Elderly care as a professional occupational field deals with the care and care of old people in institutions and forms of organization, such as home nursing , outpatient care services , old people's homes , nursing homes , geriatric psychiatry and, to a limited extent, in palliative wards and hospices . The professional elderly care is usually carried out by geriatric nurses , health and nursing staff or geriatric care assistants .
The aim of care for the elderly , as long-term care , is to maintain a good, stable quality of life. Because mental, physical and social skills decrease with age , the task of care for the elderly is to maintain and promote the self-care skills of those affected as much as possible. Rehabilitation always comes before nursing care. Necessary care, which the person concerned can no longer or not always provide himself, is to be planned, determined and provided with the consent of the person concerned, if possible. The state and private long-term care insurance serves to partially secure these services financially. Overall, the relatives as well as other professional groups working in the environment are to be included. Primarily general practitioners are to be named.
Elderly care, as a general term, consists of various tasks in the family, private or voluntary environment in addition to professional activity in the area of care for the elderly or the sick . The coordination of professional and informal (private or voluntary) care for aging people in need of help is a demanding task in elderly care, as it often involves interfering with the self-determination of adults.
Change of care
Due to demographic development and medical progress, the proportion of older people in industrialized countries is steadily increasing. One consequence of this is that more and more professional support is necessary. Medical progress, the use of increasingly complex medical products , the availability of technical everyday aids (collective term Ambient Assisted Living ) and the implementation of modern care concepts require increasingly higher qualifications from the nursing staff. This results in an increasing need for trained specialists and increasing financial expenses.
According to the Home Personnel Ordinance , which has since been partially replaced by country-specific standards in the course of the federalism reform , up to 50% of employees in Germany must have trained as a nurse, usually three years. However, this also means a high proportion of semi-skilled employees who may only work temporarily in an area of work that is strongly geared towards the continuity of previous lifestyles. Despite various protective provisions, including those relating to home supervision , serious deficiencies are repeatedly found in care facilities. This ranges from neglect or acts of violence by individual nursing staff to systematic deficiencies in nursing homes, which are repeatedly criticized.
Ongoing problems in care for the elderly are also the shortage of nursing staff, known under the catchphrase “ nursing emergency ”, and financing . The length of time spent at work has not been scientifically investigated, but it is considered to be low. The reasons given are often the physical and emotional stress and frustration at the divergence between the demands and the reality of the job.
“Since nursing courses were introduced in Germany in the 1990s, nursing has become more professional ; Efforts are made to develop and establish a common understanding of nursing and a common profile of professional nursing. The fact that independent knowledge is being developed through nursing research and expert standards is a sign of emancipation, but also of the independent profiling of nursing. "
The need for nursing staff will continue to increase in the future. According to federal and state statistical offices, the number of people in need of care in 2020 is estimated to be around 2.9 million.
Care in Germany
The care work in Germany is mainly done by relatives or other close people at home. This mainly applies to low levels of care . In 2013, 2.6 million people were in need of care, i.e. around 3.3% of the population. This, like professional care, is largely (> 85%) women care and is mostly carried out by wives and daughters. Where this is not possible, or not completely, supplement, or take home care services to home care (2005, in the surface state of Baden-Wuerttemberg supplied in this way, 65% of people requiring care) nationwide employ home care services about 290,000 employees. This number of those who were cared for at home does not include all those who have not received any benefits from long-term care insurance or have not applied for it (so-called level 0). About a third of the people requiring extensive care are given inpatient care . Outpatient services and homes employ trained geriatric nurses , nurses , geriatric nurses , nursing assistants, social pedagogues , occupational therapists and, to varying degrees, semi-skilled workers . As of 2013 there are around 13,000 nursing homes in Germany with a total of around 900,000 places. On average, 63 people in need of care are cared for in one home.
Financing, organizational levels
Elderly care is financed alongside private expenses
- in Germany primarily through the benefits of long-term care insurance , if necessary also subsidiary through care help , a type of state social assistance ,
- in Austria through state benefits based on the Federal Care Act and the State Care Act .
- in Switzerland partly by the person himself and partly by reimbursements from the health insurance company. The costs are incurred for care and support at home as well as the retirement facilities (homes, nursing homes). Various public and private institutions also offer selective support (e.g. Pro Senectute ). The community branch of the old age and survivors' insurance (AHV) provides information about the AHV and the right to supplementary benefits and helplessness allowance . In the event of disputes, some cantons have set up mediation offices (ombuds offices) that can be turned to for advice on any problems in connection with a retirement and nursing home or the Spitex or Pro Senectute organizations.
In other countries, especially in the US , institutionalized elderly care is part of the commercial sector. There is z. For example, the large geriatric welfare operator "Evangelical Lutheran Good Samaritan Society" is an exception because it is a non-profit organization.
The professional organization within a nursing institution (e.g. a nursing home, outpatient service) goes from the nursing assistant and possibly voluntary service providers ( FSJ , people in the federal voluntary service ) to nursing staff ( and trainees) to the ward (also residential area management) to the nursing management . However, this does not bear responsibility for personnel itself everywhere , but is subordinate to an organizational manager or board of directors.
Forms of care
Aid for the elderly is characterized by the fact that it is initially provided by relatives or other people who have not been trained for this purpose, but when the need for help increases, more and more professionals. People in need of care usually want care to take place in the familiar surroundings of their own home for as long as possible. In addition to the wishes of those affected, the fact that some families cannot or do not want other solutions leads to the choice of the home care model . Long-term care insurance in Germany is comparable to partial comprehensive insurance. If the actual costs exceed the payments from long-term care insurance, the financing gap must be closed with the pension and any assets.
As of the end of 2017, 3.41 million people in Germany were in need of care within the meaning of the Long-Term Care Insurance Act (SGB XI). According to nationwide statistics, compared to 1999, the proportion of people cared for in homes rose by 18% and in outpatient care services by 13.5%. In contrast, there was a decrease of 4.6% among long-term care benefit recipients. As a result, the proportion of those cared for at home fell from 72% in 1999 to 68% of all those in need of care. (see also demographic development )
Partial inpatient care
- " Day care for seniors " or " night care " is an offer in a day or night care facility, if z. For example, private carers are absent from part of the care at home or care cannot be carried out for other reasons. In the other half of the day, however, the care is continued at home. This also applies to the hourly care of sick or disabled people who are accommodated in a day care center on an hourly basis on individual days. Facilities for day and night care are not understood as inpatient facilities in the sense of, with the exception of Thuringia, home law regulated by state law .
This includes the retirement home , the retirement home and the nursing home . Necessary hospital treatments are carried out, e.g. B. in a geriatric psychiatric or geriatric department, however, are not a part of inpatient care for the elderly, because they should not be permanent, but only temporarily.
Due to the principle of long-term care insurance of promoting “ outpatient before inpatient ”, fewer and fewer elderly people who do not need care live in inpatient care facilities for the elderly (old people's homes , formerly also known as old people's homes). These facilities are increasingly offering places for people in need of care, i. H. some of them are also being transformed into nursing homes designed for people with high care needs.
Single , severely demented and over 85 years of age are the main characteristics that justify moving into a nursing home. In 2003, 73% of the women in the nursing home were widowed (38% of the men, data from destatis , latest figures from 2007).
The length of stay in inpatient care facilities for the elderly has fallen rapidly overall, in some cases to less than a year (there are significant regional differences). Not least because of this, concepts of terminal care, such as those developed for hospices, should find their way into inpatient care facilities.
Another special feature of the various old people's homes is the relatively low level of training of those employed in care. The German Heimgesetz prescribes a quota of skilled workers, which for most institutions should be 50% (i.e. half of the work performed would have to be done by trained professionals). This quota is not adhered to by all institutions (or not always; especially not on weekends and at night). Formally, this situation was improved by the introduction of the profession of state-certified geriatric care assistant .
Levels and degrees of care
The type and scope of the benefits of the German long-term care insurance depend on the intensity of the need for care. For this purpose, people in need of care are assigned one of five care grades by the care funds on the basis of an expert report by the Medical Service of the Health Insurance (MDK) . The amount of benefits also depends on whether home or inpatient care has to be provided.
In most cases, however, not all costs of care are covered by long-term care insurance. For those affected and their relatives, the need for care almost always means a financial burden.
There are seven levels of care in Austria; the care allowance is the same for home and inpatient care.
Care support points are set up by the health and care insurance funds on the initiative of a federal state and offer advice and support to those seeking help. If those seeking help are in need of care themselves or have relatives in need of care, they will receive all the important information, application forms and specific assistance at the care support center. You will also find the care advisors of the care insurance funds in the care support points.
If people in need of care or their relatives want to remodel an apartment in a way that is suitable for the elderly, they inform the employees of the care support points about possible subsidies from the care fund. If a suitable nursing home is to be found, the counseling staff has an overview and can help. An overview of voluntary offers in the municipality can also be provided by the care support points.
At the care support point, the entire range of services for those in need of care should be coordinated at the request of the individual. Care support points can therefore also offer caregiving relatives support in the preparation and organization of all aspects of care. They enable efficient networking of all offers for people in need of care on site and in the region and are also intended to help overcome the boundaries between social service providers.
Assisted living is also a suitable form of living for older people, provided they do not require constant care. The term is not standardized or protected. In most cases, the corresponding offers are completed rental or owner-occupied apartments from commercial property developers , etc. U. the norms of the elderly or handicapped accessible building not, or only partially take into account. In addition, basic support is provided in a long-term contract. B. a nursing service with on-call service ( house emergency ) and a caretaker service for a fee agreed. These additional costs can also be charged as a lump sum. Assisted living is also organized in the form of cooperatives with the participation of a welfare agency. The DIN 77800 quality requirements for providers of assisted living for older people have been in place since 2006, in which the minimum requirements for the quality of this type of living are defined. The aim is to give consumers more security and to force “sham packages” out of the market. This is done through certification, which consists of the assessment of assisted living by independent experts and, if the criteria are met, leads to the award of a quality mark.
This domestic alternative way of living and living, which shapes solidarity between young and old, be it in families, between singles and / or single parents, enables older people to live independently and responsibly in their own apartment for as long as possible. In emergencies and care cases, roommates and additional outpatient services help. The elderly can, however, also help the children and families and single parents of the multi-generation house if they want. Normally, however, this requires a basis of trust that has grown over the years.
Relationships in the care situation
There are special social relationships in elderly care. This can be due to the knowledge advantage of therapists, the interpretive sovereignty of the individual or different expectations of mutual roles , financial dependencies, etc. a. lie. A relatively common problem is the role reversal of the "caring daughters" (also applies to the less caring men). Some theories of nursing specifically address social relationships in the nursing situation.
The high proportion of interpersonal communication in the care can lead to conflicts that have their roots in the common past. In addition, there are always cases of personal inadequacies or even criminal goals, which are reflected in neglect, abuse or, in extreme cases, killings. If this happens in an institutional setting, the public will speak of care scandals.
In contrast, critics of the supply deficits in Germany speak of a systematic undersupply that would only be criminalized in individual cases. In its entirety, however, the undersupply is a system error (see care scandal ).
A critical point in care for the elderly is moving from one's own apartment to a nursing home ( home admission ). The elderly are more vulnerable than usual in several respects due to their acute illness. Moving into an old people's home as the “last stop” in their life confronts them not only with the thought of death, but also possibly with the awareness that they are no longer of themselves to be able to care. In addition, there can be complex conflicts with close relatives, who in turn experience this situation with feelings of guilt and often have to finance the home stay through parental support. The professional caregivers are now in the midst of these interrelationships, mostly without any closer knowledge of the family situation.
Legal basis (Germany)
For the benefits of the statutory long-term care insurance, the Eleventh Book of the Social Code is fundamental. Health insurance law according to SGB V is decisive for the medical parts of the care .
The Geriatric Care Act regulates the framework conditions and the content of training for the elderly care profession as well as the requirements for using the professional title of geriatric nurse.
The Regensburg lawyer Susanne Moritz classifies empirically verifiable grievances in German nursing homes as unconstitutional. The cause of a completely inadequate nursing care of the home residents and the considerable use of force against those in need of care are primarily the legal framework conditions for nursing care, in particular the financially inadequate benefits of the nursing care insurance. By failing to improve the financial situation of care facilities, the state is violating its duty to protect those in need of care. The VdK supported a constitutional complaint on the basis of this argument, but the Federal Constitutional Court did not accept it for decision.
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- Federal Ministry for Labor, Social Affairs and Consumer Protection - Austrian Senior Policy
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