Nursing home

A nursing home is a facility in need of care all day ( inpatient ) or only during the day or only at night ( day patient ) be accommodated and cared for and under the responsibility of professional nurses. In inpatient facilities usually takes place a permanent and lasting accommodation, in some nursing homes in addition temporary respite care is offered. Reasons for admission to a nursing home are aging, a serious chronic illness or an obvious handicap.

Dependent elderly people are mostly dependent people with disabilities placed in nursing homes, in institutions for the disabled. Often, elderly care homes with nursing homes are combined. Nursing homes are distinguished from residences, even if disabled, or sick persons in need of care may be permanently housed at both facilities. Although in halls of residence people may also be in need of care, the focus is there, but the integration of the resident in the social environment, possibly in a professional activity not care. In the nursing home the level of dependence on the supply by third parties usually very high.

In Germany, of the total 709 955 inpatient supplied care in approved nursing homes or inpatient facilities to aid disabled people in late 2010:

• 290 759 persons ( = 41.0 %) in care level I
• 279 055 persons ( = 39.3 %) in care level II
• 140 141 persons ( = 19.7%) in category III.

5531 care ( = 3.9 % of the patient care level III) were recognized as a hardship case.

• 4.1 The charities
• 4.2 nursing home chains
• 4.3 Further developments in elderly and healthcare markets
• 4.4 Central and regional occupancy certificates

Staffing

The home operator must ensure that the number of employees and their personal and professional competence for the activity they perform sufficient. The supervising activities may only be undertaken by a specialist or a fair share of skilled workers. At least half of the employees responsible for supervising activities must be professionals. In nursing homes, at least one expert must always be present even at night guards.

In order to be approved by the social care insurance, it must be ensured that the long-term care residents are maintained under constant responsibility of a trained nurse ( Carer, health and (child) nurses). In the closable supply contracts between the carriers of the nursing facility or an authorized representative association the same carrier and the national associations of the care funds, differentiated by levels of care, set benchmarks for the numerical relationship between care, nursing and care professionals and nursing care residents ( staffing ). The same applies to the management and the administration area of the home and the home economics and technology.

In Baden- Württemberg, the following key personnel are provided, for example:

• Ratio of nursing and care staff, of which at least half of nurses to residents in need of care Care Level I: 1:3,96 1:3,13 up
• Care Level II: 1:2,83 1:2,23 up
• Care Level III: 1:2,08 to 1:1.65

• For the care of dependent residents who additionally suffer from dementia, the following key applies: Care Level I: 1:2,38
• Care Level II: 1:1,70
• Care Level III: 1:1.25

• A personal target of up to 1:5.9 is true regardless of the levels of care for home economics and technology.

• For management and administration of a personal guideline of up to 1:30 shall apply regardless of the levels of care.

Compliance with these values ​​are monitored by the home supervisor and the Medical Services of the health insurance (MDK ).

Nursing grievances

For years, there have been reports about critical conditions in some nursing homes ( so-called care scandals ). Some long-term care were not treated with dignity and care. In extreme cases, there was mistreatment, personal injury and death cases. In part, this was up to individual misconduct of individual nurses. However, the proportion of bedridden held and as a result of pressure ulcer (wound deck ulcer) suffering residents or patients as a whole was too high. This is mainly due to limited financial resources and thus a shorter and shorter daily care time per cultivated person. There is also a discussion about the organization of nursing work by the supervisor (organizational failure) and to the institution of nursing home generally. From some the introduction of new care concepts, such as palliative care ( Palliative Care) in nursing homes is considered to be a forward-looking solution to many problems.

According to the latest report on the quality of care of health insurance in the year 2012 approximately 140,000 patients are fixed to bed or wheelchairs. In approximately 10% of this happens without a warrant. The Patient Protection Organization German Hospice Foundation complains even that 42 % of residents in nursing homes lived " under custodial measures." With regard to the supply of food and drink, the supply situation has improved significantly. However, it is still sometimes on pressure ulcers caused by faulty maintenance. Also, residents were too many sedated by pills.

Financing

Nursing homes finance the ongoing costs for the most part by the charges, which must apply the support of the nursing home due to the home Treaty the residents. As far as the residents of nursing homes that are approved by the care insurance funds in Germany, who claims to benefits from the social care insurance, the compensation components for the care and supervision costs, the kind principle be following, settled directly with the care fund, which therefore also referred to as cost objects will. The same applies if a carrier of social assistance provides assistance for nursing care. The residents themselves only pays the fee which is not covered by the insurance provider.

Another source of financing public subsidies to cover investment costs.

Care insurance ( Germany )

Is a resident at least greatly in need of care, he shall, if it is legally care insurance, against the long-term care entitlement to a benefit package for the proportion of the home fee which to pay for the care-related expenses, the expenses of social care and the expenditure on the medical treatment care is. The amount of each grant depends on the level of care in which the residents is classified: Since 1 January 2012, these are in accordance with § 43 Section 2 SGB XI (each maximum) for the level of care I: € 1023, for the level of care II: € 1279 and for the care level III: € 1,550 and category III ( hardship ) € 1,918.

Not to be taken over by the care fund, the so-called " hotel costs" of care facility (cost of accommodation, meals and incidental investment costs ( purchase, hire and maintenance of the home building). ( § 4 para 2 sentence 2 SGB XI).

The amount of benefits by long term care insurance indirectly determines the amount of the home fee. Since the vast majority of the population is legally care insurance, nursing homes rely on to be approved by the care funds. Admission is by entering into a supply contract between the carriers of the nursing facility or an authorized representative association the same carrier and the national associations of the care funds in agreement with the above local social welfare organizations in the country. In the supply contracts is determined that the amount of the charges for the care and support services, the so-called care rates, according to separate agreements have to direct care rate, which shall be concluded between the nursing home makers and payers.

Own share in the financing of care increased steadily as

The payments of long-term care is flat and limited amounts only for the cost of care in the home (for the care expense, medical treatment care and social assistance ) ( part power - insurance). They cover not from the much higher -lying total cost of a stationary home stay. The so-called " hotel costs " (accommodation and meals), investment costs or the possible costs for special comfort services had from the beginning ( the long-term care ) be paid to the patient itself. According to the original planning for introduction of care but should be at least the cost of care (see above), will be borne by the insurance COMPLETELY.

But a result of the 1995-2008 total lack and then completely inadequate Leistungsdynamisierung had an average of 163 euros / month in the year 2001. Pfl for stage I, 303 EUR / month. Pfl for stage II and 576 euros / month. are fed pays for Pfl stage III of the patient to the care costs. This self- interests in the maintenance costs that were applied by the patient, or its close relatives ( children), or from social services / war victims ( in this order), have grown steadily continues to rise ( In this way, therefore, a " Cold privatization" performed). 2011, the average equity stake in the maintenance costs 346 euros / month. Pfl for stage I, 532 euros for Pfl stage II and 768 euros for Pfl stage III.

Moreover, since the so-called " hotel costs " and the investment costs must also be borne by the patient himself, the long-term care services cover far less than half of the total home fee. So 2011 was applied by the patient in -patient care co-payment TOTAL 1380 € / month. Pfl for stage I, 1566 € / month. Pfl for stage II and 1802 euros / month. Pfl for stage III.

Welfare

Another portion of the financing wear the urban districts or counties as a welfare agency. This is required to hedge costs, the need of care on the care of the nursing care packages going out, but can not afford on their own income or assets.

Before the social security office shall assume these costs, it checks whether children can be used for payment. The so-called "parent maintenance" is according to BGB (§ § 1601ff. ) Demanded so-called warranty obligation of children towards their parents and in-laws. In particular, § 1601 and § 1602, Section 1 of the Civil Code. To determine whether the / the child / ren are capable of, the social security office may require the / the child / children information about their income and assets. These must be disclosed pursuant to § 1605 BGB. If the performance of the / the child / children is found, can be / her income and assets are used to so-called " reasonable deductible ". Do the kids, however, are other dependents (eg children, divorced spouses ), a ranking of the maintenance creditor is defined in § 1609 of the Civil Code.

Investment costs

Another source of funding is the further calculation of investment costs to the residents, but in NRW can receive care for housing allowance with a corresponding need. States and municipalities have supported this for many years, operators of retirement facilities on the purchase and construction through interest-free loans and other benefits. This subsidy funds were private operators only limited available.

Total monthly costs

In Germany, cost 2011, a full in-patient care time per month on average 2853 euros (total compensation = care costs accommodation and meals investment costs).

For the individual levels of care amounted to the total monthly costs:

• Care Level I - 2 403 euros

• Care Level II - 2845 EUR

• Care Level III - 3312 EUR

Total lifetime cost of care

If wife / husband at the age nursing care, she / he must apply a small fortune to be adequately supplied. In the published in November 2012 Care Report 2012 Barmer GEK with the focus on " cost of care", was developed by experts of the Centre for Social Policy ( ZeS ) determined a research institute of the University of Bremen for the first time, which overall cost of care from their beginning to the death (total lifetime cost of care ) of the statutory long-term care, social assistance, or have to be borne privately. For the study, the total lifetime cost of care for approximately 2000 policyholders were examined from 60 years, which were first became a long-term care in 2000. To this end, the outputs of long-term care, social assistance and the private expenses of care from 2000 to 2011 were summed. For the part of the patient, who had not yet died at the end of the observation period, the costs were estimated and added.

Thus, overall, falling from the beginning of care until death ( outpatient inpatient care / maintenance stages I - III) following costs:

For women: approx. € 84,000 ( long-term care self share social assistance)

For men: approx. € 42,000 ( long-term care self share social assistance).

In this article alone find the cost of inpatient (home) care attention.

This (total lifetime ) costs for vollstätionäre care be for women (on average): total € 62,346.

The € 62,346 split down as follows:

€ 24,226 long-term care ( 38.8%)

€ 4451 to help care ( welfare office ) ( 7.1%)

€ 33,706 equity share (own pension / n assets or income assets of the spouse / or close relative ) ( 54.1 %)

This (total lifetime ) costs for vollstätionäre care be for men (on average): total € 26,923.

The € 26,923 split down as follows:

€ 10,406 long-term care ( 38.7%)

€ 2059 to help care ( welfare office ) ( 7.6%)

€ 14,458 equity share (own pension / n assets or income assets of the spouse / or close relative ) ( 53.7 %)

The reason for the higher cost for women to see the researchers in the average longer-term residential care in women. This caused women to privately contribute significantly more money than men. All numeric data is averages. The cost of long term care insurance or private equity Shares may be of little height, but can reach up to € 305,000 and ( in extreme individual cases).

Development

Originally designed as dormitories, have increasingly developed over the last 20 years, the retirement homes to pure nursing homes. The length of stay in the homes falls resistant. In large cities, the residence now stands at about ½ years. The nursing homes (or departments ) were transformed mainly to geriatric psychiatry nursing homes, where in addition to dementia sufferers and non- age specific spiritually and mentally ill patients are cared for in an increasing extent.

The charities

In 2009 there were in the Federal Republic 11,643 nursing homes with a total of 845 007 places. Of these nursing homes, more than half was administered by the non-profit charities:

• Workers' Welfare
• German Caritas Association
• German Joint Welfare Association
• German Red Cross
• Social Service Agency
• Central Welfare Office of Jews in Germany

And some other non-profit organizations that do not belong Welfare Association.

The German Caritas Association considers a share of 14 % of all nursing homes, or about 1300 to 1400 homes.

In Diakonia business directory of homes and in-patient facilities as well as other forms of housing for the elderly, the Social Service calls | Diakonia 784 inpatient facilities (possibly with short-term care places ) and another 34 in-patient facilities with pflegefachlichem focus (mostly for dementia sufferers ). The statistics also show that the two major churches certainly are doing here is the larger, more powerful institutions. However, it must be added that the owners are both local associations. And their weight is regionally very different. In Baden- Württemberg there were to January 1, 2006, for example, 39% by the two churches, 20.3% by other charitable organizations, 28 % of private traders and government bodies or public foundations managed 13 percent. The residential care was needed in Schleswig -Holstein from 38.7 %, in Brandenburg and Hesse, however, only just under 25%. Within the states there are each still a strong urban-rural difference in the extent of use of the homes.

Nursing home chains

As a nursing home chain is called nursing homes whose owners are legally and economically united in a group. It can also be involved in other facilities such as acute care and rehabilitation hospitals. Nursing home chains are common in the area of ​​private ownership. The parties have different legal forms, usually limited liability companies, trusts or limited liability companies that are partly tax purposes recognized as charitable. The largest by number of facilities three nursing home operators in Germany are 2013 companies per seniors, Kursana and Curanum. Curanum part of the French coriander Group, which is Europe's market leader in the nursing home sector.

The distribution of nursing home chains has increased only very slowly in Germany in the last decade. Nursing home chains grow either through acquisition of existing facilities or the construction of structured similar homes in different locations. First, there were chains in the dormitories ( senior residences ) that consciously deposed in their power spectrum of the hitherto usual three-tier retirement homes and nursing homes high price segment.

Further developments in elderly and healthcare markets

In contrast to previous major operators ( free nonprofit associations, companies ) develop after hospital sector, increasingly since 1995, open -profit associations of companies in the field of residential and nursing homes. This is due to the usual operating variables of the nursing homes from 50 to 200 customers compared to the hospitality industry or the hospital chains operating and economic order " dwarfs ". Devices of the big charities are various reasons mostly not as a group but at local or regional level independently organized and therefore can not be referred to as nursing home chain, even if they dominate overall, large segments of the " home market ".

In addition beginnings can be observed ( first between the NL, GB and D) internationalization in this area. When the operators or owners are partly to former Senior Manager or directly to the mentioned associations themselves, which are characterized by the different legal form a larger, also financial, enable action space. In part, produced some large companies from the real estate industry.

Central and regional occupancy certificates

Individual local authorities are due to the complexity of the market gone over expand a current for their region occupancy detection. Thus, members can learn about long-term care, where in their environment free care places in nursing homes are located. See Care Transition.

The AOK Hospice Navigator of the local health insurance funds has gone since 2007 a ​​step further. There are recorded with a valid supply contract with the AOK, the yes is also the largest long-term care in the areas of inpatient care, respite care, day care and night care facilities nationwide. He's looking at a comprehensive list of over 11,000 records of nursing facilities. The search criteria are location and zip code and type of care and maintenance specialist priorities ( dementia, night care, etc.). The Navigator also provides information on the prices of nursing services and the charges for which the insured themselves. The date of the last update is indicated.