Advancing Spiritual Care Through Research

Huge investment in spiritual care in the Netherlands

Transforming Chaplaincy welcomes this report from Marije Vermaas and Joep van der Geer of Agora:

The Dutch government has decided to make major investments in spiritual care in palliative home care. In this article we describe the reasons and factors that play eda role in this policymaking.

Home care. In recent years it has become policy in the Netherlands for elderly people to continue to live at home as long as possible. The elderly only end up in a nursing home when the necessary health care cannot be provided at home. Nursing homes have therefore been transformed from places with residents with lighter needs for help, like dressing, cooking or cleaning, to places where people need extensive care. Mostly people with advanced dementia or severe health issues now live in nursing homes; other patients stay at home with help from professional home care and informal caregivers such as family members. The result is that many palliative patients therefore stay at home as long as possible.

Legal aspects. By law hospitals, nursing homes and other inpatient healthcare settings are obliged to provide spiritual care for their patients. Hospices are considered to be a substitute homecare facility and are not considered to be inpatient healthcare settings. Funding of hospices is often not sufficient to offer professional spiritual care. Furthermore, for patients receiving care at home, professional spiritual care was also not funded. Presently, many more patients are sent home while still ill or recovering. They often have questions like ‘How many more months do I have to live? Can I still live in this house I have lived in with my loved ones for so many years? Who will notice when I fall or hurt myself? Does anyone care about me?’ With a view to these needs, research is being conducted on whether spiritual care at home should also be made available, either by requiring it by law or through means of health care insurance.

Other developments. There are several reasons that play a role in the rising need for non-institutionalised spiritual care. One of them is the decline of the number of people who belong to a church or to another community where spiritual care is provided. Many people do not know to whom to turn when major and disturbing life events occur, such as the loss of a close relative or health. Spiritual questions remain, but people do not know how and where to address them. A society with a focus on individualism also contributes to people feeling lonely, stressed and burned out. New ethical dilemmas also play a role, due to the fact that so much more is possible in health care than ever before and that requests for broader options for legalised euthanasia are rising. The focus on positive health (due to the innovative research of Machteld Huber) and the changing relation between patient and doctor/health professionals are also factors worth mentioning.

Three themes. The current government has therefore decided to subsidize healthcare chaplains to provide spiritual care to patients at home. For the period 2018-2021 €35 million has been made available to cover the costs of healthcare chaplain activities (€5 million per year) and develop new structures for spiritual care at home. To develop this program, the government supported the appointment of a central coordinator (Joep van de Geer) by Agora, a national organization on palliative care and community care. The task of the coordinator is to bring the various organizations together in order to develop structures and methods to facilitate care. Three central themes have been chosen:

  1. Daily practice of spiritual care in palliative care. The involved organisations are, for example, the national professional association of spiritual caregivers VGVZ, the central organisation of palliative networks, and the central organisation of social care in local areas.
  2. Teaching and education. There are universities and other educational institutions for the training of spiritual care givers, but also programs to educate volunteers and professionals in health care on skills in recognizing and dealing with spiritual issues.
  3. Research by universities and scholars. Besides the funding allotted for spiritual care, the government also intends to invest several million euros in scientific research for the development of chaplaincy care. Research will be initiated, for example, on the registration of patients and their spiritual care givers, but also on the impact of spiritual care on the wellbeing of patients. Narrative and other types of interventions will be investigated and models for (spiritual) care will be developed.

Dr. Joep van de Geer has been appointed as coordinator to maintain an overview of the various themes and projects concerning spiritual care at home for palliative patients. He has been employed by Agora, an organisation that supports palliative care in local communities.

More information. This investment in spiritual care in the home setting will have a major impact on Dutch (palliative) care and homecare. We will be glad to keep you informed during the process. If you would like more information, please contact Joep van de Geer at or check

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