"There for the safety net, not the dreams": local decision-makers' perceptions on scarcity, trade-offs, and caregiving responsibilities in social care resource allocation in the Netherlands.

BACKGROUND AND OBJECTIVES: In the Netherlands, municipalities are responsible for providing social care to enable older individuals to age in place. Resources are largely allocated by local decision-makers who translate policy into individual-level decisions, yet little is known about how they interpret and weigh relevant considerations in practice. This study examines how local decision-makers perceive the scarcity of social care resources, trade-offs they make, and challenges they encounter in everyday decision-making. RESEARCH DESIGN AND METHODS: We conducted interviews with 27 local decision-makers, structured around perceptions of scarcity, trade-offs, and challenges. The analysis was guided by analytic questions focusing on interpretations of the Social Support Act, perceptions of scarcity, trade-offs, challenges in decision-making practice, and views on caregiving responsibility. RESULTS: Local decision-makers varied in how they perceived scarcity and interpreted the statutory principles of the Social Support Act, resulting in different approaches to prioritization. Participants described a paradox between local discretion and a narrowing ability to target resources for particular priorities due to case law. Another identified challenge concerns the mismatch between policy expectations and societal views on caregiving responsibilities. DISCUSSION AND IMPLICATIONS: Local decision-makers' challenges with conflicting aspects of the Social Support Act is reflected in different and sometimes incompatible prioritization approaches. Paradoxically, the Act's broad, open formulation results in increasingly restricted ability to allocate resources effectively in view of local needs. Better alignment between national legislation and local realities is required to allow scope for meaningful local discretion, alongside national debate to clarify priorities to support transparent and equitable allocation of social care resources.