould always have their region’s best interests at heart.”Interaction and consultation with neighbouringmunicipalities helps establish a multiform region, whichallows young people to live out in the country if they sochoose and old people to move closer to where thefacilities are.

The current housing demand and supply are not alwaysin alignment with demand. This is why collaborationbetween housing associations is very important.“Housing corporations and municipalities should worktogether as natural partners. There is a lot they can learnfrom each other. Housing corporations have theknow-how and the necessary finances, whereasmunicipalities have unrivalled expertise in responsiblebusiness practices”, Mencke argues. When it comes tospatial development, municipalities can also create theright preconditions for an integrated, cohesive andcollaborative approach to care and education, forinstance. These developments should always tie in withthe population’s needs. Municipalities have to make surethey stay in touch with their citizens. By taking aneighbourhood-oriented approach and deployingcommunity teams, municipalities can work actively atuncovering the issues residents are struggling with and


Municipality of Hoorn - Frans Mencke

Mr. G. (Frans) Mencke has occupied the post of town clerk in thetown of Hoorn since March 2, 2009. Prior to that, he served as townclerk in Heerhugowaard and Heiloo and was head of the GeneralAffairs department of Heerenveen. Mencke is also Secretary of theexecutive committee of the Association of Town Clerks.

tackle them head-on. According to Mencke,municipalities should, wherever possible, make use ofexisting social networks and tap into people’sresourcefulness. “Once municipalities start pamperingtheir citizens, self-reliance is destroyed.” Menckeillustrates this with an example from another municipality:“Their meals-on-wheels service used to deliver freshwarm meals to a large number of elderly residents on adaily basis, using an extensive network of up to sixtyvolunteers. In order to cut costs, the decision was madeto change to a weekly delivery of frozen meals. As aresult, the network collapsed and people became sociallyisolated. The social costs of this measure far outweighedthe costs that may have been saved. Unfortunately,social costs weren’t taken into consideration during thedecision-making process.”


Ageing is a key concern for municipalities, but as it ismostly an external problem, it is hard for them to tackleand solve on their own. “Municipalities should join forceswith other parties to examine the issue. They should notdismiss it because they think it is not going to affectthem”, Mencke says. “It is crucial that leadingdecision-makers look beyond their own organisation andabandon the notion that whatever happens in the outsideworld belongs to the domain of national politics. Asprimary advisors to the municipal executive, civil serviceexecutives will have to adopt an outside-in perspective,identify problems and offer advice on possible solutions.”Entering into a dialogue with partners such as housingand care institutions is essential to get on the same pageand work together at finding solutions. On the subject ofthe credit crunch Mencke has the following to say:“Municipal cutbacks make collaborating with others evenmore important. Poverty is the mother of invention. Ifthere is no money, we have to work together. Partnersshould be encouraged to join forces and municipalitiesshould take on a supervisory role.”

When developing its town vision, the municipality ofHoorn expressly looked at the role of its citizens andincorporated this into its approach to citizen relations.“When residents of Hoorn visit our service desk to ask forassistance, we think of them as clients, and theirpersonal circumstances become the starting point. Theconversation serves as input for our public officers, whocan deploy a full range of products and services tailoredto meet individual needs”, Mencke explains. “Not alldepartments employ this way of working, however, andsometimes legal requirements won’t allow it.Nonetheless, we do require our employees to takeinitiative and think about how best to meet clientdemand.” This does not mean municipalities should waiton their residents hand and foot. According to Mencke,municipalities should always think about whether to takethe initiative in providing certain solutions or leave it tothe resourcefulness of private citizens. “Municipalitiestend to pamper their residents. This makes citizensdependent. It discourages personal initiative.Municipalities can, however, make it easier for citizens toparticipate in society.” Better use should be made of theresources that are already in place. Active citizenship canbe promoted by relatively simple means, for instance byencouraging initiatives such as National Neighbour Dayand allowing communities to organise barbecues withouthaving to apply for a permit. “Starting small and scalingup often produces the best results. It is activities likethese that best meet local demand.”


Community team employees should get a feel for whatgoes on in their neighbourhood and act upon thisinformation when necessary. “Neighbourhood teamshave to be attuned to social trends”, Mencke says.“This requires a special way of thinking and working.”This does not always happen spontaneously and to someworkers, adopting this approach may not come easy. Thecoming years will see a shift in staff profiles. This meanssome employees may have to change the way they dothings. Recruitment procedures should be geared to


these developments. Strategic HR policy should nolonger focus exclusively on simply replacing staff, butrather on attracting the right mix of competencies.Mencke explains: “Future municipal personnel should beteam players who are able to adopt an outside-inperspective and are also able to take on a supervisoryrole. This transition is already taking place and some staffmembers are having trouble adapting. Some are moreresistant to change than others.” As employers with avery diverse staff pool, municipalities should try to handlethis issue delicately. To illustrate, Mencke uses theexample of diversity among older municipal employees:“There are over-55s who decided to retire early a longtime ago and are now merely counting down the daysuntil their retirement day comes along. Unsurprisingly,these people are not likely to make significantinvestments in their professional development. They arevery hard to motivate, they do not welcome change andthey are afraid of losing tasks they are familiar with andexperienced in. Ageing may well push back their horizon,however, for instance by forcing employers to raise theretirement age. On the other hand, there are a lot ofover-50s who are eager to change and developprofessionally. These so-called ‘happy greys’ abhor thethought of early retirement and may even be prepared tocontribute in some capacity after the age of 65.” Not allemployees are the same. Consequently, not all individualneeds are the same”, Mencke argues. To maintain avigorous and energetic staff pool, it is becoming evermore important for municipalities to adopt a personalisedapproach to HR facilities. Making use of customisedarrangements, for instance in the form of personal budgetschemes, can contribute to keeping people active in theworkforce. “Partial retirement schemes and the like wouldbe a godsend to many happy greys”, Mencke says.

Staff members with young children may, on the otherhand, have a very different set of needs, as Menckeexplains. “One of our female employees always arrived atour city office around nine because she had to drop offher child at school before work. As a result, she couldnever find a spot in our designated parking lot and wasalways forced to park in a nearby residential area.Luckily, the town office has an underground charged carpark, so the employee chose to use her personal budgetto purchase a parking permit. This relatively simple stepmade her job that much more pleasant.” Small exampleslike these show that in order to safeguard the vitality oftheir organisations, municipalities as employers shouldtake an individually tailored approach.

Making jobs more flexible and exciting is also crucial.Mencke explains: “The young people of today havegrown up around IT. The sky is the limit. Consequently,they want to be able to work wherever and wheneverthey want. And after a few years, they are ready to moveon to a new position. This also goes for happy greys, whoare young at heart and continuously looking for newchallenges. As diverse and opportunity-rich employers,municipalities should and can offer a lot of options. Bymaking these options accessible to staff, employers willcontinue to be attractive and inspiring employers.” Amajor challenge in achieving this lies in successfullyplanning internal mobility and bridging theintergenerational gap.


4 Justice, law enforcementand safety

“Ageing should be a moreprominent issue within theRotterdam Rijnmond SecurityRegion.”

Don Berghuijs’ point of view


“At the moment our security region is hardly paying anyattention to the subject of ageing and its consequencesfor our internal and external surroundings”, Berghuijssays. The topic may have been discussed briefly inrelation to other developments in the security region, butit has never been dealt with specifically.

One of the pertinent aspects of the ageing problem issafety. Berghuijs explains that the British communitysafety methodology has shown that over-60s run anincreased risk when it comes to creating fire hazards,because people tend to become less observant and moreforgetful as they age. This means population ageing will

most likely lead to a higher safety risk. It is important,however, to put these British developments intoperspective: gas ovens are not as common in theNetherlands as they are in the UK, which means thesafety risk will probably be lower.

Another aspect of ageing is the age composition of thepopulation. When the ageing phenomenon is at its peak,there will not be as many young people, which alsomeans there will not be as many students. According toBerghuijs, student housing facilities typically are buildingswith an increased fire risk. When it comes to safetyaspects, it is therefore safe to say that ageing will cause ashift in both type and level of risk. VRR is currentlypreparing for these coming changes.


As explained above, ageing will result in a changing (andincreasing) demand for VRR services. Berghuijs indicatesthat VRR is trying to respond to this by offering new typesof services.

As part of a pilot project, VRR is collaborating with thelocal government to fit homes in the Nesselande area of


Rotterdam Rijnmond Security Region (VRR) -Don Berghuijs

J.D. (Don) Berghuijs is the general director of VRR, an organisationthat consists of five separate directorates that deal with majorincidents and crisis management issues, i.e. Risk and CrisisManagement (SRC), Rotterdam Rijnmond Ambulance Services(AZRR/VRR), Joint Emergency Control Centre (GMK), Incident andDisaster Medical Services (GHOR) and Regional Rotterdam RijnmondFire Services (RBRR).

Rotterdam with electric smoke detectors. Berghuijsexplains that this measure gives people an early warningand allows them to call out the fire brigade much sooner.Not only is this form of service provision of greatimportance to elderly citizens, it can also bring someadvantages to the fire service. The number of calls mayactually drop as fires can now be detected at an earlierstage, when people may still be able to put them out bythemselves. It may also help to cut the fire brigade’sresponse time.

Another service reform concept that is currently beingconsidered is deploying small, flexible, round-the-clockintervention teams. Although this avenue is mainly beingexplored because of impending cut-backs, it may alsoprove useful for combating safety issues caused byageing. This new service delivery approach involves theformation of teams consisting of a firefighter, anemergency medical technician and possibly a policeofficer as well. In view of the distribution of social costs, itwill in the long run become untenable to have firebrigades on standby at fire stations, waiting for a call toswing into action. Instead, these new intervention teamscan be deployed, which may be the answer to theexpected ageing-related increase in small incidents.

With regard to the recent swine flu pandemic, Berghuijsnotes that the elderly tend to be physically weaker andmore vulnerable to complications. The (new) approachtherefore focuses on preventive vaccination schemes forthis particular at-risk group. Berghuijs adds that becauseof its sizeable staff buffer, VRR does not expect toexperience any pandemic-related impediments to itsoperational services. Only if more than 30 percent of staffcall in sick will there be any real problems. This scenariowill only come to pass if the entire population is hit by theflu virus and as yet, this is not the case. Berghuijsemphasises, however, that ageing may cause pandemicsto spread more rapidly. An important measure to keepthe flu from spreading is having GPs visit flu-strickenpatients at home rather than having sick patients showup in crowded waiting rooms. Berghuijs indicates thisissue is being addressed by the public information

campaign on the flu pandemic. A possible option wouldbe for VRR to supply cars to GPs so they can make theirrounds, as some practices are no longer set up formaking a large number of house calls. With populationageing just around the corner, general practitioners willhave to restructure and adapt their service provision.

Berghuijs feels that there is much to be gained fromimplementing self-organising IT systems, such as remotecare and online support programmes, but a greater senseof urgency is needed to propel innovation forward.


Berghuijs indicates that he does not expect the fireservice staff pool to be negatively affected by populationageing in the foreseeable future. In the seventies therewas a large influx of professional firemen, many of whom(50 percent of the total workforce) retired from the fireservice a few years ago, resulting in a rejuvenatedorganisation.

The ambulance service GHOR, on the other hand, isanother matter. The age composition of ambulanceservice personnel is very different and staff shortagesmay well arise. Berghuijs fears the demand for medicalcare is going to grow whilst capacity (partly due tocut-backs) is bound to decrease. He feels every effortshould be made to find a solution for the impendingstaffing problem.

Berghuijs concludes with the observation that ageingshould be a more prominent item on the VRR agenda.It takes time to organise matters in a different way andinvest in making changes. Now is the time to deal withlong-term issues. Berghuijs says this interview has helpedhim gain insight into a number of interesting long-termstrategy perspectives that may contribute to combatingthe challenges population ageing is going to bring.


“Projections estimate that half ofour current staff pool will have leftthe service by the year 2017.”

Leon Kuijs’ point of view


“Not much is known about how ageing is going to affectthe environment in which the police force operates”, Kuijssays. It is interesting to speculate on what an ageingpopulation could mean for the police. It may result in alower crime rate. It could also result in a higher number ofdispatches because compared to young people seniorcitizens are less tolerant of problems like anti-socialbehaviour. Senior citizens may also spent a longer periodof time away from home to spend the winter in warmerclimes, which could result in an increase in the number ofbreak-ins. But whatever the consequences of ageing mayturn out to be, the policy service will have to adjust itscapacity planning accordingly.

The police have recently rounded off a senior citizensproject that focused on forecasting changing demand.What are elderly people’s needs? What does safety meanto them? What are the current trends? One of the issuesthat arose was the increase in cases of elderly abuse.

Another interesting question is at which point peopleactually become a ‘senior citizens’. It seems like thedefinition of the concept is beginning to transform. The50-year-olds of today have a different take on life thanpeople who were in their fifties several decades ago.Kuijs stresses that most crime will develop in ways thatare entirely unrelated to the ageing issue. “In this line ofbusiness, we get to deal with a lot of youth crime andnuisance. Ageing is not going to diminish this problem.Furthermore, there are types of crime that are notaffected by ageing. The Netherlands are a relativelyaffluent country, a trading nation characterised by openborders. This mentality also extends to the criminalcommunity. Modern crime often transcends nationalborders and new types of crime like cybercrime willdevelop autonomously from the ageing phenomenon.”

Although Kuijs indicates that additional efforts are stillneeded to prepare the police force for ageing-relatedchanges in supply and demand patterns, the subject of


Board of Head Commissioners - Leon Kuijs

Corps chief L.Th.C. (Leon) Kuijs has been the chairmen of the Boardof Head Commissioners since 1 January 2009. The Board of HeadCommissioners is an advisory and consultative body for the Ministryof the Interior. It also develops visions on (national) police serviceissues. Kuijs has been working for the police service for some thirtyyears, becoming corps chief of the Brabant Zuidoost police region in2002.

population ageing has already been incorporated into itsemployer vision. Ageing is not, however, explicitlyincluded in its strategic agenda. While this may not benecessary as such, the subject of population ageingshould in some way be factored into all cornerstones ofpolice policy. Kuijs feels that this interview has been aneye-opener when it comes the potential effects of ageing.“The police will have to spend a judicious amount of timeon exploring this issue so they can face the futurewell-prepared. We should commission experts to doresearch into how ageing can be incorporated into eachand every pillar of police policy.”


Ageing can lead to a changing demand for policeservices. The police are and will always be society’ssafety net. Pensioners have more time on their hands andproviding services to the elderly may take up more of ourtime. “It’s an interesting question to ponder”, Kuijs says.“How can a young police force serve an ageingpopulation adequately? We will have to adjust our servicedelivery.”

Today’s police officers are already providing a variety ofservices and uniformed policemen are already expectedto adjust their approach depending on the type of personthey are dealing with.

In relation to new service delivery concepts, Kuijs feelsthat the possibility of tightening or relaxing privacy lawsshould be explored, as the current privacy laws seem tobe benefitting criminals. Kuijs supports the notion ofcreating so-called communities. Citizens should haveownership of their own privacy and be able to determinewhich personal data they want to make available. Theamount of personal data citizens share then determinesthe degree to which they can participate in these variouscommunities. The strength of these communities lies inthe fact that they do not need policing. This would resultin a facilitating rather than an enforcement-orientedpolice force. To accommodate this, police training would

have to start focusing on dealing with communities ratherthan individuals.


As a large employer, ageing of the workforce is definitelyan issue of import to the Dutch police force. At present,the average age of police service employees is 43-44.Projections estimate that half of the current staff pool willhave left the service by the year 2017. Employee outfluxis expected to reach its peak at 2014 and may affect theforce in a variety of ways. Current policy stipulates thatover-55s are exempt from the obligation to work nightshifts (i.e. night shifts are optional). Should olderemployees make use of this option en masse, the forcewill be faced with a major problem in terms of planning.Many of these employees are relatively expensive andsome of them do not work the streets. This will have alarge impact on the deployability of police.

At regional level police forces have been trying to preparethemselves for these developments, for instance byrecruiting additional police officers, but if they exceed thenorm the money has to come from their own budgets. HRpolices are also being re-evaluated, as a youngerworkforce demands a different style of management.

The Dutch police service has carried out a study into theneeds of its personnel. The findings revealed that youngrecruits find it very important to 1) feel like they belong 2)do a job that makes a difference 3) have opportunities forrapid career advancement. The police service is currentlyable to meet the first two needs without problem, but thethird carries an inherent risk. At present, the policeorganisation is very hierarchical and opportunities forcareer advancement are mainly vertical. “Older policeofficers feel like you have to earn your stripes before youare allowed to take another step up the ladder.” A strikingexample in this respect is a recent pilot project involvingthe lateral influx into the Criminal InvestigationDepartment of staff with an applied science degree.These new recruits are entering the CID at the same level


as highly experienced police officers with vocationaltraining. “Often these newcomers have fast-track careers.This creates tension on the work floor.” This tension canalso be felt in works councils, which often consist ofsenior employees. Kuijs thinks resentment can beprevented by also offering development opportunities toexisting staff, for instance by enabling them to study foran applied science degree. In view of the current casebacklog, increasing investigative capacity is and willalways be an important issue for the police.

Young people have a different take on careerdevelopment than the old. Kuijs feels “it is not logical forthe police service to have a one-track human resourcepolicy. HR policy should become more diverse to be ableto respond adequately to all these developments.”


“Expectations are we won’t haveto make significant alterations toour service delivery concepts toserve the ageing target group.”

Hans van der Vlist’ point of view


“So far, ageing has not been a prominent issue in thejustice domain.” The Public Prosecution Service hasdone some research into the relationship betweenpopulation ageing and crime development, but this hasnot yielded any shocking conclusions. The justicesector’s primary target groups are youths and repeatoffenders. Ageing does not play a significant role in thesocial context in which we operate; therefore it does nothave a major impact on the policy agenda.In the long term, ageing might even lead to lower crimerates. Compared to the young, the elderly are far lessoften engaged in criminal activity. It should be noted,

however, that the relationship between population ageingand lower crime rates also depends on other, externalfactors such as immigration.

The safety sector is in many ways ruled by the existingbalance of power. Nowadays, discussions on spendingare increasingly being conducted on the platform ofpublic opinion, as demonstrated by the debate about thefeasible and affordability of increasing police presence onthe streets. The Netherlands may have become a safercountry these past few years, but public perception saysotherwise and the media are only too eager to feed intothis notion. Ageing could have a major impact on howpeople perceive safety. “If this is the case, policy issueswill largely be determined by the perception of safety”,Van der Vlist says.


People on the work floor, such as prison guards, are themost important factor when it comes to making changesin the justice domain. If changes indeed prove necessary,they will mostly revolve around making adjustments tothe way various target groups are approached. Havingsaid that, it should be noted senior citizens require more


Administration of Justice and Lawenforcement - Hans van der Vlist

Mr. J. (Hans) van der Vlist has been working as Director-General forthe Administration of Justice and Law Enforcement (Ministry ofJustice) since August 1, 2005. Before assuming his current post, heworked for the Council for the Judiciary and was director of theFinancial and Economic Affairs department of the Ministry of Justice.

or less the same approach as the current category ofover-40s. “Expectations are we won’t have to makesignificant alterations to our service delivery concepts toserve the ageing target group.” It also remains to be seenif the group of criminal senior citizens is actually going toexpand.

Building on the notion of safety perception potentiallybecoming a more important factor, policy-makers shouldstart focussing more on improving people’s perception ofsafety by investing in communication and marketing. Vander Vlist feels that the central government could andshould be stepping up its communication and marketingefforts anyway.


“Current prognoses do not predict a sudden exodus ofretirees from the justice domain”, Van der Vlist says. Hetherefore does not expect to encounter anyinsurmountable problems when it comes to laboursupply. Van der Vlist feels the impact of ageing onstaffing may well prove smaller than predictions wouldhave it. Nowadays age is perceived differently thantwenty years ago. People feel younger, are more likely topostpone retirement and find it easier to relate to youngergenerations. This trend of ‘mental rejuvenation’ isexpected to continue in the years to come.


5 Health insurance companiesand pension funds

“Ageing is going to cause labourshortages.”

Martin van Rijn’s point of view


Ageing is expected to lead to a growing demand for care.The nature of demand is also going to change. Newclinical pictures will emerge and chronic illnesses aregoing to become more prevalent. Clients are also goingto have changed needs. Van Rijn explains: “Careconsumers are going to evolve: clients are going to havemore disposable income and be much more vocal. Also,they will want to live independently for as long as theycan.” This will result in a different demand for care andhousing.” Van Rijn expects that there will be somecompetition between wealthy care consumers andconsumers who are less well-to-do. “We will have to getrid of this ‘living your silver years in luxury’ notionpopularised by TV ads, because we will need this moneyto finance care.” Van Rijn expects that future healthcare

coverage is not going to be as all-inclusive as it is today.The central government is under an increasing amount ofpressure to cut back on collective resources. “People willbe asked to take responsibility and make a largerfinancial contribution to the care they receive.”

According to Van Rijn, a more prominent place will bereserved for new schemes that involve senior citizensspending part of their pension on care or housing plans,paying extra for any additional or luxury care they wish toreceive. “In the future, there will be a wide variety ofpackage deals, allowing consumers to opt for a specificpackage with an integrated range of housing, care andpension related products. This will broaden consumers’options and take some of the work involved in sorting outthese issues off their hands.” This will automatically resultin differentiation of demand: some people may wish tohandle their own housing, care and pension affairs,whereas others are going to need some expert advice tolook into these things. A third group may opt forintegrated products.

To make sure that care remains accessible to all, thecentral government should vouch for a basic standard ofcare. “It is the government’s responsibility to makechoices about the quality, safety, affordability and


PGGM - Martin van Rijn

Drs. M.J. (Martin) van Rijn is the chairman of PGGM, a pension fundfor the care and welfare sector. He is also the chairman of the Boardof Commissioners of Espria, a collaborative body formed by housingcorporation Woonzorg Nederland and care providers Philadelphiaand Evean. Van Rijn has made a name for himself in the field ofhousing, finances, care and local government. From 2003 to 2008,he occupied the post of Director-General of the Healthcaredepartment of the Ministry of Health, Welfare and Sport. In thiscapacity he was responsible for the implementation of the newHealth Insurance Act. Prior to that, Van Rijn has worked for theMinistry of Housing, Spatial Planning and the Environment and theMinistry of the Interior.

availability of housing, care and pensions. Individualconsumers can’t be expected to make these choices.”


PGGM is increasingly making use of the internet forservice delivery purposes. Van Rijn expects that thiscommunication channel will become ever more importantin the future, with more and more people turning to theInternet to make transactions and obtain services andadvice. Clients will get an active role in managing theirpersonal data and interacting with the organisation. Mostof this will be carried out online.

Thus far, care innovations have not seen large-scaleimplementation. Van Rijn feels the biggest hurdle toovercome is the gap in pace between innovation and theallocation of funds to finance implementation. “Innovationis a gradual process requiring large-scale investments.These investments in turn require a larger share ofventure capital, which is why innovation plans often meetwith opposition. As a result, organisations are often notable to take decisive action in response to externaldevelopments.” Van Rijn indicates that external stimuliare needed to kick modernisation and innovation intogear, such as the advent of new players in themarketplace.

According to Van Rijn, there is much to be gained fromforming logistic or care supply chains. Care providers inthe logistic supply chain (such as hospitals, home careorganisations and cleaning services) will have to startrelying on each other more, which means more and morehorizontal and vertical networks will begin to develop.There is still room for improvement when it comes toefficiency. By offering housing, care and pension relatedproducts collectively, care resources can be allocatedmore efficiently. These integrated housing, care andpension schemes are still in a transitional phase,however. “As yet, care providers are mainly focusing ontheir own affairs, so developments are slow to progress.”As key player and broker in the care, housing and

pension arena, PGGM can play an important part inorganising the supply chain.


According to Van Rijn, ageing is going to cause labourshortages. Improving labour productivity is vital tocushion the blow. Van Rijn has high expectations for theimplementation of new technologies in the care sector,such as home automation and IT, provided that all partiesinvolved start working together on logistics, innovationand technology. “For implementation to be a success,parties will have to start looking beyond their owndoorstep.” IT and new technologies can be deployed ona large scale to help take some of the pressure off of theworkforce. Van Rijn mentions the examples of remotepatient monitoring and diabetes patients using insulinpens to self-manage their condition.“The back office, too, offers many opportunities forefficiency improvement”, Van Rijn says. “Administrativeprocesses can be more fully computerised. Also,consumers can be given a more active role, for instanceby enabling them to manage their own data online.” Thishighly computerised form of service delivery requires adifferent type of know-how and experience on the part ofcare workers than traditional services. Van Rijn thinksthere is an advantage to this: care workers can stay inservice for longer because they have the option ofswitching to work that is less physically demanding andcan be carried out at flexible times and locations.


“When it comes to care, part ofthe responsibility and initiativeshould be handed back to thepublic.”

Roger van Boxtel’s point of view


How is population ageing going to affect the futuredemand for care? According to Van Boxtel, it will takesome time for ageing to take effect. “The first group ofbaby boomers will be moving into retirement in thecoming years. These are relatively healthy people withactive lifestyles who will not be relying on care for sometime. Essentially, the demand for care is delayed tenyears or so. The coming twenty years are ultimately goingto see a cumulative rise in care demand, however, as thebaby boom generation ages and becomes morecare-dependent. This means we will be facing a massivedemand for care further down the line.” The risingnumber of chronically ill people is going to drive up

healthcare costs. “Pulmonary disease, heart failure,diabetes, Alzheimer’s, these are all illnesses that aregoing to become much more prevalent as a result ofageing”, Van Boxtel says. The corresponding rise inhealthcare expenditures cannot be absorbed by thecurrent method of financing.

Van Boxtel explains that the current welfare state is apost-World War II institution that has heightened people’sexpectations of what the government can do for them.“When it comes to care, part of the responsibility andinitiative should be handed back to the public”, VanBoxtel argues. “This allows them to create and exploittheir own opportunities. We should encourage people tostand up for themselves and take charge when thesituation calls for it. But if they are unable to do so, theyshould be able to fall back on collective resources.”According to Van Boxtel, healthcare reform is needed tomake this concept work: “We should already be workingon the next reform bill to stay ahead of future problems.”Unfortunately, the sense of urgency seems to be lacking.“To counter this”, Van Boxtel suggests, “we should makethe implications of ageing tangible and visible in terms ofcosts: put a figure to current healthcare expenditures andwhat the costs will amount to in twenty years time.”


Menzis - Roger van Boxtel

Mr. R.H.L.M. (Roger) van Boxtel is a former Dutch politician forDemocrats 66 (D66). In 1998 he held the post of minister withoutportfolio in the second Kok administration. In this capacity he wasresponsible for the government’s integration, communications andmajor city policies. Before becoming active in politics, Van Boxtelworked for the Association of Netherlands Municipalities. He alsoworked as an organisation consultant and interim manager and wasthe vice chairman of the national asylum seekers’ resourcefoundation POA. As an MP, Van Boxtel served as vice chairman ofD66 and acted as spokesperson on the issues of public health andminorities. In 2003, he became the chairman of health insurancecompany Menzis.

Van Boxtel has often observed the prevalence ofshort-term thinking in politics. “Annually, we are spendingsixty billion euro on care, with an additional ten to fiftybillion on informal care. Add to that the costs of othercare-associated domains, such as housing, and itbecomes obvious we will be spending a much largerpercentage of our gross national product on care if wedon’t take action. Healthcare costs will be out of control.”Van Boxtel feels these costs should be managed farmore effectively.

He expects healthcare premiums to go up in the future.“At the moment healthcare premiums are low due to theintroduction of the Health Insurance Act, which promotedcompetition among health insurance companies andforced them to use some of their reserves to dampenpremiums. In the future, premiums will rise to cover themounting costs.”

According to Van Boxtel, it is crucial to make sure thatessential medical care stays accessible to all. “But whatis ‘essential’ medical care, exactly? There is no universaldefinition.” He points out that it will be our collectivechallenge to safeguard intergenerational solidarity. “Wehave to work towards a system that offers universalaccess to basic types of care and charges additionalpremiums for added comfort and luxury.”


In order to absorb the growing demand for care, the caresupply will have to be organised differently. “People willhave to start looking after themselves more. Many tasksdo not necessarily require the presence of a careprovider. The way care is currently organised is not veryefficient and stands to benefit from a work processoverhaul.” Van Boxtel compares the transition the caresector is currently facing to the evolution in banking. “Weused to go to the bank to make our deposits andwithdrawals. Nowadays, we do most of our bankingonline, from the comfort of our own homes. Why shouldpatients visit hospitals or doctor’s offices for procedures

they themselves could just as easily perform at home,with or without some assistance? The current caresystem was developed hundreds of years ago when pesthouses were established. These pest houses were theprecursors of sanatoriums, which eventually evolved intothe hospitals we know today. The notion of visiting alarge institution when you are sick persists to this day,but the implementation of new technologies will enablepatients to self-treat certain conditions at home.” Anexample is Menzis’s Koala project, which focuses onpromoting patient self-reliance.

Van Boxtel stresses that this requires a whole new way ofthinking. “New technologies already give chronically illpatients access to 24 hour medical call centres. Thesecall centres are manned by trained nurses who cananswer patients’ questions and monitor their medication.This removes the need for patients to visit an outpatientward, which not only makes things much more convenientbut also helps to bring down costs.” It should be notedthat not all types of care are suitable for this approach.Acute care would be a good example. When it comes toelective care, however, the implementation of IT may helpto drastically reduce costs. There are plenty of possibilitiesto standardise procedures, such as making use ofso-called quick fit knee and hip ‘express lines’, butchanges like these will force care providers to makechoices. Keeping the job interesting for doctors is also anissue that needs to be addressed when considering awork process overhaul.

Cost reduction is hampered by annual budgets and the lackof a special budget for spreading investment costs (such asthe one used by municipalities). At this time, it is alsounclear how some costs, such as the cost for emergencycare, are covered. The growing distinction between thebudget financed care and the free segment is a contributingfactor in this. Cohesive solutions are needed. “We shouldlook beyond our own narrow domain at possibilities tolink dossiers and look for connections.” An example ofsuch a partnership is the primary care centre recentlylaunched by Menzis. “By collaborating with chainpartners, costs have been reduced and the services on


offer have met with positive client response.” Van Boxtelalso sees possibilities for integrating housing, care,welfare and pensions, but this requires mutual trust and afair amount of willpower. Political courage is needed tobring about change. “I can imagine some sort ofinnovation fund being set up by parties in the careindustry to realise this transformation. Each partycontributes to this fund with a percentage of its turnover.It does not necessarily have to be a government-fundedaffair.” Van Boxtel thinks lack of courage and initiative arethe biggest obstacles for innovation. “The partiesinvolved should formulate a joint agenda and initiate aflagship project as a launching customer to present to thecentral government.” According to Van Boxtel, there aremany problems the central government cannot handle.“As the problems with our child welfare systemdemonstrate, the central government often falls shortwhen it comes to dealing with wide-spread problems.You can assign more social workers to a case, but whenthere is no one to contact when problems arise, thingstend to fall through the cracks.”

The question is who should coordinate the efforts. VanBoxtel proposes the foundation of a ‘care society’ formedby representatives from care providers, health insurancecompanies, employer and employee organisations andpatient associations.


“We will be facing labour shortages against a backdropof growing care demand. This development not onlyapplies to care, but to other sectors as well, such as thepolice force, the judicial sector and industry. Withdejuvenation on the rise, the competition for competentstaff is going to be fierce.”This development will force organisations to strengthentheir training policy. Due to dejuvenation of the workingpopulation, people will be required to work and learn for alonger period of time. According to Van Boxtel, trainingand development schemes should be put in place tofacilitate employees in familiarising themselves with newinsights and competencies. “In order to safeguardcontinuity, organisations will have to make work moreflexible. Staff members should have the opportunity tomove both upward and sideways on the career ladder.”Menzis has given this issue a prominent place on itsagenda, for instance by implementing an age-consciousHR policy and launching its own training academy.

Van Boxtel expects that deploying IT may partly softenthe blow of staff shortages, but this requires a transitionin how nurses and doctors define their job. “There aredifferent ways of seeing patients and some do notnecessarily involve actual visits to outpatient wards.” VanBoxtel foresees some hurdles and barriers that will needto be conquered first. “Initially, hospitals will be reluctantto redesign care in this manner because this will lead to adrop in the number of outpatient visits. Also, the practiceof annual budgeting is at odds with the long-terminvestments and stamina that are needed to innovate thecare sector.”


“GPs will continue to play animportant role in the community,but they will have to startconcentrating on their coretasks.”

Martin Bontje’s point of view


According to Bontje, ageing is going to have a majorimpact on the care sector. There will be a growingnumber of elderly people who will obviously have agreater need for care than the young. A complicatingfactor is the labour-intensive nature of care provision.“Care is manual labour”, Bontje says. “75 percent of carecosts are actually labour costs. This raises the questionof whether there will be enough hands on deck to providethe necessary care in the future and if there is anythingwe can do to attract workers to the care sector.”

Over two-thirds of total care costs can be attributed tothe treatment of chronic illnesses. The number ofchronically ill patients is expected to rise as a result ofageing. Bontje explains: “In the past, chronic illnesseswere far more likely to be fatal. Nowadays in many caseschronic illnesses do not prevent people from reaching aripe old age.” Bontje thinks there will be changes to theway the care consumption is managed. “Care consumerswill have a greater say in the care they receive. They willmore often turn to third parties for help, such as supportgroups or patients’ associations. Bontje thinks thesepatients’ associations are set to become key players inthe years to come. “They will be putting their stamp onthe care sector, for instance with regard to thereimbursement for certain types of medication andmedical aids. This could drive up costs.”

The senior citizens of tomorrow will be better-informedand more assertive and they will have access toresources such as the Internet to find the information theyneed. A possible side effect of this may be that they willbe quicker to visit their GPs with vague complaints thatmay point towards certain ailments or diseases. “Thismay result in higher care consumption”, Bontje says.


UVIT - Martin Bontje

With care as his area of expertise, M.J.W. (Martin) Bontje has servedon the board of insurance company UVIT since 2007. UVIT is theproduct of a merger between insurance companies Univé andVGZ-IZA-TRIAS. With a client base of some 5 million people, UVITcurrently ranks as one of the largest insurance companies in theNetherlands, and over 4,2 million health insurance clients - 25% ofthe Dutch population - make UVIT the second biggest player in thefield of health insurance. The property insurance branch of thecompany boasts another 800,000 clients.

When it comes to housing and care, Bontje distinguishestwo developments. “On the one hand, people will live athome for as long as they can, with the required care andsupport. On the other, people will opt for housing conceptsthat allow them to receive care as and when they need it,without having to transfer to a nursing home.” There willbe variety of schemes on offer to cater to every purse.“Obviously, the more you are prepared to pay, the morecomfort and luxury you will be able to enjoy.”


Bontje thinks the care industry will need to overhaul itsservice delivery concepts to meet the growing futuredemand for care. The current care concept is based onthe age-old notion that you need a pair of hands toprovide care. According to Bontje, care consumersthemselves should step up to the plate. “There is a lotpeople can do at home, with some support from ITapplications.” Bontje comments on the rapid advance oftechnological developments in the care sector: “Care TValready allows clients to communicate with careproviders without having to leave the comfort of theirhomes. With the right support, they can also monitor theirown blood pressure and glucose levels.” Bontje thinksdevelopments such as these will take flight in the years tocome and play a key role in resolving capacity issues. “AtUVIT, we refer to this form of care provision as‘convenient care’ rather than ‘remote care’.”

Compared to the speed of technological developments,the implementation of IT is lagging behind. Bontje feelsthis the result of limited investment opportunities and lackof courage. “Many care providers think and workaccording to fixed patterns. They are afraid to thinkoutside the box. GPs for instance tend to perform animportant social function, much like priests and teachersdid in the days of yore. Whereas the social role of priestsand teachers has diminished somewhat over the years,GPs are still important pillars of the community. As aresult, GPs devote 80% of their time to secondary tasksthat are not - strictly speaking – part of their core

business as medical practitioners. Up to this point, GPshave been slow to delegate these tasks to other parties.”According to Bontje, the role of GPs will have to changein the future. Rather than performing a social function80% of the time, doctors should start focusing on whatthey were trained to do: treating patients. There are otherinstitutions that can perform these social duties. “Modernpatients no longer need as much doctor’s care”, Bontjeelaborates. “They are perfectly capable of performingcertain procedures themselves. We can support them byproviding them with professional back-up such as onlinetreatment, or access to online communities that allowthem to exchange experiences with fellow patients.”Bontje notes that the demand for digital services isalready growing and will only continue to rise in thecoming years. “GPs will continue to play an importantrole in the community, but they will have to startconcentrating on their core tasks.”

In order to keep costs manageable in the future, Bontjealso thinks changes should be made to the way care isfinanced. “At the moment, care providers’ expendituresare fully covered. Ultimately, we will have to movetowards a system in which funding is based on clinicalpictures rather than the delivered care.” Bontje explains:“Let’s say there is a region with many cases of COPD.Health insurance companies and care providers canmake joint agreements to reduce these numbers, forinstance by encouraging people to change their lifestyle.”To do this, health insurance companies and careinstitutions should to some extent let go of theirautonomy and collaborate with other partners in thesupply chain. “To me, the notion of establishing a specialcentre for diabetics, for example, does not sound thatfarfetched”, Bontje says.Bontje thinks that health insurance companies can playan important role as initiators. “Collaborative efforts likethese do not evolve spontaneously. Health insurers canhelp launch such initiatives by providing the necessaryfunding.” In Bontjes’ opinion, this would give the firstparties to step into this market a significant head start,with all the opportunities this entails.


In order to keep future costs under control, people willhave to pay more for the care they receive. “People willbe asked to dip into their own pockets for additional careand comfort. I think care providers will start providing agreater variety of luxury care. Maybe the ‘first class’hospital rooms of the past will make a reappearance.”


As a result of population ageing, care demand will rise asthe capacity for care provision decreases. According toBontje, this will put more pressure on informal care.“Ageing will lead to a drop in the number of householdsin the near future, which will also reduce the number ofpotential informal carers. To meet the demand for care,people will lay a greater claim on social organisations. Wewill also go back to a situation in which families have totake in their elderly or care-dependent relatives when theneed arises.”

To combat the projected labour shortages in the caresector, Bontje thinks it is important to ensure thatworkers stay fit and motivated. This will allow them tostay in service for a longer period of time. Employershave the responsibility of providing the optimumpreconditions and promoting the speedy reintegration ofworkers on sick leave. To set the example, UVIT hasdeveloped a programme that seeks to improve the healthof its employees.

Bontje does not expect ageing will cause major problemsfor UVIT in terms of staff. “Ageing is a gradual processand I am sure a solution will present itself. We should letthe market do its job and fill the vacancies.” Bontje doespoint out, however, that employers should adapt their jobofferings to the various age categories. “With youngpeople, the boundary between personal and professionallife is starting to blur. They are less likely to adhere to atraditional nine-to-five routine and they need flexibleworking hours to accommodate this. As an employer, youshould facilitate this, for instance by offering them theresources they need to work from home.”


“Staff shortage problems in thecare sector are not yet acute.”

Jeroen van Breda Vriesman’s point of view


In the coming years ageing and dejevunation will have asignificant effect on the affordability of our resources.According to Van Breda Vriesman, the pension marketwill hit sooner and in a different way than the healthinsurance sector.

Health insurance has annual premiums, which can beadjusted every year in response to changes in the caresector. Furthermore, care is consumed in the same yearas the premium is paid. Ageing will lead to a higherconsumption of care and higher care expenditures.Dejuvenation will drive up the costs even more, bycreating staff shortages and putting pressure on the caresupply, which leads to scarcity and, thus, higher prices.Fortunately, unlike pension premiums, health insurance

premiums are paid both before and after retirement.Nonetheless, a large claim will be laid on the youngpopulation’s sense of solidarity.

Pension plans are organised differently. You accumulatea pension over the years and only consume the fundsafter you retire (currently at the age of 65). With anageing, pension-consuming population, the total amountof revenue garnered from premiums will decrease andpension funds will have start relying more on investmentsand other financial resources to meet their obligations. Allin all, developments in the care and pension sector willforce retirees to set aside a large part of their pensions topay for the care they receive. Consequently, pensions willbe subject to inflation.

With the problem of pension inflation looming overhead,we should take appropriate action to keep pension fundsstable in value. A possible future option would be to(partly) pay pensions out in kind, for instance in the formof care or housing. This concept asks for extensivecollaboration between housing corporations, careproviders, pensions funds and health insurancecompanies. Ageing is going to change the demand forproducts and services. “Ageing may at this point hardlybe noticeable, but the clock is ticking. The demand for


Eureko (Achmea) - Jeroen van Breda Vriesman

Mr. J.A.S. (Jeroen) van Breda Vriesman studied Dutch law at theUniversity of Utrecht and started his career at the Hongkong branchof ABN AMRO. He subsequently assumed various posts in thebanking and insurance (National Nederlanden) branch of ING. In2004, he was appointed chairman of Achmea’s Social Securitydivision. In 2006, he became chairman of the Healthcare division(which includes health insure company Zilveren Kruis Achmea). As of1 October 2008, Van Breda Vriesman serves on Eureko’s executiveboard. His portfolio includes healthcare and pensions.

housing/care concepts is going to show a marked growthin the coming years”, Van Breda Vriesman expects.


In order to improve care and absorb the anticipated staffshortages, Van Breda Vriesman identifies three possiblesolutions: making use of technology, making use ofinformal care and efficiency improvement.

“Making use of technology will relieve care providers ofpart of their care duties. Technology will enable theimplementation of better treatment methods for self-care,primary care and secondary care, whilst reducing therequired number of man hours.” Health insurancecompanies can be an important link in this process bybringing the various parties and initiatives together. Anexample is the newly signed covenant between AchmeaCare and Philips to bring technological innovation to thecare sector, such as new concepts for people withchronic conditions such as heart conditions and diabetes.

Implementing innovations in the care sector is no meanfeat. Van Breda Vriesman explains: “The technology isthere, but most of the time it is not being used for thepurpose for which it was developed. Sometimes it doesnot correspond with work-floor practices. Although theremay be too great a distance between care providers anddevelopers, it is the users who are the key toimplementation. To name but one example: there is asystem for transmitting blood values online. This can onlybe put to good use if doctors and nurses are indeedwilling to share this kind of information. Not only witheach other, but with other parties in the care supply chainas well.” The successful implementation of technologydepends on user (i.e. doctors and nursing staff) support.“Personal agendas and work practices should not get inthe way of innovation”, Van Breda Vriesman says. Inshort, care workers should be prepared to adjust theirwork methods. Money is another obstacle, but it is notthe lack of money that causes problems. Sixty millioneuro should be enough to finance adequate care

provision. Health insurers can play various importantroles when it comes to these kinds of innovations: theycan help finance or facilitate them.

A second possible solution is the use of informal carers,but there is a catch. “Not only will there be a shortage ofcare workers, informal care providers will be in shortsupply as well. In order to be able to absorb this,people’s social circles should be put to effective use withthe necessary support from primary and secondary careresources. This allows people to live at home for a longerperiod of time, shortening the length of stay at carefacilities or preventing admission altogether. A similaroption is promoting self-management. Both informal careand self-management will ease some of the pressure offof the healthcare system, which is going to be crucialfurther down the line.”

A third avenue that can be explored is efficiencyimprovement. “We will have to make more efficient use ofour resources”, Van Breda Vriesman says. “On the onehand, we will have to optimise our processes. Anotherpart of the equation is working on providing care workerswith support, resources and development opportunitiesto ensure optimum employability.

Van Breda Vriesman explains Eureko has madelarge-scale investments in care optimisation initiatives.“Together with care providers, we are looking into waysof organising care processes in a more efficient way, forinstance by adopting so-called lean production methods.If these prove successful, we are going to implementthem in the care supply chain on a larger scale.” This isone of the projects initiated by Eureko. Van BredaVriesman sees many possibilities for improving theefficiency and quality of care, but thinks large-scaleinnovation and care optimisation do not evolvespontaneously. “Incentives are needed to encourageparties to participate in these kinds of projects.” Financialincentives for quality improvement can help win careproviders over to the cause. “Making care more efficientenables care institutes to treat more patients. Morepatients means more money to compensate for the


perceived loss of revenue associated with engaging inefficiency and quality improvement activities.”

It is also important to keep employees active in the labourprocess for as long as possible. Van Breda thinks soundHR policies are going to become more important.“Management efforts should be aimed at keepingemployees healthy and in shape and preventing healthproblems associated with high workload.”


Van Breda Vriesman has not yet observed any majorproblems in the care sector labour market. “Staffshortage problems in the care sector are not yet acute. Ifwe look at the current demand to supply ratio, there issufficient staff to meet care demand. Things are about tochange, however. There is still room for efficiencyimprovement when it comes to the way care is organisedand managed.”

Van Breda Vriesman thinks capacity planning is going tobecome more important in the future. “As long as there isno one to coordinate long-term capacity planning, thecurrent situation will persist. The different parties in thesystem sometimes have opposing interests: careproviders operate at regional level – health insurancecompanies often operate at national level; healthinsurance companies work with annual cycles - careproviders sometimes focus on the long term.Overcapacity in the market is rampant. One only has tothink of unused MRI equipment. In the future, healthinsurance companies will probably play a more activerole in managing capacity planning, but the centralgovernment should also take charge and provide clarityas to where responsibilities lie.”


6 Education

“When it comes to staffrecruitment, we are alreadyhaving to look abroad more andmore often.”

Dymph van den Boom’s point of view


When it comes to supply and demand patterns,population ageing affects the education market in anumber of ways. Mature students have a different take oneducation and some academic disciplines seem to havea particular appeal for this group. This forces universitiesto take a close look at their curriculum and think aboutwhether they should develop a curriculum aimedspecifically at this target group. So-called contracteducation also presents universities with a dilemma:should they recruit teaching staff for these courses ifthere is no research-related funding to cover theirsalaries?

According to Van den Boom, so-call Lifetime of Learningprogrammes are slow to come to fruition.

Knowledge valorisation is an issue that requires anacademic staff pool with a more diverse set of skills.Whereas in the past education institutes usuallyassembled highly specialised teams of researchers, theyare now expected to take a more multidisciplinaryapproach to team formation. Employability is alsobecoming a more important concern. Staff membersshould receive special training to broaden theircompetencies and departments should become moreflexible with regard to assigning tasks: not all employeeshave the skills to teach, do research and market theirknowledge. By promoting and facilitating employability,organisations may encourage employees to tap intohitherto unused qualities.

The UvA is an important social partner to the city ofAmsterdam in a variety of ways. Students and staff areputting their knowledge to practical use at local supportcentres in vulnerable districts to help tackle some of theproblems residents are facing. Senior, more experiencedemployees are often at the forefront of these kinds ofprojects.


University of Amsterdam -Dymph van den Boom

Prof.dr. D.C. (Dymph) van den Boom is vice-chancellor of theUniversity of Amsterdam. With 28,000 students, 5,000 staff membersand a budget of over 487 million euro, the UvA is one of the largestcomprehensive universities in Europe. The UvA has a broadacademic curriculum and in many disciplines its academic researchis at the top of the international league.

As part of the Knowledge for the City programmescientists are working on issues put forward byrepresentatives of the municipality of Amsterdam.Another platform for knowledge sharing with themunicipality are regular luncheons with the MunicipalExecutive. Ageing is one of the items on the agenda. Howcan we keep the city attractive for senior residents? Howcan we keep them active and involved? Van den Boomfeels collaborating with its two universities allowsAmsterdam to further enhance its image as city ofknowledge.


Senior students could well become a new target group.For now, Van den Boom has not observed a substantialincrease in students from this demographic. Olderstudents require a different set of skills from teachingstaff, as they are usually not short on time, come tolectures well-prepared and take the opportunity to ask alot of questions. While the resulting interactive dynamicmight help to enliven lectures, it must not get in the wayof educational goals and younger students’ needs. Whennot managed properly, the situation could ultimatelyresult in discord between senior and younger students.

Another potential pitfall is the widening gap betweenyoung students and ageing university lecturers. Youngstudents prefer a modern approach to education, with allthe new information and communication tools this entails.New education methods and teaching aids such asBlackboard cater to this need, but older lecturers mayrequire training to learn how to work with these newmedia.


The Van Vucht Tijssen report prompted the UvA to take along hard look at its HR policy. In the sixties the UvAexperienced a massive influx of academic staff thatstayed put. Faced with a large pool of soon-to-retire staff,

faculties started drawing up strategic staffing policies.Research programmes where large numbers ofemployees were due for retirement around the same timewere forced to expedite the recruitment of new staff tosecure the transfer of knowledge and expertise. As someof the faculties’ flagship disciplines were facing majorknowledge drain, special programmes such as ‘YoungTalent’ and ‘Young Generation Campaign’ were launchedto pass knowledge on to junior staff members via aso-called overlapping shingle construction. Themomentum thus gained was used to update andimplement strategic staffing policies in the organisation.“Ageing may at that time have caught us off guard, but ithas taught us a valuable lesson in that it alerted us to theimportance of strategic staff planning.” Another means ofresolving shortages created by retiring employees istaking an international approach. “When it comes to staffrecruitment, we are already having to look abroad moreand more often.”

Luckily, population ageing also has some positive effects:young people bring fresh new ideas and it also offersemployers the opportunity to give team diversity a boost.Nowadays teams should be a mix of complementaryskills to compensate for the fact that individualemployees cannot possibly meet each and everyrequirement. Departments can introduce some flexibilityto the rigid ‘60 percent teaching, 40 percent research’requirement specified in job profiles by making better useof team diversity and reassigning tasks.

A large percentage of university graduates will not beable to find a job in academics. National data show that70 percent of graduates will have to find employment inother sectors. This also goes for the UvA. Consequently,university graduates should be trained and prepared fornon-academic careers, for instance by launchingapprenticeship programmes, promoting entrepreneurialskills and preparing them for the teaching profession.


Van den Boom says a more international staff pool and acommensurate increase in cultural diversity may promptteaching institutes to reflect on their work methods. Thesame goes for the student body. Americans students, forexample, tend to be very ambitious, being the product ofa more competitive educational system. Their drive tendsto rub off on Dutch students, lecturers and researchers.With the international experience they bring, staffmembers and students from abroad raise professionalstandards and make education more attractive.


“Ageing will create an evergrowing demand for care-relatedtraining programmes.”

Hermien Hendrikx and Simone Blenk’s point of view


Hendrikx thinks the Lifetime Employment concept isgoing to materialise now that professionalisation is finallygetting the attention it deserves. At the moment, most ofROC Midden Nederland’s course participants are underthe age of 45, but projections say this is going to change.At the moment, over-55s are often given dispensationwhen it comes to refresher and additional trainingcourses, but in the coming years the upper age limit isexpected to go up and older employees too will berequired to participate. With people retiring at a later age,senior citizens will need to keep honing their professionalskills, and companies are turning to ROC MiddenNederland to help them achieve this.

The Bakker commission on labour participation has madethree recommendations:1. get more people involved in the labour process2. focus on improving employability3. gradually requiring people to work for a longer period

of time

As part of an education sector that offers training to sixtypercent of the population, ROC is keenly aware of theBakker report’s effects on policy.

ROC Midden Nederland consults with municipalities, forexample, on issues such as encouraging the inactivepopulation to become fully involved in the labourprocess. Developing appropriate training schemes aimedspecifically at people who have trouble findingemployment is one of the preconditions. The currentyouth unemployment figures may have removed some ofthe urgency, but Blenk feels the problem will soon beback on the radar.

Blenk also indicates that ageing will create a growingdemand for care training programmes. Additional staffwill be required to keep up with the increasing demandfor care services and we may well need to recruit andre-skill staff from other countries. This means the currenttraining curriculum should be restructured: trainingcourses should be more flexible and made available asseparate modules.


Regional Education CentreCentral Netherlands (ROCMidden Nederland) - HermienHendrikx and Simone Blenk

Drs. W.J.M. (Hermien) Hendrikx (left) serves on theboard of ROC Midden Nederland and handles theportfolios of education and HRM. Drs. S. (Simone)Blenk (right) is director of the HRM department.ROC Midden Nederland's curriculumencompasses vocational education, corporatetraining, reintegration programmes and integrationcourses. Amerpoort’s area of operation includesthe provinces of Flevoland, Utrecht and part ofNorth-Holland.


Due to the aforementioned developments, education willhave to be designed in a more flexible way. “Education isalways evolving, and so is the form it takes”, Hendrikxstresses. There will be a higher demand for programmesoffering remote, part-time and weekend education.Private training institutes such as LOI are experts atproviding services for this particular market and havebeen drawing a growing number of students. Education isincreasingly becoming a custom-made affair. Studentswant to have more opportunities for home study, which iswhy ROC Midden Nederland has already been workingon making education programmes more flexible.

Implementing competency-oriented education has beena major innovation in the field. Within ROC MiddenNederland there has been much debate on how to realisethis. According to Blenk, diversity in staff composition (inage, ethnicity, gender and work experience) is aprerequisite for innovation. Hendrikx adds: “This issue,too, can partly be realised by adopting both an outside-inand an inside-out approach. As a teacher, you can onlyinnovate if you are willing to adopt a broader view.”


Both nation-wide and within ROC Midden Nederland, theissue of staff composition has been getting a lot ofattention. Education currently ranks as the most ageingsector in the Netherlands, with 46 percent of thevocational training staff being over the age of 45 andROC Midden Nederland’s staff pool being even olderthan average. These older employees are mostly male,with young female teachers making up the majority ofnew recruits.

As education is primarily aimed at educating the young,population ageing can be viewed as matter for concern.“Young people are often taught by middle-aged teachersand to students these are not the most likely rolemodels.”

A balanced mix of junior and senior staff would bepreferable.

In view of the growing teacher shortage, however, ROCMidden Nederland should retain older staff members.

Recruiting staff with a professional (i.e. non-teaching)background may help resolve the issues of ageing staffpools and teacher shortages. These staff members willbe holding a dual job: half of the time they will bestanding in front of a blackboard; the other half they willbe doing their regular job. Being taught by someone withexperience ‘in the field’ has a lot of added value,particularly considering the fact that ROC’s curriculum isaimed specifically at preparing students for professionallife. “This approach would improve education bothqualitatively and quantitatively. Many teachers in thevocational education sector lack up-to-date fieldexperience in the disciplines they are teaching youngstudents.” For older employees, combining a teachingjob with a regular job could be an attractive option.“Rather than being limited to newly qualified teachers,our labour market is broadened to include professionalsfrom other fields as well”, Hendrikx explains. “It is ourambition to institutionalise this approach, so that iteventually becomes par for the course”, Blenk adds. “Wewill obviously make sure these professionals receiveproper training to make them qualified for the teachingjob. Education institutes should uphold their owneducation standards, after all.”

According to Blenk, ROC Midden Nederland’s HRpolicies pay a lot of attention to diversity. Theorganisation has formulated an age-conscious HR policythat focuses on the employability of older staff members.With vitality being identified as one of the key factors,Roc has recently launched a health improvement projectconsisting of five components: Stop smoking, Take timeto relax, Exercise, Eat healthily and Limit your alcoholintake (STEEL).


“Besides the trend of adopting an outside-in approach,adopting an inside-out perspective is also gainingground”, Hendrikx says. Having a professional career inaddition to being a teacher makes for a more dynamiccareer. Teaching can be tough, and occupational varietymay contribute to keeping employees vital. “Teachersshould broaden their horizons.” While some of them aredoing just that, it is not yet common practice, eventhough the quality of education would surely benefit. Itwould also make the teaching position more interestingand therefore competitive on the labour market. Forbusinesses, having employees explore the teachingprofession may also be an interesting proposition. Blenksays this would result in a benign blurring of labourmarkets. Hendrikx adds that implementing such schemesrequires semi-permeable demarcations between labourmarkets and training institutes should always safeguardthe quality of their core tasks. This can be achieved byoffering proper coaching and sound training courses.


“For the education sector, one ofthe most pressing aspects ofageing is the fact that youngpeople are increasingly movingaway from rural areas.”

Pieter Boekhoud’s point of view


For the Albeda College, population ageing is notexpected to give rise to dramatic shifts in the demand fortraining. Traditionally, Care and Welfare has always beenits largest discipline, and with an expectedageing-induced increase in care demand that is not likelyto change. One potential problem is the fact that careworkers will often be required to extend their studies.There is sufficient staff to provide first and second levelcare, but when it comes to level three and four thenumbers dwindle. This means many graduates will haveto continue their studies after graduation. To ensure itsstudents are adequately equipped for this, the Albeda

College has intensified its participation in care institutes’own training programmes. It stands to reason this willhave an effect on how the college is managed. It is alsomeans Albeda College employees will have to develop akeener sense of commerce.


For the education sector, one of the most pressingaspects of ageing is the fact that young people areincreasingly moving away from rural areas. Whereasstudent numbers in the highly urbanised Rotterdam areaare expected to remain stable, education institutes inother regions will probably see their enrolment numbersfall. We need to think about how to maintain a basiceducational infrastructure in those areas. Another sideeffect is that training institutes will go where the studentsare and launch branches in the Randstad region. Thisobviously has an effect on how these institutes are run.

Similar to the age of teachers, the average age ofstudents has also gone up. At this time, a quarter ofAlbeda students are over the age of 22. Culturallyspeaking this is a good thing, because these olderstudents can take younger students and junior staff under


Albeda College - Pieter Boekhout

P. (Pieter) Boekhoud is the chairman of the Albeda College inRotterdam. The Albeda College is a regional education centre withsome 2,400 employees and 28,000 course participants, spread outover 50 locations in the Rotterdam Rijnmond region. Boekhoud hasdedicated his career to education and promoting education forvarious target groups.

their wing. On the management side it does presentsome obstacles, primarily because the financing systemis not geared to the deviating study paths these olderstudents tend to follow. Also, older students require adifferent kind of preparation and a different kind ofcoaching.


The Albeda College started thinking about the ageingissue in the early nineties. At that time managementfeared it might soon be facing a teacher shortage.Luckily, the problem did not turn out to be as bad asexpected. The age at which teachers exit the labourprocess has risen substantially and as a consequence,the average age of teaching staff has gone up. There isan upside to this: because of their experience andcoaching skills, older teachers turn out to have a positiveeffect on students and junior colleagues alike. This doesnot take away the fact that the problem has beenpostponed rather than averted. A third of Albeda’steaching staff pool is set to retire within the next fiveyears. If student numbers indeed remain stable this isgoing to become an issue, but as student numbersnation-wide are projected to drop, ageing-related teachershortages may not become as pressing a problem asmany fear.

In response to a newspaper article that claims populationageing might actually help save costs as senior - andthus expensive - retirees are bound to be replaced bycheaper staff, Boekhoud expresses some reservations.There may be additional costs involved in retaining olderemployees, providing coaching and arranging additionalcapacity. Also, recruiting new staff members comes witha price tag.

All in all, Boekhoud concludes that population ageing willlikely pose some challenges for the education sector. Thescope and complexity of those challenges will dependlargely on where training institutes are located and on thecurriculum they offer.


Final words: the future has already begun

Nineteen decision-makers from various sectors within thepublic domain have expressed their point of view on theissue of ageing. What do these interviews teach us, andwhat should we as companies, organisations or individualreaders be focussing our attention on?If you compare these various points of view, you will findremarkable similarities. Even though all interviewees viewthe issue and the solutions from their own perspective,the concepts they put forward fit together like a jigsaw.The following picture emerges.

Increased strength and increased vulnerability

Ageing will enhance the strength of a population. It willalso increase its vulnerability. On the one hand, there is agrowing group of senior citizens who will continue towork, provide informal care and have money to spend.They need new products that enable them to stay active.On the other hand, there is a growing group of (older)geriatrics who are especially vulnerable due to theiradvanced age and the multiple afflictions they are likelyto have. What these seniors need most of all is socialcohesion. Ageing will lay a large claim on the youngpopulation, and they in turn will lay a large claim onsociety. The young expect personalised, individuallytailored service provision and a government thatfacilitates their busy existence. Ageing ethnic groups mayhave specific care needs that require customisedsolutions from care providers and the government.How do we deal with all these changes?

Multiform and life phase proof regions

The interviews seem to tell us that setting up a multiformregion should be the first step. A multiform regionaccommodates all age groups and puts the communityrather than the individual centre stage. This meansNational Neighbour Day is an important event and youshould no longer need a permit to organise small localevents. Neighbourhoods and villages are life phase proof.This means senior citizens can move within their owndistrict to accommodation that is closer to the facilitiesthey need; an updated version of the notion that oldpeople prefer to stay in their own homes. The applicationof home automation is an important aspect of life phaseproof regions, and a lot of attention is paid to safety inand around the house.

Villages, districts and municipalities should start lookingbeyond their borders. Instead of the old adage ‘eachcommunity should have its own facilities’, the possibilitiesof the region as a whole are taken into account. Thismeans highly specialised facilities are bundled, with thecaveat that each district or village should at least have aprimary care facility and some sort of protected livingoption. Care institutes shall have to adapt their buildingsto older clients who need more physical care.

This brings us from the ‘hard’ aspect of homeconstruction and spatial planning to the ‘soft’ aspect ofcare and service delivery. What are the main areas forattention?

New care and service offerings

Care and service providers will be more mindful of thevariety in senior citizens’ lifestyles. Hospitality will be akey factor. Senior citizens want to feel at home and theyexpect ever higher standards of service. Senior citizenswith an ethnic background will in some cases requirespecific types of care and services.

Training institutes will cater to senior citizens’ interest inart, literature and culture by offering courses that fitdemand. Service concepts for the young seem to bechanging. New innovative forms of education such ase-learning are beginning to emerge, making it easier foryoung students to study at home, at their ownconvenience, without having to set foot in an actualclassroom.

When it comes to dealing with the effects of ageing,prevention has long been the magic word. It should benoted, however, that prevention delays rather thaneliminates the demand for care. Having said that,prevention measures undoubtedly improve people’squality of life. They may help reduce care expendituresand the incidence of chronic illness and add to the yearspeople spend in good health. Despite all this, we all knowthat good health is finite and will be followed by period ofill health, be it at the age of seventy or ninety. We shouldtherefore be weary of viewing prevention as a financialsolution, but cherish its social benefits.


As is the case with home construction and spatialplanning, care and service providers will sharpen theircommunity focus. The concept of working with ‘newstyle’ community nurses is gaining ground. Visitingnurses coordinate care, identify problems and take onsome of the tasks traditionally handled by GPs.Neighbourhood-oriented intervention teams consisting ofpolice and emergency services take care of safety issuesaround the clock. Residential care institutes opt for asmall-scale approach. They provide care in small groupswith regular staff, who will have more professionalfreedom than they have now.

In order to meet the growing demand for care andservices, care organisations will have to standardise partof their processes, which has the added benefit ofreducing overhead. This clears the way for devoting moreattention to types of care and service delivery thataddress clients’ individual needs and questions (and maytherefore require a personalised, unique approach and aslightly higher overhead). This approach depends on thefurther optimisation of service delivery to and betweensupply chain partners, which allows alleviation ofregulatory pressure.

(Information) technology and digital care

All interviewees mentioned the role of IT and technologyas one of their biggest concerns. Even though much hasbeen achieved these past few years, the decision-makersthat contributed to this booklet still identify majorpossibilities. Service providers (be they municipalities,pension funds, health insurance companies or careinstitutes) have been providing a growing number ofdigital services. Clients are awarded an active role inmanaging their own data and interacting withorganisations through so-called self-service conceptssupported by computerised, client-driven systems.Interactive applications are popping up like mushrooms.Skype, e-mail and screen-to-screen care are gaining inpopularity, also among senior citizens.

Strikingly only one interviewee expressed some doubtsas to whether senior citizens actually want all these newtechnologies. All other interviewees view the growingimportance of IT as an inevitable, and in most casesdesirable, development. When applied as discussed, IT isnot seen a tool that deprives people of face-to-facecontact, but as a tool to establish contact where little or nocontact would otherwise exist. It enables senior citizens tostay in touch with relatives and loved ones and allowsthem to speak to or even see counsellors and careworkers online. Care can be organised more flexibly andsome clients may be more candid about the problemsand questions they are dealing with than they would be inface-to-face encounters. In the words of one interviewee:‘We prefer to call this convenient care rather than remotecare.”

IT also offers some indirect benefits to the elderly.Decision-makers in the care sector expect IT tocontribute significantly to averting anticipated staffshortages. This brings us to the next area for attention:labour market developments.

The role of employers

All decision-makers that touched upon the subject agree:keeping employees fit and vigorous is going to be crucialin the coming years. Diet, exercise and health checks areimportant ingredients of health-conscious policy. Linemanagers may even start bringing up smoking habitsduring job appraisals. Offering staff ongoing training andin-company development opportunities falls under thesame header. Alleviating work pressure is also firmly onthe agenda. Some interviewees commented that seniorcitizens may need to accept having to take a step backon the career ladder. By keeping them involved in thelabour process in some capacity, senior citizens canmake a valuable contribution to the economy and helpprevent staff shortages in the care and service provisionsector.


In the education sector, working for a longer period oftime translates to an ongoing need for training. Olderemployees can make a valuable contribution to youngpeople’s knowledge development by passing on theirexperience and expertise. At the same time, retainingolder teachers will only postpone the staff shortage issue.Sooner or later, they are going to retire. One of the mostcrucial challenges for the education sector issafeguarding the quality of future education by facilitatingthe influx of young employees.

In order to appeal to younger employees, employerswould do well to take their particular wants and needsinto account. Offering young recruits a substantial salarymay not necessarily suffice; an interesting job thatmatters, flexible working hours and an organisation thatinspires a feeling of belonging are also importantincentives. Employers may even wish to consider offeringemployees shareholder or stakeholder schemes.

New jobs and foundations

A question yet unanswered is how this new society isgoing to distribute the various tasks and responsibilitiesand who is going to provide the necessary finances.

Senior citizens themselves will be assigned a moreimportant role, but the notion that “they are becomingincreasingly assertive and will be taking charge of theirown care and service requirements” needs to bemodified. Whereas this may be true of some seniors, careproviders need to make allowances for a large group ofpeople who are unwilling or no longer able to be thisself-reliant. The role of community nurses has beendiscussed. Perhaps appointing community hostesses ormanagers to deal with enquiries may also be an option.More and more elderly people will use the Internet tokeep in touch with peer groups and patient associations,organisations that are expected to make a large mark onthe care and service delivery landscape. In the future,there may even be care organisations with clientshareholder schemes.

Municipalities and provinces have an expanding rolewhen it comes to structuring the environment andcreating possibilities for participation.

Not only are senior citizens expected to get a greater sayin care and service provision; they will be expected tomake a larger financial contribution to the care theyreceive. Resorting to measures that involve peoplepaying extra for customised care or additional luxury andsaving money to pay for future care is no longerconsidered off-limits. There are also some fairly concretesuggestions that involve partially paying pensions out inkind (i.e. in care or housing) and offering integratedpension/housing/care packages.

And finally: let’s get to work!

The interviews showed a number of organisations havetheir work cut out for them when it comes to dealing withageing-related changes to supply and demand,production volume and service delivery concepts. Inorder to develop solid strategies and bring balance to thedecision-making process, it is important to take acomprehensive approach and not put things off for toolong. The future has already begun. As a reminder, wehave added a list of the ageing issue’s ten most pressingareas for attention.


Nr./ Area for attention


Nr. Area for attention

What

1 Be aware of the growing group of vigorous, active seniors, but also take into consideration the growing group ofvulnerable geriatrics with a complex need for care, social security, safety and social cohesion.

2 Cater to senior citizens and young people who want to handle their own affairs, but also accommodate people who areunwilling or unable to do so.

3 Accept the fact that citizens will have to pay extra for additional care and service delivery and take new concepts such asoffering integral pension, welfare, care and housing schemes under consideration.

How

4 Set up multiform regions in which highly specialised facilities are bundled and primary care facilities and protected livingfacilities are spread out throughout the area.

5 Work towards hospitality-oriented care and service delivery.

6 Make care and service delivery more community-oriented. Care organisations should take a small-scale approach to careprovision.

7 Enhance the role of IT to support service delivery, work processes and digital care.

Who

8 Standardise generic components of public service delivery, reduce the overhead of generic services and focus instead onimproving individually tailored services.

9 Promote the enduring fitness and vitality of staff.

10 Be an attractive employer to young recruits by offering flexible work hours, meaningful and exciting jobs, opportunitiesfor development and social cohesion.

About the authors


Gertjan Baars

Drs. Gertjan Baars is an information management expert and director of the Information Management team within PwCNetherlands’s Local Government group. Working from a clear vision on future developments in e-services andmanagement processes behind the digital front office, his primary focus is the implementation of IT applications in themanagement processes of municipalities, provinces and water boards. Since a few years Baars has been specialisingin population ageing and its effects on the local and regional government domain, advising government agencies onhow to deal with the issue.

Anneke Offereins

Drs. Anneke Offereins is a management and organisation expert and advisor with the Healthcare Advisory Group, asubdivision of PwC Netherlands’s Advisory division. In this capacity, she works on strategic and organisational issues,focussing mainly on improvement of elderly care. As part of the Healthcare Advisory Group, Offereins has beenstudying the effects of ageing on the care sector and advises care providers on how to optimally prepare theirorganisations for the coming changes. Besides her position at PwC, Anneke is also part-time employed as researcheron Ageing & Social Innovation in the Healthcare sector at the Research Centre for Social Innovation of the Academy ofApplied Science in Utrecht.


PwC Netherlands Ageing Taskforce

Under the supervision of Gertjan Baars and Anneke Offereins, PwC Netherlands has assembled a multidisciplinary teamof professionals that study the population ageing issue and work daily at providing clients with optimum assistance andat developing comprehensive products and services. This enables our clients to make efficient use of the opportunitiesageing has to offer and circumvent potential stumbling blocks. PwC’s advisors base their work on client consultationand a profound knowledge of the public sector.

The following professionals contributed to the nineteen interviews in this booklet:

Drs. R. (René) van KuijkMr. M. (Marc) van DijlDrs. J. (José) van ZwietenDrs. A.H. (Arjan) de JongDrs. K.M.P. (Kam Mai) TanDrs. M. (Marlijn) Moors

Acknowledgements

A special word of thanks goes to drs. Anneke van Mourik and drs. René van Kuijk, who have been instrumental to therealisation of this booklet.

Contact

pwc.com Assurance � Tax � Advisory

Would you like to know more?

For further information, please contact:

Gertjan BaarsTelephone: + 31 88 792 6412Email: [email protected]

Anneke OffereinsTelephone: + 31 88 792 7355Email: [email protected]

ageing in the netherlands - pwc · 2015-06-03 · reed business bv, p.o. box 152, 1000 ad...

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