It calls for new ways of working. That does not mean less care, but smarter, better organised care. We have written before about how technology can help make care more efficient, provided that new technology is properly implemented. The use of technology is one strategy; there is also a growing focus on how elderly care as a whole can be organised differently. A good example of this is the Dutch project „Thuis als het kan" ("Home if Possible") (UNO Amsterdam | Thuis als het kan).

Project "Thuis als het kan"

The project “Thuis als het kan" aims to reshape geriatric rehabilitation in response to the question: "How do we maintain good elderly care as demand grows while capacity does not?" Geriatric rehabilitation focuses primarily on the recovery of vulnerable elderly individuals after surgery, an accident, or illness. The goal is to restore independent functioning and support a return to the patient's own living environment. One concept that is receiving increasing attention is outpatient geriatric rehabilitation: part of the rehabilitation trajectory that would normally take place in a care facility shifts to the patient's own living environment.

What does that look like in practice?

With outpatient rehabilitation, patients spend less time in a rehabilitation facility. As soon as possible, the patient continues rehabilitation at home, guided by a physiotherapist or other treatment team. This may be supported by digital tools such as video calling and apps (Oostrik Arch Gerontol Geriatr. 2025).

Replacing part of the clinical rehabilitation with outpatient rehabilitation aligns with the principles of appropriate care. According to the Dutch Healthcare Institute, appropriate care is efficient, person-centred, and affordable care that is evidence-based and determined together with the patient. It is an important principle for making Dutch healthcare future-proof. It is expected that by carrying out part of the rehabilitation at the patient's home, the throughput speed in clinical settings will increase, meaning patients spend less time in the care facility, allowing more people to be treated with the same number of beds. Outpatient rehabilitation also fits within the concept of "positive health," which focuses on human dignity, preserving independence, and looking at what a person is still capable of.

Patients themselves often experience outpatient rehabilitation as pleasant and less burdensome: people prefer to recover in their own familiar environment, and rehabilitating at home saves a trip to the rehabilitation clinic or hospital. Moreover, the physiotherapist can work more purposefully in the patient's own environment by practising situations specific to the patient's home setting. It also relieves pressure on rehabilitation centres. It is therefore not about less rehabilitation care, but about a different distribution: a shorter clinical phase, followed by a well-supported trajectory at home.

"Thuis als het kan" is part of the publicly funded program "Beter Thuis" ("Better at Home") run by ZonMw and is carried out in collaboration with, among others, Maastricht University / AWO-L, Leiden University Medical Centre / UNC-ZH, and Amsterdam University Medical Centre / UNO Amsterdam. Eight care organisations from different regions in the Netherlands are involved, including Pieter van Foreest in Delft (ZonMw | Thuis als het kan). Bike Labyrinth collaborates with Pieter van Foreest for research purposes.

The research

The research project 'Home if Possible' was conducted from September 2023 through January 2026. In this project, three universities and eight care organisations across the Netherlands jointly developed and tested a shared working method. The study examined how part of the clinical elderly rehabilitation could be replaced by rehabilitation close to or at the patient's home (outpatient rehabilitation).

The outpatient rehabilitation trajectory is based on five principles:

1. A short stay in the rehabilitation facility followed by care at home.
2. Working toward goals that promote recovery and connect to the patient's daily life from the moment of hospital admission.
3. Optional use of supporting technologies, such as video calling with the treatment team, rehabilitation apps, and activity monitoring.
4. Extra attention to patient independence.
5. Close coordination between the patient, family, and care providers.
   
   The study consisted of a group of rehabilitation patients who followed the outpatient programme (n = 110) and a control group who had previously undergone exclusively clinical rehabilitation in the same eight centres (n = 240). These two groups were compared to assess whether outpatient rehabilitation could be a viable alternative to fully clinical rehabilitation.
   
   The first results were published in early January, revealing a number of interesting findings:

• Outpatient geriatric rehabilitation following a short hospital stay proved to be feasible.
• Upon completion, it proved equally effective as a fully clinical trajectory in terms of independence in activities of daily living.
• The outpatient rehabilitation trajectory also appears to be slightly less costly compared to a fully clinical trajectory: the costs of the 'Home if Possible' programme were on average €713 lower per patient than regular clinical rehabilitation.
  Patients, families, and care providers responded predominantly positively. It was therefore concluded that the outpatient programme following a shortened clinical stay is a fully-fledged alternative to the complete clinical programme. The researchers also note that the programme has further potential for development. A scientific publication, manual, flowchart, and several fact sheets are currently available (Prins J. Clin. Med. 2023, UNO Amsterdam | Thuis als het kan).