Caregiver

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Birthday of a resident of a home - beautiful moments are also part of the job of a geriatric nurse
Ward nurse in a hospital, 1985

Geriatric nurses and geriatric nurse care and support for sick or aging people within the social care profession in the outpatient and home care , for example through social centers in their homes or stationary in retirement and nursing homes . They are also used in rehabilitation clinics , day care centers and geriatric hospitals ; some are freelance workers. They perform activities in the self-care usually undertaken by adults and sometimes in household chores.

General

The elderly care places high demands on the nursing, psychological and social skills. A geriatric nurse must be able to implement both medical treatment care and social care / psychiatric care independently and in cooperation with other professional groups. The formal requirements for planning and documentation have risen sharply in the years since 1995.

Responsibility and the type of activity differ depending on the place of care:

  • Social stations and care services look after people in their own homes; the nurses are only present there for a relatively short time.
  • People living in institutions often suffer from several diseases at the same time ( multimorbidity ), including severe forms of dementia . A permanent presence of trained nursing staff is therefore necessary.

Elderly care workers must carefully document all care services on a daily basis , this is used for billing and information for general practitioners and specialists, other care workers or other groups of people involved in the therapy.

job profile

In Germany, care for the elderly was a secondary aspect of nursing until the 1960s . Unless they were nurses, staff in this area were trained in courses or short courses. An education that was more extensive in terms of content and time developed slowly and inconsistently. Based on nursing, but also in contrast to it, an independent professional profile and professional ethos emerged. The job is predominantly a woman's job ; the proportion of men among trainees and examiners has been consistently below 20 percent for years.

A change in the assignment of the occupational field to medically oriented care or to social work has been discussed intensively for a long time.

The care of the elderly struggles to have an independent job description and a different understanding of tasks , especially in contrast to nursing . The terminology also differs only slightly but significantly. The name of the person to be cared for in hospital care is patient ; In elderly care, these are widely referred to as residents or by name. In outpatient care, the term customer or client is becoming more and more important, as the elderly order and pay for individually selected and specially tailored care measures. There is usually no medical prescription for this.

Related or supporting professions are those of geriatric care assistants and, in Switzerland, specialist care (m / f). The fact that men are underrepresented in the professional field is discussed again and again.

Fields of activity

In the care of the elderly, besides everyday tasks (self-care such as washing, etc.) and medically delegated tasks (nursing), some activities are performed that clearly distinguish them from hospital care. The biography and habits of the patient are taken into account. This results from the necessary or desired long-term accompaniment of a person in their private environment. The terminal care requires consideration of the principles of palliative care . Elderly care includes the social environment of a person, i.e. first of all the family members, in the care planning . The consideration of geriatric psychiatry lies in the frequency and severity of age syndromes with massive changes in personality .

Taking into account the biography

In care for the elderly, one focus is on dealing with the biography of the person to be cared for and the special opportunities that arise from this for care in the event of psychological changes. (This basic principle of care for the elderly is sometimes referred to as " biography work ".)

Gerontopsychiatry

Due to their special training, especially in dealing with mentally altered patients suffering from various degrees of dementia types suffer many geriatric nurse working in general psychiatric institutions or in special departments of care (see Geriatric Psychiatry ).

Palliative care

Due to the frequent multimorbidity (presence of several illnesses at the same time) in seriously ill patients over the age of 85 and the progression of chronic diseases, palliative care is a core part of elderly care activities. The goal of care is then no longer healing, but rather to enable the maintenance of the highest possible quality of life until death . Is death foreseeable that starts dying .

education

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

Elderly care training in Germany

Legal bases

The main legal basis for training to the occupation of the Old nurse or nurse for the elderly are in, which came into force on 1 August 2003 Elderly Care Act (AltPflG) and in the regulation pursuant to elder care law Geriatric Care Training and Examination Regulation regulated (AltPflAPrV). With the enactment of the Geriatric Care Act, geriatric care training was for the first time regulated nationwide, after the Federal Constitutional Court had confirmed the relevant competence of the federal legislature. The training for the professions of geriatric care help, however, is regulated by state law.

Number of geriatric nurses in Germany 1994–2004 without municipal facilities.

Entry requirements and remuneration

The prerequisite for access to the training is the secondary school leaving certificate , another completed ten-year general school education or a successfully completed geriatric care assistant examination. If the grade 2.5 or better has been achieved, the second year of training can be “entered” directly. There are other ways to shorten the training period.

According to Section 17 (1) AltPflG, trainees are entitled to appropriate training remuneration, unless they are entitled to unemployment benefit , unemployment benefit II or transitional benefit in accordance with the provisions applicable to benefits for participation in working life in the case of further professional training . If the relevant requirements are met, trainees can receive training grants according to BAföG .

Structure and content of the training

The training lasts three years. It can also be carried out part-time and in this case lasts up to five years.

It includes at least 2,100 hours of instruction and at least 2,500 hours of practical training. The lessons are given in a geriatric care school, which also bears overall responsibility for the training and ensures the practical instructions; practical training takes place in an elderly care facility for at least 2,000 hours.

While health and nursing care includes care for the entire population, training in care for the elderly aims at care, including advice, support and care for the elderly.

The theoretical and practical lessons in elderly care are divided into four learning areas:

  1. Tasks and concepts in elderly care
  2. Supporting old people in shaping their lives
  3. Legal and institutional framework
  4. Elderly care as a profession

The learning areas are in turn subdivided into different learning fields (see Appendix 1 to § 1 AltPflAPrV).

The practical training is structured as follows:

  1. Getting to know the field of practice, taking into account institutional and legal framework conditions and technical concepts
  2. Collaboration in the comprehensive and planned care of the elderly, including advice, support, supervision and assistance in medical diagnostics and therapy under supervision
  3. Taking on independent subtasks according to the level of training in the comprehensive and planned care of the elderly, including advice, support and support and participation in medical diagnostics and therapy under supervision
  4. Take on independent project tasks, e.g. B. in the organization of the day or in the design of the home care situation.

Continuing education and training

The tasks of geriatric nurses are changing. Continuing education and training are required in this profession, but not legally anchored. Each carer initially bears responsibility for participation. As a management task of the PDL , however, they belong to the improvement of the structural characteristics of the care quality of the respective facility. The PDL should identify educational needs and encourage participation within its budget . She will address this in the context of the personnel development talks.

In the care of the elderly, due to the up to 50% high proportion of untrained workers, special attention must be paid to the further training of auxiliary workers.

The topics of extensive advanced training in recent years are: care planning, care quality / quality officers , complaint management, hospice work, dealing with relatives. In addition, the classic advanced training courses, mostly financed by employers, on managerial tasks and special care such as geriatric psychiatry are still important.

Advanced training

Further training serves to maintain and expand the knowledge and skills acquired through training or professional activity. In the health sector in particular, advanced training courses are very important due to the constant flow of new knowledge in medicine, and recently also in nursing research. No new qualifications are acquired through further training, only successful participation is usually certified.

A distinction can be made between different types of further training in terms of the goal:

  • Expansion,
  • Conservation,
  • Adjustment,
  • Advancement training

Another type of distinction is the classification according to the organizational form:

  • internal training
  • external training

further education

Further training in nursing has the goal of qualification in order to further develop and advance professionally. The advanced training usually ends with an examination and leads to a new job title.

Typical further training courses in geriatric care are, for example:

Similar training courses often differ in the duration and cost of the events. The obligation to assume the costs must be checked in each individual case. Employers sensibly support employees in this.

There are various funding options for the costs of certain advanced training courses, for example master BAföG , a scholarship from the Robert Bosch Foundation .

The prerequisites for participation, lessons to be given, necessary training-related internships are usually described by state training and examination regulations or by the sales prospectus (private organizers).

Education

history

Elderly care is a relatively young profession compared to nursing . Until the 1920s , elderly people in need of long-term care and dementia sufferers were housed in so-called infirmary homes or in old people's homes, some of which were in a catastrophic condition. The care in the few homes was mainly the responsibility of people who had no professional training, but who agreed to this activity out of charity and other reasons. By contrast, there were hardly any trained nurses here until the end of the 1950s . These were mainly employed at management level. Registered nurses were “too expensive” for the providers of the facilities in traditional long-term care or they could not be motivated for the activities.

In the 1960s, training took place in courses that are not regulated by the state or short courses. Gradually, individual federal states issued training regulations and curricula for initially one-year, later up to three-year training courses. This resulted in a very inconsistent training landscape. Up until 2003 there were 17 different training regulations in the 16 federal states (state elderly care laws).

The 1950s

In the 1950s there were relatively few old people's and infirmary homes. Care for the elderly was almost exclusively family care. The capacities were soon no longer sufficient because in the course of the post-war years and the economic miracle there were more and more elderly and disabled people who no family wanted or could take care of. Both world wars and the industrial revolution had destroyed earlier family structures in many places. The leaders of these homes were now urgently looking for new employees. There weren't enough nurses and they were relatively expensive. For the care of the elderly, v. a. female workers wanted as auxiliary workers. These were easier to finance and ostensibly because of all the “typically female characteristics” they were supposed to look after old people even without training. At the end of the 1950s, some denominational institutions began to conduct in-house training courses for their geriatric nurses. Because the social hardship of old people and with it the number of homes continued to increase, the first denominational and later also communal training centers emerged. The course lasted from a few weeks to a maximum of 6 months.

The 1960s

In the 1960s, caring for the elderly became a political issue for the first time, and at the state level there were examination regulations for the first time at the end of the 1960s for this new, social care-oriented profession of carer for the elderly.

The 1970s

In Baden-Württemberg and other countries there was a state-wide regulation for a 1.5-year training course in the 1970s . Part of this time was work / internship without lessons, the so-called recognition internship. At that time, the professional understanding of care for the elderly was formed from a mixture of lifelong support, medical care, housekeeping, hotel service and individual customer care.

In the 1970s u. a. Founded as a professional association of the DBVA (German Professional Association for Elderly Care) and published the first drafts for a professional profile.

The 1980s

The training course in almost all federal states has been extended to 2 years and the content has been expanded.

The DBVA formulated a job profile for state-approved geriatric nurses and expanded the training concept again. Since the end of the 1980s, the payment of geriatric nurses according to the Federal Employees' Collective Agreement (BAT) has prevailed, as is the case with nurses . The large part of private homes as employers also (to a large extent) depends on this due to the market situation (lack of staff).

The 1990s

In Baden-Württemberg and other countries, there are now at least 2890 hours of practical work and 1760 hours of school in the subjects of religious studies, German, vocational and legal studies, gerontology, health and disease studies, pharmacy, psychiatry, nutrition, care for the elderly and sick, activation and rehabilitation, practice Compulsory in care for the elderly and possibly other optional subjects or working groups (e.g. data processing, senior dance). Prescribed internships make up the majority of the "apprenticeship period", which is closely based on the dual system. Most internships are completed in nursing homes , others in retirement homes , in open and outpatient care for the elderly (e.g. social station , counseling center) as well as in hospitals and psychiatric care . In 1997 there were around 6,000 students in Baden-Württemberg. Before 1980 there were fewer than 300 participants per year, but the number of students has increased steadily since then.

It was not until the end of the 1990s that the three-year training was implemented nationwide and that elderly care workers such as health and nursing staff could carry out medical treatment care on behalf of a doctor (injection, etc.). Three-year trained geriatric nurses are now also being employed in social stations.

Thanks to the financing secured by long-term care insurance , many new outpatient services have been established since 1995 . You need skilled workers to provide the services contractually agreed with the health insurers. In addition, illegally employed foreigners (mostly from neighboring countries to the east) have since offered a new field of care for the elderly; In addition to the existing institutions, around-the-clock care is provided on behalf of the relatives at home as an au pair service (accommodation in the household). They use the cash amount from long-term care insurance as pocket money (wage replacement). These women from Poland and the Czech Republic usually work without training and without standardized quality standards and without the protection of a verifiable contract. In relatively few cases, the - somewhat more expensive - option of legal employment ( brokered by the Federal Employment Agency ) is used ( foreign domestic help ). In the nursing homes there is a change in the severity of the disease of the newly admitted residents. The care wards now care for a large part (70–80%) of elderly people with dementia without being equipped as a psychiatric hospital .

The 2000s

The geriatric care training was regulated nationwide by the Geriatric Care Act of November 17, 2000 in the version of the announcement of August 25, 2003 and is legally counted among the "other" medical professions . The duration of the training was extended from two to three years. The practical training can be carried out in both inpatient and outpatient settings. The further training of teaching staff and management staff (see nursing management ) is also being improved , although not nationwide, through the establishment of university courses .

In 2013, the average earnings of a geriatric nurse was 2568 euros in the west and 1945 euros in the eastern federal states.

From 2020, the previous three training courses in health and nursing , geriatric care, and health and children's nursing will be combined into one occupation with the qualification as a nurse . Within this apprenticeship, after all two years of common apprenticeship, there is the opportunity to specialize in the professional qualification of geriatric nurse or health and child nurse ( see: Nursing Professions Act ).

See also

literature

  • Manfred Engl: Employment Compass Altenpfleger / in. Employment opportunities and alternatives . Edition Aumann, 2010. 136 pages. ISBN 978-3-942230-00-1
  • Frank Drieschner: Sr. Elvira's feeling for happiness . Between care and administration, the everyday life of a geriatric nurse. Series: Heroes of Today (1). In: DIE ZEIT No. 18 of April 27, 2006, p. 4.
  • Annette Riedel: Professional care of the elderly. Modern (elderly) care training in response to social needs and the reforms of the care professions. Tectum Verlag, 2007. 661 pages. ISBN 978-3-8288-9419-8
  • Brigitte Zellhuber: Elderly care - a profession in crisis? An empirical investigation of the work situation as well as the stresses of elderly care workers in the home area. Kuratorium Deutsche Altershilfe : Cologne, 2005 - Series: thema, Volume 199. 219 pages. ISBN 3-935299-59-1
  • Sonja Schiff: 10 things I learned about life from old people - insights from a geriatric nurse. edition a, Vienna 2015, ISBN 978-3-99001-139-3 .

Web links

Wiktionary: Altenpfleger  - Explanations of meanings, word origins, synonyms, translations

Individual references, comments

  1. ↑ Elderly Care Act in the currently applicable version
  2. ↑ Geriatric Care Training and Examination Ordinance (AltPflAPrV) in the currently applicable version
  3. ^ Judgment of the Federal Constitutional Court of October 24, 2002 - 2 BvF 1/01 -
  4. ↑ Study by the Institute for Employment Research (IAB) of the Federal Employment Agency, quoted from: Jan Drebes: Altenpflege for 1700 euros gross. Rheinische Post online, January 28, 2015 (accessed May 19, 2017)
  5. ↑ Hamburg: New nursing training can start in good time. In: www.aerztezeitung.de. September 18, 2019, accessed September 22, 2019 .
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