HEALTHCARE
Room for healthy growth
Healthcare real estate will, in the coming years, be shaped by several mutually reinforcing megatrends. Within the Megatrend Demographics & Well-being, population ageing and the rapid increase in the number of people aged 75+ are driving a structurally higher demand for suitable housing and care solutions. At the same time, labour shortages are intensifying and healthcare costs are rising further, putting increasing pressure on the system. Added to this is the sustainability challenge, an important theme within the Megatrend Climate & Energy. A large part of the healthcare real estate stock is outdated and must be upgraded to meet stricter requirements for energy performance, comfort and long-term resilience. The Megatrend Technology & Artificial Intelligence is accelerating the use of new technologies and digital solutions, changing the way care is delivered. Hybrid models, with more care at home and digital support, require different types of buildings and facilities. The attractiveness of healthcare real estate continues to rise because it combines positive social impact with stable operations and sustainable long-term returns. This makes the segment stand out positively in a capital market that is becoming increasingly selective.
In this Outlook, we share our vision on the most important trends and developments shaping the future investment climate for healthcare real estate. We show how demographics, labour market dynamics and policy influence the demand for healthcare locations, which shifts are occurring between intramural and extramural segments, and what role prevention and primary care play. We also address financial and investment dynamics, concluding with our investment outlook on the sector.
Living, care and services in De Makroon, Amsterdam
Market dynamics
The ageing counter keeps ticking
Demographic pressure on housing and care continues to increase. From just over 18 million inhabitants today, the Netherlands is expected to reach 19 million inhabitants around 2037, and surpass 20 million inhabitants by 2060. The share of older adults is rising quickly within the population structure. The group aged 70+ will increase from 14.9% to more than 19% by 2040. This is an increase of nearly 1,000,000 people (Source: CBS).
At present, 40 percent of all households consist of a single person, and more than one quarter of these single-person households are aged 70 or older. In particular, the share of single households within the 80-plus age group is very high (Source: CBS). As a result, demand for suitable housing increases, and pressure on local care and support structures also grows.
FIGURE 1: Ageing: growth of the population aged 70 and older
Source: CBS (2025), edited by Achmea Real Estate
Informal care: the invisible foundation
A large part of the support that older adults receive comes from informal carers. This is often described as the invisible foundation of the Dutch care system. According to MantelzorgNL, around five million Dutch citizens provide informal care, of whom approximately 830,000 provide intensive care. The average time spent each week has increased to more than thirteen hours. Nearly one in ten informal carers reports feeling overburdened. Most informal carers are between 55 and 65 years old. Many of them combine work with caring for parents or parents-in-law.
This current generation of informal carers will eventually need care themselves, and the following generation of caregivers is much smaller. In the future, more support will therefore have to come from outside the family circle and neighbourhood-based support networks will become more important. This is often referred to as “naboarschap”.
This development is not only necessary but also creates opportunities for new care oriented housing concepts, such as courtyard communities, multigenerational homes and clustered living arrangements where care can be provided at home for as long as possible. This is important, because the formal care system is also under pressure.
Informal care supports ageing in place
More care with fewer workers remains the key challenge
The biggest barrier to expanding care capacity is the shortage of care staff. Without personnel, care institutions cannot treat clients, and without clients, there is no income. Fixed costs, such as housing costs, continue regardless. Labour shortages in elderly care are structural.
The development of care demand differs across care disciplines. According to the Labour Market Programme for Care and Welfare (AZW, 2024), staff shortages will rise to 200,000 by 2031, with a possible peak of 300,000 after 2034 if the inflow of new workers does not accelerate (see Figure 2). That inflow remains insufficient due to ageing within the workforce and continued outflow to other sectors. Although pressure is high everywhere, there are regional differences. Care demand is concentrated in urban areas where labour supply is tight. In more peripheral regions, staff may be slightly more available, but travel distances and limited scale create new challenges.
Pressure is therefore increasing to deliver more care with fewer workers. Technology, digitalisation and more efficient healthcare buildings are becoming essential building blocks. Complexes that support care processes efficiently, with short walking distances, shared facilities and space for digital tools, have a structural advantage. In curative care this includes enabling digital triage and remote monitoring.
FIGURE 2: Development of care demand (% compared with 2023) and labour market shortages in healthcare (absolute numbers)
Source: Vektis, CAK, CBS, AZW Statline, edited by ABF Research
Financial panels are shifting
After years of tight margins, elderly care organisations achieved surprisingly strong financial results in 2024. According to BDO and EY, average profitability increased to around 3 to 3.5 percent. This was partly due to the postponement of previously announced tariff reductions. Solvency and liquidity also improved, although room for investment remains limited.
Operational margins appear healthy, but with an EBITDA margin of around 7 percent, structural room remains too limited to finance innovation and sustainability improvements independently (WfZ, 2025; Finance Ideas, 2025). At the same time, a financial shadow remains over the sector. The government is planning further cost reductions in the coming years, mainly through lower tariffs and efficiency requirements in the coalition agreement. The intention is to slow down the growth of healthcare costs. As a result, the financial room for investment remains fragile, even though the need for investment continues to rise.
A higher Normative Housing Component
A positive development is the increase of the Normative Housing Component (NHC) as of 1 January 2026. This adjustment will provide better coverage of existing housing costs and create more room to invest in buildings that are suitable for the future. Despite the financial pressures described earlier, we expect that a higher NHC budget will strengthen the feasibility of business cases for new construction, replacement projects and sustainability improvements, particularly within intramural care. This will ultimately help more care projects move forward.
Intramural care in Campagne, Maastricht
Projects struggle to get off the ground
Although financial performance has improved temporarily and policy incentives provide some relief, developing new healthcare real estate remains complex and time consuming. The accumulation of requirements relating to sustainability, affordability and quality leads to significantly longer development trajectories. Construction and financing costs remain structurally higher than in previous years, while revenues are limited by regulated tariffs and capped rent levels.
Municipal programming also acts as a limiting factor. Senior housing and care-oriented residential concepts are still not sufficiently incorporated into area development plans, causing many projects to stall in early stages. CBRE research shows that current housing policy, which strongly prioritises affordability, does not always match the actual preferences of seniors. Many older residents have accumulated substantial wealth and increasingly look for larger and more comfortable apartments, which they are willing to pay for. This leads to mismatches between supply and demand.
Construction capacity remains limited as well, and permitting procedures continue to be slow, despite national objectives to accelerate them. The market requires a more pragmatic approach. This includes clear prioritisation of suitable locations, realistic sustainability objectives and more flexibility to repurpose and transform existing buildings quickly. Simplifying regulation is essential to achieve the necessary acceleration. Only then can the renewal of the healthcare real estate stock take place in time.
“The accumulation of requirements is causing development processes to take increasingly longer.”
Care and housing under construction: Maestro, The Hague
Changes in long-term care
Within the Wlz-system, there is a clear shift towards heavier care needs. The threshold for intramural admission has increased, meaning that mainly older adults with complex and intensive care needs qualify for placement in a nursing home. This leads to a heavier care burden, higher pressure on staff and stricter requirements for real estate.
A clear differentiation is emerging in long-term care housing. On one side, larger intramural facilities are being developed for highly complex care needs or for residents with limited financial resources. On the other side, private and extramural living concepts continue to grow. In these concepts, residents live independently and receive care through a Volledig Pakket Thuis (VPT). Rent and other housing costs are for the resident’s own account, but the personal contribution for care remains lower than in intramural settings. This expands choice and flexibility for residents.
Structural Wlz demand continues to rise
Despite recent signals of lower waiting lists and local vacancies, structural demand for Wlz places will continue to grow. According to ABF Research, the number of clients with a Wlz indication will increase by nearly 100,000 by 2040 (see Figure 3). The recent drop in occupancy is therefore mainly temporary. It is caused by staff shortages that prevent available beds from being used and by outdated buildings that no longer fit the expectations of residents. Additionally, more older adults choose to receive care at home through VPT arrangements. In the medium and long term, population ageing and increasing life expectancy will continue to drive demand for both intramural and extramural care housing.
FIGURE 3: Demand for Wlz places (intramural and extramural)
Source: ABF Research (Fortuna 2024), edited by Achmea Real Estate
Growth of the VPT segment
One of the most notable developments is the continuous growth of the VPT segment. While care providers often still act as master tenants, it is expected that investors will take this role more frequently in the future. Care providers will then focus exclusively on delivering care.
This shift creates opportunities but also raises new questions. Responsibility for allocating residents moves partly towards the property owner. This requires close coordination with care providers, municipalities and regional care offices, while avoiding conflicting interests. Vacancy risk also becomes a more explicit part of operations. On the other hand, higher net rental income, the ability to move towards market-based rents and full technical management responsibilities create new opportunities.
As these relationships evolve, the quality and location of the real estate become even more important for stable and future-proof operations.
Intramural care at Westhovenplein, The Hague
More plans than actual (care) homes
The transition from intramural care to living with care in the community continues. National policy targets 290,000 additional suitable homes for seniors by 2030. Many of these should take the form of clustered housing concepts, such as courtyard living, care integrated housing and lifetime adaptable homes. While the direction is clear, implementation significantly lags behind. CBRE reports that in 2024 only 1.4 percent of the required 290,000 senior homes were delivered. Capital Value notes that in the past years only around 600 senior rental homes per year were added. With five years remaining, achieving the national target appears unlikely. Towards 2040 the challenge becomes even larger. Based on ABF Research data, 425,000 additional lifetime adaptable homes will be required (see Figure 4).
FIGURE 4: Required suitable homes for seniors
Source: ABF Research (Fortuna 2024), edited by Achmea Real Estate
Strong demand for independent living
Demand is not the problem. Results from WoON 2024 show that older adults are willing to move, but the right housing options simply do not exist. Only a small share of people aged 65 and older still considers moving to a nursing home. The vast majority prefers to live independently, with care available nearby when needed. However, moving remains difficult. Many seniors cannot find suitable housing in their own neighbourhood or options that fit their living preferences. As a result, mobility in the housing market stagnates. Family homes remain occupied longer and overall housing shortages become more severe.
The government is exploring a “new style care home” as an intermediate form between independent living and nursing homes. This concept aims to reduce pressure on elderly care facilities. However, sector organisations such as ActiZ, Aedes and IVBN strongly criticise the proposal. According to these organisations, such a new category is financially inaccessible for many seniors, difficult to realise due to staff shortages and disruptive to existing development programmes for senior housing. The organisations agree that the need is clear, but they question the necessity of adding yet another housing category. Their appeal is clear. Focus on accelerating the implementation of existing agreements on clustered senior living concepts. These concepts already combine housing, care and well-being and offer realistic opportunities to support independent living at manageable cost.
“Demand is not the issue. The vast majority of people aged 65 and older prefer to live independently with care nearby.”
Lifetime adaptable and extramurally supported homes in De Nieuwe Sint Jacob, Amsterdam 📷
Well-being and prevention as the missing link
Between independent living and nursing home care lies an often overlooked layer. This includes well-being, prevention and light forms of support. Day activities, community spaces, exercise programmes and initiatives such as Nestorgym offer structure, social interaction and physical activation. These elements contribute directly to reduced healthcare usage. They make the difference between living independently and being able to remain living independently. Integrating these functions physically within senior housing projects, for example in the ground floor or through shared neighbourhood facilities, strengthens the concept and makes it more resilient and socially valuable.
Nestor Gym, De Nieuwe Sint Jacob, Amsterdam (Foto: Fotografie van AnneMarie)
Hybrid care offers more flexibility
The shift towards hybrid care contributes to a more flexible care infrastructure. Increasingly, treatments take place outside hospitals, for example at the GP, at independent treatment centres or at home. Digital consultations, remote diagnostics and temporary treatment facilities bring care closer to the patient. Innovative initiatives for home-based care illustrate this trend. Examples include the “Hospital on Wheels” concept, which delivers medical specialist care at home, and networks of independent clinics that jointly operate surgical centres. These developments show how flexible the care infrastructure is becoming.
Home diagnostics
Investment perspective
Although transaction volume in healthcare real estate has been limited in recent years, this should not discourage investors. The sector remains attractive for Dutch institutional investors who seek stable cash flows, limited risk and measurable social impact. The continued search behaviour among institutional investors confirms this interest. The current limited supply of new healthcare real estate offers opportunities for early movers to enter the market and benefit from future growth.
Market fundamentals have stabilised. Inflation and interest rates have entered calmer territory, although the new equilibrium remains higher than before 2022. Prime gross initial yields also stabilised in 2025, which indicates renewed balance in pricing. Given the stable net returns and the current spread relative to long-term government bonds, yield compression is unlikely and capital growth resulting from vacant possession value increases remains limited (see Figure 5). As a result, investor focus shifts towards direct returns and inflation-linked cash flow growth as the main sources of performance.
Intramural and curative healthcare real estate currently offer an attractive entry point. Higher initial yields, stable demand and a structural shortage of high-quality care locations form a strong foundation in a market that is normalising.
FIGURE 5: Spread between net income returns for healthcare real estate and Dutch 10-year government bonds
Sources: MSCI Netherlands Quarterly Property Index (Unfrozen), Oxford Economics, edited by Achmea Real Estate
Investment view
Healthcare real estate is becoming an increasingly attractive component of institutional real estate portfolios. It fits well within the broader framework of megatrends. The segment combines appealing direct returns with stable capital growth and strong social impact. Underlying demand remains robust across all healthcare real estate segments. It is driven by demographic ageing, policy continuity and the rising need for sustainable and future-proof care locations. Opportunities exist in both new development and the upgrading of the existing stock. Healthcare real estate is maturing into a liquid and strategically relevant asset class that aligns with the long-term perspective of institutional investors.
Campagne, Maastricht
Stable return profile with social value
Healthcare real estate distinguishes itself through stable cash flows, high occupancy levels and importantly, relatively low sensitivity to economic cycles. Combining different segments across care and cure provides attractive direct returns, often higher than those in the residential sector. Capital growth mainly results from solid indexation of long-term leases with care operators and increased vacant possession values for lifetime-adaptable housing. This creates a healthy risk and return profile that aligns well with the long-term strategies of institutional investors (see Figure 6).
Healthcare real estate also aligns seamlessly with impact objectives, given its strong social relevance. Providing efficient and sustainable care infrastructure supports both users and policymakers. Growing institutional investor interest in the sector increases liquidity and marketability, making healthcare real estate a compelling component in portfolios that require flexibility.
FIGURE 6: Returns, volatility and sharpe ratios for real estate segments 2012-2025
Sources: MSCI Netherlands Quarterly Property Index, edited by Achmea Real Estate
De Banne, Amsterdam
Combining segments for stability and impact
Combining different healthcare real estate segments remains essential for achieving a stable and socially meaningful return. Lifetime-adaptable housing benefits from strong housing demand and the emerging care needs of older residents. Clustered living concepts that integrate care, well-being and service functions offer strategic advantages for both users and investors. Homes that can eventually be sold separately benefit from structural housing shortages and corresponding value growth.
Intramural and private nursing home concepts for people with more complex care needs provide solid, inflation-linked long-term income streams that are largely funded by the government. Direct returns are higher than in residential real estate, although capital growth depends mainly on rent growth rather than rising vacant possession values, because a sell-off scenario is typically not applicable.
The curative segment, consisting of health centres and clinics, complements healthcare real estate portfolios with higher direct returns than care-related residential real estate. A good mix of professional and financially healthy care providers is essential. Functions such as general practitioners and pharmacies act as anchor tenants for well-functioning health centres.
Combining these segments provides the right balance between return, diversification and social value. Portfolios that cover the entire care chain are less dependent on policy or market conditions within a single segment and benefit from broader structural demand. Primary care plays a particularly important role in creating broad social impact across the full chain of housing and care for an ageing population.
Broad geographical focus
Population ageing and the associated increase in care demand occur across the entire country. In large urban areas the impact is significant both in absolute and relative terms. In more peripheral provinces the ageing effect is more relative, as internal migration flows of younger households accelerate demographic ageing in smaller towns.
The stronger the care component of the housing concept, the less relevant geographical location becomes for valuation and pricing. For this reason, the differences between the seven categories of the opportunity map have become smaller than they were before. This means that, in addition to the major urban centres, medium-sized cities and rural regions also offer clear investment potential. However, in the more rural regions the smallest towns face long-term pressure due to population decline and limited availability of local services.
Within the opportunity map, attractive propositions can be found up to and including region 6. For lifetime-adaptable homes in the private rental sector, the preferred focus is on municipalities within opportunity map regions 1 to 4, or on the larger municipalities in regions 5 or 6 that demonstrate healthy local market dynamics.
The opportunity map aligns with national spatial planning policy, which was updated in 2025 in the ’Ontwerp Nota Ruimte’ (National Spatial Strategy). In addition to the 17 existing NOVEX locations, four additional large-scale residential development areas were announced in 2025, each planned to deliver at least 3,500 homes. In total, the government has allocated 300,000 homes to be delivered across these 21 major development locations within the next ten years. There are also various smaller-scale development locations, particularly in and around cities. Nearly all 21 major sites fall within opportunity map categories 1 to 3.
For intramural and private residential care concepts and for health centres, opportunities also exist in regions 5 and 6, provided that basic infrastructure and municipal services offer sufficient long-term prospects. In these areas, it is particularly important to pay close attention to local market conditions.
FIGURE 7: Opportunity maps for age-friendly housing, institutional and private housing
Investment opportunities
Many of the conditions needed to accelerate investment in healthcare real estate are now in place. Demand is broad-based, supported by residents, care providers and investors who seek to combine social value with stable returns. Policy direction is also clear, and there is wide recognition that investment in suitable housing and care infrastructure is essential.
Despite this, supply continues to lag behind demand. New development volume remains limited, and the scope for expansion in the intramural segment is restricted by regulation. The recent increase in the Normative Housing Component may provide the necessary financial boost for many renovation or redevelopment projects to move forward. In this segment we expect more supply to enter the market in the coming years, although these processes remain lengthy.
For health centres, clinics and healthcare campuses, there are clear differences between new build and existing stock. New-build projects face relatively high construction costs compared with their revenue potential, which limits delivery. As a result, initial yields tend to be relatively sharp. Existing complexes, on the other hand, often suffer from deferred maintenance and require additional investment to ensure long-term operational continuity. In practice, the difference in initial yields between new build and existing stock is therefore substantial.
For lifetime-adaptable housing and private nursing homes, opportunities exist both in new development and in acquiring existing properties. Senior housing often requires additional investment in building quality and service facilities to make it genuinely suited for long-term independent living. In the past, this made the segment less attractive for developers and landowners, as revenue potential for standard residential development was often higher. Because senior housing has become a priority on municipal and national agendas, investment opportunities in this segment are expected to grow. The 21 large-scale residential development locations designated by the government in the Nota Ruimte will create further investment prospects in the years ahead.
Healtcare campus, Zaandam
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