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Care farming is a promising example of multifunctional agriculture: it is an innovation at the crossroads of the agricultural and healthcare sectors. Our objective is to develop a framework for understanding the success of initiatives in this field. We link empirical data with the multi-level perspective from the transition sciences and extend this perspective with insights from the literature on entrepreneurship, alliance management and organisational attributes. This framework allows us to explain the success of the three major types of initiatives: (1) individual care farms; (2) regional foundations of care farmers; and (3) care institutions collaborating with groups of farmers at a regional level. We propose that the main factors responsible for the success of initiatives are the commitment and competences of the entrepreneur, the creation of alliances, the quality of the new regional organisations and the implementation of the care farm services in care organisations. The relative importance of the factors varies between the different types of initiatives and local and regional levels.

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Surveys among care farmers and data from the National Agricultural Census were analysed to describe the care-farming sector in the Netherlands. The number of care farms increased from 75 in 1998 to 591 in 2005. Care farming is the fastest growing sector of multifunctional agriculture. In 2005, nearly IO,OOO clients made use of care farms, of which 8000 used non-institutional care farms. The main client groups were mentally challenged clients, psychiatric clients, autistic persons, elderly people and youths. The average annual revenue of care activities on a non-institutional care farm was about € 73,000, which amounts to annual revenues of € 37.1 million for the total Dutch non-institutional care-farming sector. The annual revenue for care activities was considerably higher than for other extended activities. Care farming resulted in 473 additional jobs in 2005. The prospects of care farming are positive and the growth in number of care farms is expected to continue.

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Nature-based adult day services (ADSs) in urban areas are relatively new services in the Netherlands. Since knowledge about these services is still scarce, this study aimed to elucidate their value for people with dementia and their family carers in terms of health and wellbeing. We interviewed 39 people with dementia attending nature-based ADSs in urban areas and their family carers, and 17 providers of these services. Respondents indicated that nature-based ADSs in urban areas positively affected the health and wellbeing of people with dementia. According to them, these services support contact with nature and animals, activity engagement, physical activity, structure, social interactions, healthy eating, a sense of meaning in life and a focus on normal daily life. Respondents further indicated that these services stimulate respite, reassurance and maintenance of family carers’ own activities and social contacts. We conclude that nature-based ADSs in urban areas have a wide range of benefits that might affect the health and wellbeing of people with dementia and their family carers. Worldwide, demand is growing for innovative practices in dementia care. It is therefore worthwhile monitoring the development of dementia care innovations, such as nature-based ADSs, and for countries to exchange lessons learned from these services.

The aim of this paper is to describe and understand the evolution of the care farming sector in one of its pioneering countries, the Netherlands. Care farms combine agricultural production with health and social services. Care farming is a phenomenon that faces specific challenges associated with connecting two different domains. Organizational ecology, social movement theory and the multi-level perspective are helpful concepts in interpreting and contextualizing the developments that have taken place. Organizational ecology explains how the number of care farms, and the legitimacy and diversity of the care farming sector, have increased rapidly over time. Strategic actions of dedicated boundary spanners have played an important role in the development of the sector. Social movement theory explains the impact of collaborative action in the pioneering and later stages. The multi-level perspective explains changes in the care regime, like the introduction of the personal budget of patients and the liberalization of the Dutch health care sector, helping to provide access of foundations of care farms to the collective health insurance for the costs of long-term care. Media exposure, contacts with ministries and politicians and the development of a quality system have contributed to the legitimacy of the sector. Changes in the care regime and collective action promoted a further expansion of the sector and provided direction to the ways the sector developed qualitatively, especially in terms of the emergence of structures aimed at facilitating existing and promoting new care farming practices. Our framework sheds light on changes in agriculture and transsectoral collaboration.