Care needs

Care need is the totality of help according to type, scope and duration that a person needs due to illness or disability, taking into account their available resources and the requirement of holistic activities in everyday life by others. The need for care results in the services that are necessary to guarantee high-quality health care from a professional point of view.

Individual care needs in long-term care insurance law

In long-term care insurance , the long-term care insurance fund determines a person's need for care and decides on this basis whether and which services they will provide. Since there are maximum amounts for the benefits, these are by no means always covering the needs. In order to be able to determine the need for care, the long-term care insurance company instructs the Medical Service of the Health Insurance (MDK) to determine the extent to which the insured needs help with normal and regularly recurring activities in daily life due to illness or disability. According to the extent of the need for help, the classification is made in a care level . The need for care must be at least considerable.

A new definition of the need for long-term care is to be introduced by law in Germany by 2017.

Care needs of a group

In summary, however, a whole group of people can be considered (scientifically) whose needs are to be met in the future. In this case, the need for care is a “planning variable” for which either estimated values are assumed or whose forecast is based on a documented workload.

Assessment of the need for care

A “theoretical value of the need for care” describes the sum of activities that require partial or full support from third parties. It can only be an estimate based on empirical values for the expected activities. It can also be a self-assessment of the person concerned and their family. The size remains theoretical because in real life a determination cannot be made exactly even by multiple time measurements. The support given or withheld is based on the (current) assessment of the caregiver as to what the person being cared for can / wants to do independently. This can be an underestimation or excessive demands .

Example: Estimation of the need for care for 1 million people who will suffer from dementia in the future. This already reveals the problem of such assessments that the clinical picture will not be as uniform as the assumption suggests. Also the future framework conditions are unknown, in which one will have to care. All of this bypasses the assessment because initially it only wants to offer a basis for current, current political action.

Measurement of the need for care

Methodologically, it is more correct to start from the “actual need for care”. This applies not only to caring for one person, but also for a group. It is assumed that the nursing work actually carried out and recorded and the workload required for this. From this, an average calculation variable can be derived, which applies all the more, the more homogeneous the needs of the group of people are.

Example: Determination of the care needs of all persons who received long-term care insurance benefits according to care level II - inpatient - in 2003 . Such a large group of people is not homogeneous. That would be the same with 20 people in a single home. But the large number simulates a reliability of the average number, which in practice cannot exist. The average size of 282,880 affected persons must not be compared with the average daily requirement of an individual when it comes to the allocation of personnel capacities. At least not if the cost bearer does not want to allow any deviation based on current needs. And negotiations on nursing rates are all about such questions.

The “personnel assessment for all persons in need of care” in an area / facility must also be based on the “actual need for care”. Past values are transferred to the future as a forecast. This is the sum of the nursing staff's working hours that are necessary

are necessary to meet the residents' individual care needs (i.e. depending on the instruction or takeover of basic activities and treatment care on behalf of a doctor),
a reserve capacity to be determined in more detail is taken into account in order to be able to respond to daily or occasionally changing needs - keyword "human dignity",
appear to be understandably desirable for individual life planning (in the sense of leisure time, participation in social activities (also outside the respective institution))
for the associated care process control (including documentation and for coordination with other therapeutic professional groups) and
to carry out the necessary administrative tasks (within the framework of the contractual relationship).

Working hours and the presence of the caregiver for a person (or a group) to be cared for do not match one hundred percent. The work process requires "preparation and preparation times" that cannot be directly assigned to the person requiring care, e. B. Handover meetings, taking vacation periods into account.

Care needs that only take into account attendance would explain the elderly to an object on which work can be carried out at will, and the nursing staff to machines that can be switched on and off at will.

Explanation of individual time proportions

Resident-specific care needs

These times consist of instruction or (partial) assumption of basic activities and treatment care on behalf of a doctor in accordance with the care plan drawn up. The different performance capacities of the person being cared for and the care goal they are pursuing are taken into account. Time values from nursing standards can simplify planning but cannot replace it.

Reserve capacity

It must be taken into account that the caregivers may respond to daily or occasionally changing needs. This must be possible in order to respect the human dignity of the person being cared for.

Times for an individual way of life

According to the Basic Law and also according to the care concept of the ATL concept, every person has the right to organize leisure time in their own way and to participate in social activities. In individual cases it can be difficult to determine who has to bear the resulting costs. But the freedom to participate outside the respective institution is exactly the opposite of being locked away in a prison or in a psychiatric prison.

Nursing process control

These are times that are required to organize the care as part of the nursing process; they include the

Preparations in the sense of the care process, for example the care history , which corresponds approximately to the descriptions in the cost estimate in the case of a contract award to craftsmen used for comparison;
Care planning and evaluation
Documentation of the care services provided
Time spent on all coordination processes with other medical and therapeutic professional groups.

Administrative tasks

Each work process in nursing also includes different administrative activities. They are often dealt with together for one area / station. This can also be done by people who do not do nursing themselves.

Individual evidence

↑ Robert Paquet: Two stages of the nursing reform and their history. A long way - shortly before the goal ( Memento from September 3, 2014 in the Internet Archive ) in : MDK Forum , issue 2 | 2014, Essen (link checked on August 31, 2014).

[1] Robert Paquet: Two stages of the nursing reform and their history. A long way - shortly before the goal ( Memento from September 3, 2014 in the Internet Archive ) in : MDK Forum , issue 2 | 2014, Essen (link checked on August 31, 2014).