According to a recent survey by the Private Health Insurance in Germany (PKV), more than one in three German citizens has a nursing case in their personal environment. In addition to providing good care for those in need of care, it is important that caring relatives take their time off.
Long-term care insurance in Germany
Providing for people in need of care will be a major challenge. The website of the German Federal Ministry of Health (BMG) outlines the history of long-term care insurance in Germany. Long-term care insurance was established as an independent branch (5th pillar) of the social insurance system on January 01, 1995. It is the youngest branch of social insurance. Long-term care insurance is a compulsory insurance for all persons insured under both statutory and private health insurance schemes. Every person who is registered with a statutory health insurance is thus automatically insured in the social long-term care insurance. Persons with private health insurance must take out private long-term care insurance. The costs of long-term care insurance are financed by social security contributions, half of which are paid by the employee and half by the respective employer. There are different care levels, which are based on the amount of help needed.
Need for long-term care on the rise in Germany
People in Germany are getting older and older. Demographic developments are having an enormous impact on all areas of society and are leading to growing financial burdens on social insurance systems. For long-term care insurance, the older the population, the higher the number of people in need of care will become. People are in need of care if they are permanently dependent on assistance in carrying out ordinary and regular activities of daily living to a considerable or greater extent due to a physical, mental or psychological illness or disability. In this context, permanent refers to a period of at least six months. In Germany, it is predicted that the number of dementia cases will increase significantly in the coming years. In a 2014 information sheet, the German Alzheimer’s Association predicts that the number of dementia sufferers, currently 1.5 million, will double within the next 30 years. People in need of care can decide whether and, if so, how and from whom they want to receive help. They can choose whether they want to be cared for by professional specialists, for example in nursing and retirement homes, or whether they want to receive care allowance instead, which they can pass on to their family caregivers. Long-term care insurance often does not cover all the costs of care, and the persons in need of care or their families must provide the remaining financing. A permanent need for care often means great physical and psychological strain for all those affected, in addition to the financial burden. The caring relatives naturally want their loved ones to be well cared for, but at the same time it is important that they themselves also take their time off as well as necessary rehabilitation and preventive measures after illnesses or operations or for preventive purposes. Some facilities, such as the Bad Bocklet Rehabilitation and Prevention Center in Bavaria, offer family caregivers the opportunity to take their rehabilitation measures while the family member in need of care is being cared for during the treatment period. The care of the person in need of care is provided by nursing professionals. There are several options available: the family caregiver can go to the rehab alone, while the care of the family member is realized at the place of residence. Another option is to place the person in need of care in a nursing home that cooperates with the rehab center and is located in the immediate vicinity. If separation is not possible or desired, both persons can be accommodated in the rehab center. The caregiver can also learn special nursing activities, such as wound care, on the person in need of care, if desired. Another option is joint rehab with active participation, during which the family caregiver completes a rehabilitation program at the geriatric clinic in addition to his or her own rehab. This can be useful if the geriatric rehabilitation can improve the care situation.
Introduction of a new concept of need for long-term care
In November 2006, the German Federal Ministry of Health established an advisory board to review the definition of the need for long-term care. In 2009, the advisory board published two reports aimed at a new concept of need for care. According to these reports, the focus is no longer on the time required for individual care measures, but on the degree of a person’s independence. As the reports failed to provide many answers on the specific introduction, in December 2011 the expert advisory council on the specific design of a new definition of the need for care was commissioned to clarify the unanswered questions. This committee presented a report in June 2013. The key finding of the report is that the new definition of the need for care should be expanded. This was done by including the various behaviors and resulting problems that are common in mental and psychological illnesses, especially among people suffering from dementia. The focus is on limited independence due to the loss or restriction of cognitive and communicative abilities. Until now, these aspects have not been adequately taken into account – this is to change in the next few years. As part of the assessment procedure, the measures relating to the new definition of the need for long-term care are to be tested in model projects to determine their suitability for everyday use and their impact, as the BMG explains at this point. First, the assessors of the Medical Service of the Health Insurance (MDK) will be trained, and from summer 2014 a total of 4,000 assessments will be carried out nationwide. In an initial study, 2,000 assessments will be carried out in care facilities and in home care – by caregivers or family caregivers. The focus will be on questions relating to the design of the specific processes involved in implementing the new definition of the need for long-term care and with regard to acceptance among the insured, as well as findings and current information on the number and distribution in the new care levels. The second study focuses on the care requirements of the new care levels in inpatient care facilities. Around 2,000 people in need of care from 40 nursing homes across Germany will be assessed. The aim here is to determine the time required for care services in the respective care levels so that better care can be provided in the future.
