The Elder-Care Delusion
The Netherlands has one of the most generous long-term-care insurance systems in the world, yet nearly half of its elderly residents still rely on informal care from family and friends. Many Americans assume that they can afford paid help in older age and won't need to rely on kin, but this is a misconception. The majority of elder care is still done informally, usually by spouses or children, and it is likely that this will continue to be the case even if formal care services are scaled up.
- ▪The Netherlands spends 4.1 percent of its GDP on formal elder-care services, with 94 percent of it publicly funded.
- ▪More than 80 percent of Americans over 65 in need of care depend on kin, with about two-thirds relying solely on informal care.
- ▪The share of American elder care done on an unpaid basis is growing over time, and this trend is also seen in other high-income nations.
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FamilyThe Elder-Care DelusionMany Americans assume that if they can afford paid help in older age, they won’t need to rely on kin. They’re wrong.By Stephanie H. MurrayIllustration by Hokyoung KimJune 23, 2026, 8 AM ET ShareSave As far as growing old goes, the Dutch have it pretty good. The Netherlands offers arguably the world’s most generous long-term-care insurance, covering professional nursing or home care for all residents who can demonstrate need. The country spends a whopping 4.1 percent of its GDP on formal elder-care services, 94 percent of which is publicly funded.
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