From cradle to grave – but dig it yourself, please

Abstract

For-profit nursing homes are a booming business in the Netherlands: where only 96 existed in 2013, that number has skyrocketed to 640 by 2026. Since 2007, private-equity firms have invested in this sector and are now estimated to control 25% of all for-profit nursing homes (Patiëntenfederatie Nederland 2026). This rapid expansion marks a sharp tension with the Netherlands' longstanding tradition of universal elderly care delivered through non-profit institutions. This thesis therefore seeks to explain the emergence and persistent entrenchment of private equity in the Dutch nursing home sector. Drawing on a critical feminist political economy framework, the thesis argues that elderly care has become a site of capital accumulation through a mutually reinforcing set of structural conditions: State-driven austerity and marketization policies have simultaneously generated the demand for private provision and constructed the market conditions necessary for private-equity firms to extract high returns from care. These dynamics are further enabled by the deregulation of financial capital and shifting state paradigms that have progressively opened public services to market actors. Underlying these developments is capital's structural tendency toward overaccumulation, which drives the search for new investment outlets - of which commodified care has become an increasingly attractive one. As demand for elderly care continues to grow, the sector is becoming ever more deeply subject to financialization, with far-reaching consequences for care quality, labour conditions, and the universalist principles that once defined Dutch elderly care provision.