Nursing home

AWO nursing home in Ilmenau (Thuringia)

A nursing home is an institution in which people in need of care are housed all day (full inpatient) or only during the day or only at night (partial inpatient) and are cared for and cared for under the responsibility of professional nursing staff . In full inpatient facilities there is usually permanent and long-term accommodation, in some nursing homes also temporary short-term care is offered. Reasons for admission to a nursing home are on the one hand aging, a serious chronic illness or severe disability, on the other hand the sometimes limited possibilities of home care ,

Elderly people in need of care are mostly housed in nursing homes , disabled people in need of care in facilities for the disabled. Nursing homes for the elderly are often combined with old people's homes . Nursing homes are differentiated from dormitories , even if handicapped, dependent or sick people can be permanently accommodated in both facilities. People accommodated in dormitories can also be in need of care, but the focus there is on integrating the resident into the social environment, possibly also into a job, not care . In nursing homes, the degree of dependency on care from third parties is usually very high.

statistics

This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

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Statistics on care levels IV and V

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In Germany, of the total of 729,546 people in need of care in fully inpatient care facilities in approved care facilities or fully inpatient facilities providing assistance for disabled people at the end of 2012:

• 313,280 people (= 43.0%) in care level I.
• 273,733 people (= 37.5%) in care level II
• 142,533 people (= 19.5%) in care level III.

6,096 people in need of care (= 4.3% of those in need of care of care level III) were recognized as cases of hardship .

In 2003, around a third of benefit recipients opted for inpatient care. As a rule, accommodation in a nursing home is often only provided at a higher level of care. According to § 15 SGB ​​XI, there were only these three care levels until 2007; since 2017 there are five levels of care.

Staffing

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The home operator must ensure that the number of employees and their personal and professional suitability are sufficient for the work to be performed by them. Supervising activities may only be performed by specialists or with the appropriate participation of specialists. At least half of the employees entrusted with supervisory activities must be skilled workers. In nursing homes, at least one specialist must be permanently present even during night watch.

In order to be approved by the long-term care insurance , it must be guaranteed that the residents in need of care are cared for under the constant responsibility of a trained carer (geriatric nurse, health and (child) nurse). In the supply contracts to be concluded between the provider of the nursing facility or an association of the same providers authorized to represent and the regional associations of the nursing insurance funds , reference values ​​for the numerical ratio between care workers and residents in need of care are specified , differentiated according to care level . The same applies to the management and administration areas of the home as well as the housekeeping and technology areas.

In Baden-Württemberg, for example, the following personnel codes were provided up to and including 2002:

• Ratio of caregivers, at least half of whom are nurses, to residents in need of care
  • Care level I: 1: 3.96 to 1: 3.13
  • Care level II: 1: 2.83 to 1: 2.23
  • Care level III: 1: 2.08 to 1: 1.65

• The following key applies to the care of residents in need of care who also suffer from dementia:
  • Care level I: 1: 2.38
  • Care level II: 1: 1.70
  • Care level III: 1: 1.25

• For housekeeping and technology, a staff guideline of up to 1: 5.9 applied regardless of the care level.

• For management and administration, a staff guideline of up to 1:30 applied regardless of the care level.

Compliance with these values ​​is monitored by the home supervision and the medical services of the health insurance companies (MDK).

Lack of care, insufficient supply

For years there have been reports of critical conditions in some nursing homes (so-called nursing scandals ). Some people in need of care were not treated with dignity or care. In extreme cases, abuse, bodily harm and death occurred. In part, this is due to the individual misconduct of individual caregivers. The proportion of nursing home residents or patients who are bedridden and suffer from pressure ulcers ( bed sores) is, however, too high overall. This is mainly due to insufficient financial resources and therefore an ever shorter daily care time per person cared for. There is also a discussion about the organization of the nursing work by the superiors (organizational failure) and about the institution of old people's homes in general. Some consider the introduction of new care concepts such as As the palliative care ( palliative care ) considered in nursing homes as a forward-looking solution to many problems.

According to the quality report for the care of the health insurance from the year 2012, around 140,000 patients in bed or wheelchair to be fixed . In about 10% this happens without a judicial order.

The patient protection organization Deutsche Hospiz Stiftung complains that 42% of the residents in nursing homes live “under custodial measures”. With regard to the supply of food and drink, the supply situation has improved significantly. However, too often pressure sores still occur due to incorrect care. Too many residents are also sedated by pills .

In the study on medical care in nursing homes (SÄVIP study) from 2005, it was noted that general and specialist medical care was inadequate in nursing homes, even in those with high monthly costs. There are, however, a large number of people living there with, in some cases, multiple and severe illnesses and disabilities and high levels of drug use. In a nationwide survey of 782 homes with 65,000 places, the study found that only eight of these 782 homes are home doctors. No visits to the doctor outside the home were recorded for 81 percent of the residents.

Nothing fundamental has changed in this situation since then. The inadequate remuneration of doctors is often cited as a cause for this. In principle, health politician Ursula Lehr as co-author of the study states: "How often could specialist treatment not only help the quality of life and greater independence of the residents, but also reduce the amount of care required." In 2013, the German Institute for Medical Documentation and Information admitted an extensive publication this problem out. Because this topic is hardly publicly aware of and only rarely taken up by the media, the News Enlightenment Initiative placed it in the 5th place of the most neglected topics in 2011.

financing

Nursing homes finance their day-to-day operations for the most part through the fees that the residents have to pay to the operator of the nursing home based on the home contract . Insofar as the residents of nursing homes that are approved by the nursing care funds in Germany are entitled to benefits from the nursing care insurance , the remuneration components for the care and support costs are usually settled directly with the nursing care fund, which is therefore also referred to as the cost unit, following the benefit in kind principle . The same applies if a social welfare agency provides care assistance . The resident himself only pays the fee that is not covered by the cost bearer. In the case of nursing homes that are not officially approved, as well as those with private insurance, those in need of care or their relatives receive a full invoice that must be submitted to the nursing care insurance fund.

Long-term care insurance (Germany)

→ Main article : Long-term care insurance (Germany)

Is a resident at least greatly in need of care , he has when he's nursing insurance law, is entitled to a performance fee for the proportion of home fee , which is to pay for the care-related expenses, expenses of social care and benefits expense of medical treatment care. The amount of the respective subsidy depends on the care level in which the resident is classified: Since January 1, 2012, according to Section 43 (2) SGB XI (maximum in each case) for care level I: € 1,023, for care level II: € 1,279 and for care level III: € 1,550 and care level III (hardship) € 1,918. The long-term care insurance fund does not cover the costs for accommodation and meals as well as the pro rata investment costs shown in the invoice (acquisition, rent and maintenance of the home building). ( Section 4 (2) sentence 2 SGB XI).

The level of benefits provided by long-term care insurance indirectly determines the level of the home remuneration . Since the vast majority of the population has statutory long-term care insurance, nursing homes are dependent on being approved by the long-term care insurance funds. Admission is granted through the conclusion of a supply contract between the provider of the care facility or an association authorized to represent the same provider and the regional associations of the long-term care insurance funds in agreement with the supra-local providers of social assistance in the state. In the supply contracts it is stipulated that the amount of the remuneration for the care and support services, the so-called care rates , must be based on separate care rate agreements that are to be concluded between the nursing home owners and the payers.

Increasing personal contribution to the financing of care services

The payments from long-term care insurance are flat-rate and limited amounts exclusively for care costs, i.e. for care expenses, medical treatment care and social care. The cost of accommodation and meals, as well as any costs incurred for additional services, had to be paid by the person in need of care from the beginning (of the long-term care insurance). According to the original plan when long-term care insurance was introduced, at least the care costs should be borne entirely by the insurance company.

Due to the completely missing and then completely inadequate performance dynamization from 1995 to 2008, an average of 163 euros / month had to be paid in 2001. for plant level I, 303 euros / month for plant level II and 576 euros / month for level III are paid by the people in need of care to the care costs themselves.

These own contributions to the care costs, which had to be raised by the person in need of care or their close relatives (children), or by the social welfare office / war victims' welfare (in this order), continued to rise. In this way, a “cold privatization” was carried out. In 2011, the average own contribution to the care costs was 346 euros / month. for plant level I, 532 euros for plant level II and 768 euros for plant level III.

Since the costs of accommodation and meals also have to be borne by the person in need of care themselves, the long-term care insurance benefits only cover part of the total home remuneration: In 2011, the total contribution to be made by the person in need of care in inpatient care was 1,380 euros / month. for plant level I, 1,566 euros / month for plant level II and 1 802 Euro / month for plant level III.

In Germany in 2011, full inpatient long-term care cost on average per month:

• Care level I - 2,403 euros
• Care level II - 2,845 euros
• Care level III - 3,312 euros

social care

The independent cities or districts bear part of the financing as social assistance providers . This is obliged to cover costs that people in need of care need in addition to the flat-rate long-term care insurance, but cannot afford them from their own income or assets.

Before the social welfare office pays these costs, it checks whether children can be used to pay. The so-called “ parental maintenance ” is the so-called obligation of the children to pay their parents and in-laws according to BGB (§§ 1601ff.). In particular § 1601 and § 1602 Paragraph 1 of the BGB. In order to determine whether the child / s are able to do so, the social welfare office can request information from the child / s about their income and financial situation. These must be disclosed according to § 1605 BGB. If the performance of the child / children is determined, his / her income and assets can be used up to the so-called “ reasonable deductible ”. However, if the children have other maintenance obligations (e.g. children, divorced spouses), a ranking of the dependents is specified in Section 1609 of the BGB.

Investment costs

Another source of funding is the charging of the investment costs to the home residents, who, however , can receive care housing allowance in NRW if they are in need . For many years, the federal states and municipalities have supported the operators of old people's facilities in purchasing and building new ones through interest-free loans and other grants. These funds were only available to private operators to a limited extent.

Total lifetime cost of care

If those affected become long-term care, they often have to pay for residential care themselves in order to receive adequate care. The care report of the Barmer GEK published in November 2012 contained a determination by the Center for Social Policy (ZeS), a research institute of the University of Bremen , with the focus on costs in the need for care, which total costs for care from the beginning to death (total lifetime costs of care) of statutory long-term care insurance, social assistance and privately. For this study, the costs of care were examined for around 2,000 insured persons aged 60 and over who first needed care in 2000. For this purpose, the respective expenditure from 2000 to 2011 was totaled. For the part of those in need of care who had not yet died at the end of the observation period, the costs were estimated and added.

Overall, the following costs were incurred from the beginning of the need for care to death (outpatient and inpatient care, care levels I-III):

• For women: around € 84,000
• For men: around € 42,000

In the following example, only the costs of inpatient (home) care are considered:

• The total lifetime costs for full inpatient care for women amount to an average of € 62,346. This amount is made up as follows:
  • € 24,226 long-term care insurance (38.8%)
  • € 4,451 help with care (social welfare office) (7.1%)
  • 33 706 € personal contribution (own pension + assets or income + assets of the spouse / or close relative) (54.1%)

• The total lifetime costs for full inpatient care for men averaged € 26,923. This amount is made up as follows:
  • 10 406 € long-term care insurance (38.7%)
  • € 2,059 care assistance (social welfare office) (7.6%)
  • 14 458 € personal contribution (own pension + assets or income + assets of the spouse / or close relatives) (53.7%)

The researchers saw the reason for the higher costs for women in the longer duration of home care for women on average. As a result, women have to contribute significantly more money privately than men. The costs of long-term care insurance or private co-payments can be low, but can also go up to € 305,000 in individual cases.

development

Originally designed as residential homes, in the last 20 years old people's homes have increasingly developed into pure old people's homes . The length of stay in the homes is falling steadily. In large cities, the length of stay is now around ½ year. The nursing homes (or departments) were mostly transformed into geriatric psychiatric nursing homes, in which, in addition to dementia patients , increasingly mentally and mentally ill people who are not age-specific are cared for.

The charities

In 2009 there were 11,643 nursing homes with a total of 845,007 places in Germany. More than half of these nursing homes were run by non-profit charities :

• Workers welfare
• German Caritas Association
• German Paritätischer Wohlfahrtsverband
• German Red Cross
• Diaconal work
• Central welfare office for Jews in Germany

as well as some other non-profit organizations that do not belong to any charity.

The German Caritas Association holds a total of 14% of all nursing homes, i.e. around 1300 to 1400 homes.

Diakonisches Werk | Diakonie lists 784 fully inpatient facilities (possibly with short-term care places) and a further 34 fully inpatient facilities with a focus on nursing (mostly for people with dementia) in the Diakonie branch directory of homes and fully inpatient facilities as well as other forms of residential care for the elderly. The statistics also show that the two large churches certainly operate the larger, more efficient institutions. However, it must be added that the owners are each local association. And their weight varies greatly from region to region. In Baden-Württemberg on Jan. 1, 2006 there were e.g. B. 39% by the two churches, 20.3% by other non-profit organizations, 28% by private traders and by state institutions or publicly administered foundations 13 percent. Care in nursing homes was required by 38.7% in Schleswig-Holstein, but by just under 25% in Brandenburg and Hesse. Within the federal states, there is still a strong urban-rural difference in the extent to which the homes are used.

Nursing home chains

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

A nursing home chain is the term used for nursing homes whose operators are legally and economically grouped together. Other facilities such as acute and rehabilitation hospitals can also be involved. Nursing home chains are particularly widespread in the private sector. The companies involved have different legal forms, mostly companies with limited liability, foundations or stock corporations, some of which are recognized as charitable under tax law . The three largest nursing home operators in Germany in terms of number of facilities in 2013 were Pro Seniore , Kursana and Curanum . Curanum is part of the French Korian group, which is Europe's market leader in the nursing home sector.

Nursing home chains grow either through the acquisition of existing facilities or through the construction of similarly structured homes at different locations. Initially, there were chains in the high-price segment of residential homes ( senior citizens' residences ), which deliberately set themselves apart in their range of services from the three-tier old people's homes and nursing homes that had been common up until then.

In contrast to the previously large operators (independent, non-profit associations, companies), since 1995 more and more profit-oriented companies have also developed in the area of ​​old people's and nursing homes. For various reasons, the facilities of the large charities are usually not organized as groups, but independently at a local or regional level and can therefore not be described as a nursing home chain, even if viewed as a whole they dominate large segments of the “home market”.

In addition, the beginnings of internationalization can be observed in this area (initially between the NL, GB and D). Some of the operators or owners are former senior managers or directly the aforementioned associations themselves, who, thanks to the other legal form, allow themselves greater scope for action, including financial ones. Some large companies come from the real estate industry . At Deutsche Wohnen , for example , which also operates care facilities for the elderly, the number of care places and apartments increased from 6,700 in September 2017 to December 2018 to 12,100.

Central and regional evidence of occupancy

Due to the confusion of the market, individual regional authorities have switched to expanding an occupancy certificate that is current for their region. This enables relatives of people in need of care to find out where there are free care places in homes in their area. See transfer of care .

The AOK nursing home navigator of the general local health insurance funds has gone one step further since 2007. Nationwide, the facilities with a valid supply contract with the AOK, which is also the largest long-term care insurance, are recorded in the areas of full inpatient care, short-term care, day care and night care. He searches in a list of care facilities comprising more than 11,000 data records. The search criteria are the place and postcode as well as the type of care and nursing focus (dementia, night care, etc.). The navigator also provides information on the prices of care services and the costs that will be incurred by the insured himself. The date of the last update is indicated in each case.

literature

• Martin Huber, Siglinde A. Siegel, u. a .: Autonomy in old age. Living and getting old in nursing homes - How caregivers promote the autonomy of the elderly and those in need of care . Schlütersche Verlagsgesellschaft, Hanover 2005, ISBN 3-87706-688-7 . - to the project Autonomy in Old Age ( short presentation of the book )
• Holger Jenrich, Ruth Schlichting u. a .: Critic in criticism . In: Altenpflege 05-2006, pp. 50–57
• Claus Fussek, Sven Loerzer: Old and deported. The nursing emergency and human dignity . Vorw. V. Dieter Hildebrandt . Herder, Freiburg 2005, ISBN 3-451-28411-1
• Claus Fussek, Gottlob Schober: In the network of the care mafia. How business is done with inhumane care. C. Bertelsmann, 2008, ISBN 3-570-01009-0
• J. Hanisch, M. Göritz: A diploma thesis on the topic: "Community and loneliness in institutions for inpatient care for the elderly" . 2005.
• Sibylle Heeg, Katharina Bäuerle: Dementia living groups and the building environment . Dementia Support Stuttgart gGmbH, Stuttgart 2005, ISBN 3-937605-03-7 . ( Review by Sven Lind from September 5, 2006 in socialnet.de)
• Martin Heinzelmann: The old people's home - still a "total institution"? An investigation into the inner life of two old people's homes. Cuvillier Verlag, Göttingen 2004, ISBN 3-86537-276-7 . ( Review in socialnet )
• Bernhard Mann: Adequacy examination of disabled adults and seniors in inpatient care for the elderly. A contribution to the sociology of housing based on a welfare study (Diakonisches Werk Bayern) . In: Journal of Gerontopsychology and Psychiatry. 1st year, issue 2, June 1988. pp. 163-173, ISSN  1011-6877
• Moesle, Hansueli: Nursing Homes and Nursing Departments, in: Health Care Switzerland 2007–2009. Verlag Hans Huber, Bern 2007, ISBN 978-3-456-84422-0
• Johann-Christoph Student, Annedore Napiwotzky: Palliative Care . Thieme, Stuttgart 2007, ISBN 978-3-13-142941-4
• Karin Wilkening, Roland Kunz: Dying in the nursing home. Perspectives and practice of a new farewell culture . Vandenhoeck and Ruprecht, Göttingen 2003, 271 pages, ISBN 3-525-45631-X

Web links

Commons : Nursing home  - collection of pictures, videos and audio files

Wiktionary: Nursing home  - explanations of meanings, word origins, synonyms, translations

• Main focus in the SWR on the subject of "care" : films, background information, answers to frequently asked questions, etc. a.
• Human dignity is inviolable - Interview on C. Fussek's demands (geo.de, December 8, 2006)
• List of publications on the topic of nursing homes - Fraunhofer IRB (building information)

Individual evidence

1. ↑ Federal Ministry of Health (BMG): Facts and figures on long-term care insurance ( Memento of the original dated May 24, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (As of November 15, 2013) 
2. ↑ http://www.buzer.de/gesetz/4851/al0-6489.htm
3. ↑ For Germany regulated in Section 11, Paragraph 2, No. 2 of the Federal Home Act. However, the Home Law will only apply temporarily until the federal states have created their own laws regulating home law. In North Rhine-Westphalia, for example, since December 10, 2008, Section 12 Paragraph 3 Clause 1 of the Housing and Participation Act has been in force that corresponds to that of the Home Act.
4. ↑ § 5 Paragraph 1 HeimPersV of the federal government (only applies as long as the states have not yet made any corresponding regulations); Section 12 (3) of the North Rhine-Westphalian Housing and Participation Act
5. ↑ Framework agreement for full inpatient care in accordance with Section 75 (1) SGB XI for the state of Baden-Württemberg dated December 12, 1996 in the version dated July 9, 2002, confirmed by the determination of the SGB XI arbitration board of September 11, 2002 and supplemented by a resolution dated September 12, 2002
6. ↑ Handelsblatt April 24, 2012: German Nursing Study. When the nursing home becomes a prison
7. ↑ MDS - Medical Service of the National Association of Health Insurance Funds: MDS care quality reports 1 - 3 / pdf ( Memento of the original from November 4, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
8. ↑ MDS - Medical Service of the Central Association of Health Insurance Funds eV April 24, 2012: Quality advances in nursing - Medical Service published 3rd nursing quality report (press release) ( Memento of the original from November 4, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and not yet tested. Please check the original and archive link according to the instructions and then remove this notice. 
9. ↑ Doctors newspaper April 24, 2012: Hospice Foundation complains of maladministration
10. ^ German nursing study. When the nursing home becomes a prison . In: Handelsblatt , April 24, 2012.
11. ^ Johannes Hallauer, Christel Bienstein , Ursula Lehr, Hannelore Rönsch : SÄVIP - study on medical care in nursing homes. Vincentz Network, Hannover 2005, ISBN 3-87870-138-1 (PDF) .
12. ↑ Eckart Roloff : Where are the doctors in old people's homes? In: Dr. med. Mabuse , issue 162 from July / August 2006, p. 8.
13. ↑ Gottlob Schober: Report on medical care in homes. In: Report Mainz , ARD, August 18, 2008.
14. ↑ Katrin Balzer et al .: Description and assessment of specialist medical care for nursing home residents in Germany , Cologne 2013, ISSN  1864-9645 .
15. ↑ http://www.derblindefleck.de/top-themen/top-themen-2010-und-2011/20102011-top-5/
16. ↑ According to statistics from the Federal Ministry of Health , 70,271,271 people in Germany were insured in social long-term care insurance on July 1, 2008. That is approx. 87% of the population in Germany
17. ↑ See §§ 72 ff SGB XI
18. ↑ See §§ 84 ff SGB XI
19. ↑ buzer.de: Act on the structural development of long-term care insurance (Long-term Care Further Development Act - PfWG of May 28, 2008 - see here § 30 SGB XI)
20. ^ Sozialverband Deutschland: Statement on the 2008 long-term care reform - s. in particular Section II, 2.
21. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, pp. 51–53 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
22. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, p. 122 / Tab. 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
23. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, pp. 12 + 122 / table 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
24. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, p. 122 / Table 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
25. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, p. 122 / Tab. 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
26. ↑ cf. Figures slightly deviating from the Barmer GEK care report 2013: Federal Ministry of Health: Report of the Federal Government on the development of long-term care insurance and the status of nursing care in the Federal Republic of Germany from December 5, 2011, p. 157 (full inpatient care) ( Memento des original from July 17, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
27. ↑ § 35 SGB XII
28. ↑ § 1601 BGB
29. ↑ § 1602 BGB
30. ↑ § 1605 BGB
31. ↑ Spiegel-Online February 2, 2011: Everything you need to know about long-term care insurance. - Here: Point 3: When children have to pay for their parents; Point 4: Why sons and daughters-in-law also have to pay
32. ↑ German Lawyers Association - Family Lawyers: A case that is becoming more and more common: Parents need to support
33. ↑ § 1609 BGB
34. ↑ Spiegel-Online November 27, 2012: High personal contribution People in need of care have to pay EUR 31,000 themselves
35. ↑ Die Welt November 27, 2012: Study. Care in old age devours German private wealth
36. ↑ Barmer GEK care report 2012 / November 2012 / PDF
37. ^ University of Bremen - Center for Social Policy (ZeS) - Homepage
38. ^ University of Bremen - Center for Social Policy (ZeS) - Press release November 30, 2012: Care costs for women are twice as high as for men. In the BARMER GEK care report 2012, health researchers from Bremen provide clarity for the first time about the lifetime costs of care . From July 2015, the ZeS will be called SOCIUM .
39. ↑ Barmer GEK care report 2012 / November 2012, p. 18.
40. ↑ Barmer GEK care report 2012 / November 2012 - s. here infographics for the 2012 nursing report; here: Graphic: This is how much a care life costs
41. ↑ Barmer GEK care report 2012 / November 2012, p. 18ff.
42. ↑ University of Bremen - Center for Social Policy (ZeS) - press release November 30, 2012: Nursing costs for women are twice as high as for men. In the BARMER GEK Nursing Report 2012, Bremen health researchers provide clarity for the first time about the lifetime costs of care
43. ^ Federal health reporting: Nursing homes and available places in nursing homes (number and density) 2009
44. ↑ Franz Burger, Matthias Weber: Inpatient care continues to gain in importance ( Memento of the original from December 19, 2007 in the Internet Archive ) Info: The  archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . In: statistik.baden-wuerttemberg.de, 2007-04
45. ↑ Group interim management report Sept. 2017, p. 3
46. ↑ Consolidated Financial Statements 2018, p. 25
47. ^ Homepage of the AOK nursing home navigator