The number of people in need of care is increasing

According to a recent survey by private health insurance in Germany (PKV), more than every third German citizen has a need for care in his or her personal environment. In addition to good care for people in need of care, it is important that caregiving relatives take their time off.

Long-term care insurance in Germany

The history of long-term care insurance in Germany is outlined on the website of the Federal Ministry of Health (BMG). Long-term care insurance was anchored in the social security system on January 1st, 1995 as an independent area (5th pillar).

It is the youngest branch of social security. Long-term care insurance is compulsory for everyone who is legally and privately insured. Every person who is registered with a statutory health insurance is automatically insured in the social long-term care insurance. People with private health insurance must take out private long-term care insurance.

The costs of long-term care insurance are financed through social security contributions, half of which are paid by the employee and half by the respective employer. There are different levels of care that are based on the amount of help required.

The need for long-term care is increasing in Germany

The people in Germany are getting older. The demographic development has enormous effects on all areas of society and leads to growing financial burdens on the social security systems. The following applies to long-term care insurance: the older the population, the higher the number of people in need of care will be.

People are in need of care if they are dependent on help to a considerable or greater degree in the long term in the exercise of ordinary and regular activities in everyday life due to a physical, mental or emotional illness or disability. In this context, permanent means a period of at least six months.

In Germany it is forecast that the number of dementias will increase significantly in the next few years. The German Alzheimer's Society predicted in an information sheet from 2014 that the number of currently 1.5 million dementia patients will double within the next 30 years.

People in need of care can decide whether and if so, how and from whom they would like to receive help. You can choose whether you want to be cared for by professional specialists, for example in nursing homes and old people's homes, or whether you want to receive care allowance instead that you can pass on to your family caregivers.

Long-term care insurance often does not cover all the costs of long-term care; the rest of the financing must be provided by people in need of care or their families. A permanent need for care often means great physical and psychological exertion for all those affected, in addition to the financial burden.

The caring relatives want to know that their loved ones are well looked after, at the same time it is important that they take their time off as well as necessary rehabilitation and preventive measures after illnesses or operations or for prevention.

Some facilities, such as the Bad Bocklet Rehabilitation and Prevention Center in Bavaria, offer caring relatives to carry out their rehabilitation measures while the family member in need of care is looked after during the treatment period.

The care of the person in need of care is guaranteed by nursing staff. There are several options: The caregiver can undertake the rehabilitation measure alone, while the family member is cared for at the place of residence. Another possibility is to accommodate the person in need of care in a nursing home that cooperates with the rehabilitation center and is in the immediate vicinity.

If a separation is not possible or desired, both people can be accommodated in the rehabilitation center. The caregiver can also carry out special care activities, e.g. learn about wound care from the person in need of care.

Another option is joint rehab with active participation, in the course of which the caregiver carries out a rehabilitation measure in the geriatric clinic in addition to their own rehab. This can be useful if geriatric rehabilitation can improve the care situation.

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Introduction of a new definition of the need for long-term care

In November 2006, the Federal Ministry of Health set up an advisory board to review the concept of long-term care. In 2009, the Advisory Board published two reports aimed at a new definition of the need for long-term care.

Accordingly, the focus is no longer on the time required for individual care measures, but on the degree of independence of the person. Since the reports failed to provide many answers to the specific introduction, the expert advisory board was commissioned in December 2011 to clarify the open questions on the specific design of a new concept of long-term care. This presented a report in June 2013.

The main result of the report is: The new definition of long-term care is to be expanded. This was done by including the various behaviors and the resulting problems that often occur with mental and psychological illnesses, especially with people with dementia.

The focus is on limited independence due to the loss or restriction of cognitive and communicative skills. These aspects had not been adequately taken into account until then - this is expected to change in the next few years.

As part of the assessment process, the measures relating to the new definition of the need for long-term care are to be examined in model projects for their suitability for everyday use and effectiveness, as the BMG explains at this point. First of all, the experts from the Medical Service of Health Insurance (MDK) will be trained; from summer 2014 a total of 4,000 assessments will be carried out nationwide.

In a first study, 2,000 assessments will be carried out in care facilities and at home - by caregivers or caregivers. The focus is on questions relating to the design of the specific processes involved in implementing the new concept of need for care and acceptance by 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 costs of the new care levels in inpatient care facilities. Around 2,000 people in need of care from 40 nursing homes across Germany are assessed. The aim here is to determine how much time is required for the care services in the respective care levels so that better care can be guaranteed in the future.