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BARMER Long-Term Care Report 2023 was presented on 05.12.2023 in Berlin

The BARMER Long-Term Care Report, which is published annually, assesses the current long-term care policy, gauges the long-term care situation, and analyses one focus theme. With respect to the latter, in this year’s  Report, the authors Prof. Heinz Rothgang and Dr. Rolf Müller (both SOCIUM) examine the situation of people in need of long-term care in hospitals.

Coalition agreement targets have not been met

The chief objectives laid out in the coalition agreement on the further development of long-term care insurance and the financing of long-term care have not yet been implemented. These concern, among other things, the tax financing of non-insurance benefits such as pension contributions for family caregivers, the exclusion of training costs from co-payments in residential care, and the refinancing of medical treatment care in nursing homes. In view of the current financial situation and its assessment by the Federal Government, it is unlikely that these projects will come to fruition in the current legislative period.

As all long-term care insurance benefits are capped or flat-rat benefits, the adjustments of their respective sum are an important issue. In the Care Support and Relief Act (Pflegeunterstützungs- und -entlastungsgesetz), adjustments have been introduced which come into force in 2024 and 2025, respectively. However, the adjustments made are inadequate: due to inflation in home care, by 2027 the loss in purchasing power amounts to 18 percent for cash benefits and 14 percent for in-kind benefits, while today co-payments in nursing home are higher than ever before and will even increase until 2026. In this respect the legislation has failed to meet its target. 

People in need of care make up a quarter of patients in hospitals

With increasing age, not only the need for long-term care, but also the likelihood of hospitalization increases, and care is needed after hospital discharge. Between 2017 and 2022, the number of people who became care-dependent during the month of hospital admission remained constant between 260,000 and 276,000 per year. On the other hand, the number of hospital cases of people who were already care-dependent before they were admitted to the hospital has risen significantly during this period – from 2.71 million to 3.45 million. Overall, people in need of care make up around a quarter of patients in hospitals.

More than one million potentially avoidable hospital cases per year for people in need of care

More than one million hospitalizations among people in need of long-term care can be considered potentially preventable. These include, in particular, hospital admissions for diabetes mellitus, type 2, volume depletion, heart failure, other chronic obstructive pulmonary disease and other diseases of the urinary system. Besides quality in nursing and medical care, the individual care dependents’ cooperation and health related behaviour also play a role here.

Suddenly in need of care – what follows after hospital discharge?

When the need for care is identified in hospital, it is often associated with relatively sudden, serious illnesses such as a heart attack or stroke, and the care grades are usually higher than in other situations in which the need for care is determined. In such cases, the question of further care arises after hospital discharge, for which the home environment is often not adequately prepared. More than half (53.5 percent) of the people who are diagnosed as care dependent in the course of their hospital stay receive exclusively informal care after discharge – i.e., without mobile nursing services or nursing home care. 39.8 per cent receive long-term and 6.4 per cent move into nursing homes. In addition, one in seven people (14.2 percent) receives short-term care. Half of these people still receive full inpatient care a month later. Short-term care thus often bridges time until adequate care is organized.

Changes also for those already in need of long-term care due to hospitalization

For people who are already care dependent, the probability not only of hospitalization, but also potentially avoidable hospitalization is higher than for people without care needs. In many cases, the care grade increases after the hospital stay. As a result, relatives may also be faced with the challenge of changed care needs. Already in the month of hospital discharge, 5.6 percent of those in need of care who hitherto received informal care make use of a mobile long-term care service, and 2.7 percent move into a nursing home. Of those in need of long-term care who previously received mobile nursing care, 8.1 percent move into a nursing home in the month of discharge. Of the previous users of the in-kind long-term care services, 15.7 percent also use short-term care immediately after discharge, which is also very often used as a bridge to full-time inpatient long-term care.

Hospital stays are significantly longer for those in need of care

The search processes that are necessary to find adequate care can delay hospital discharges, while it is in the interest of hospitals, health insurance companies and those in need of care to keep hospital stays as short as possible. Although hospital discharge management is supposed to help with the transition, it often fails simply because there are not enough places in long-term care facilities and it sometimes starts too late and is poorly coordinated. Patients with a newly identified need for long-term care, for example, spend an average of three and a half days longer in hospital than people not in need of long-term care. This may be due to a more severe disease course, but also due to a necessary bridging period. Since subsequent use of short-term care extends the hospital duration by an average of another six days, it is likely that a longer search process for appropriate care is partly responsible for the longer hospital stays.

  

Download:

BARMER Long-Term Care Report 2023

Statement by Prof. Rothgang at the Press Conference

Slide Presentation by Prof. Rothgang at the Press Conference

 

Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Heinz Rothgang and Rolf Müller from SOCIUM Research Center on Inequality and Social Policy, University of Bremen, have drawn up the Long-Term Care Report 2022, commissioned by BARMER

 

On Tuesday, November 29, the 2022 BARMER Long-Term Care Report was presented in Berlin. Besides a general overview and an evaluation of long-term care policy over the past year, the focus chapter in this year’s Report analyzes the impact of Covid-19 on the nursing home sector. Not only are the effects on the residents and the homes themselves examined, but also the financial effects on long-term care insurance.

Promises made in the Coalition Agreement have so far not yet been fulfilled

The Coalition Agreement was signed just over a year ago, and it included a set of measures for ameliorating the long-term care situation. However, none of these measures have been implemented to this day. As the measures laid out in the Agreement are urgently needed for further development, it can only be hoped that their implementation begins as quickly as possible in the coming year. Otherwise there will not be enough time till the end of the parliamentary term for carrying out the urgently needed, major long-term care reform.

Long-term care dependents in nursing homes bear the brunt of the pandemic

Nursing home residents have been affected directly and indirectly by the pandemic.

In the first wave, to limit the spread of the infection, nursing homes imposed drastic contact restrictions on visitors, volunteers, and in some cases even doctors, therapists and podiatrists. This resulted not only in restricted medical care, but in particular – not least because of isolation and loneliness – in negative effects on the mental health of the residents.

Despite contact restrictions, the share of residents suffering from COVID-19 in the first and second waves was 7-8 times higher than in the whole population, according to extrapolations of the BARMER data. Moreover, as a consequence of the vulnerability of nursing home residents, more than half of those who died with COVID-19 in the first and second waves were nursing home residents. For the years 2020 and 2021 the cumulative share of nursing home residents who died with COVID-19 stood at 45%, while the share of all care dependents among those who died with COVID-19 was 75%. Fatalities with COVID-19 led to a corresponding excess mortality. Compared with the years 2017-2019 there was an excess mortality among nursing home residents of more than 150,000 persons.

At the end of the observation period, the number of affected residents is still very high. Preparations for new variants of the virus and even more waves are therefore indicated. In order to prevent negative indirect effects, however, contact restriction measures should be dispensed with as far as possible.

Nursing home careworkers are also particularly badly affected

Contact bans in nursing homes, essential hygienic measures – including the compulsory wearing of masks for staff members – as well as staff shortages due to the pandemic, have exacerbated the situation for careworkers. They also had to carry out emotional work – which is normally done by relatives – and under more difficult conditions. As there was initially not enough personal protective equipment available, and the nature of their work made it almost impossible for them to keep their distance, they were particularly affected by the pandemic.

Consequently, sick leave figures for care workers in nursing homes in the first two waves were about five times higher than for employees in other economic sectors. In the third and fourth waves, however, figures for sick leave in all sectors levelled out again.

In order to be prepared for further COVID-19 waves and future pandemics, it is essential to recruit more employees in nursing homes expeditiously and in line with the new procedure for the standardized calculation of staffing requirements in long-term care. Only in this way can a downwards spiral of excessive demands on staff and higher sick leave figures be avoided.

After steep declines in the first two waves, the utilization of formal long-term care services has normalized again.

During the first two pandemic waves, some care dependents and their relatives dispensed with the use of formal care services out of fear of infection. Nursing homes also had to reduce their services, especially as they lacked the staff. There was a heavy drop of around 50% in demand for short-term care in the first wave. In residential long-term care the effect was primarily noticeable in a decline of around 40% in moves from home care to residential care. As full-time home residents usually have no chance of moving back into their old domestic settings, the effect of the pandemic on nursing home residents was correspondingly smaller.

The introduction of vaccinations was likely a decisive factor in the return, in summer 2021, of new arrivals in full-time nursing homes and the use of day care to pre-pandemic figures. However, the downward trend until December 2021 indicates that new waves may again give rise to reduced utilization.

Social insurance is again misused for financing obligations that concern society as a whole

It was laid down in the Coalition Agreement that pandemic-related additional costs of long-term care insurance would be financed through taxes.

In actual fact, the additional costs for rescue packages for long-term care facilities, for the prescribed POC-Antigen tests and for the Corona nursing care premium, accrued to 9.2 billion euros by the end of the first quarter of 2022, but were only offset by federal subsidies, financed through taxes, to the amount of four billion euros. This leaves the long-term care insurance fund with a deficit of 5.2 billion euros, and that is without taking the corona-related extra expenditure for the remaining three quarters of 2022 into account. As yet, therefore, this promise, made in the Coalition Agreement, has not been fulfilled, and obligations that concern society as a whole are again being subsidized through contributions.

Other financial risks render a financial reform at the beginnning of 2023 inevitable. It is to be hoped, when it happens, that the obligation to pay back the above-named credits will be waived and that corona-related costs will be fully tax-financed – as laid out in the Coalition Agreement.

Downloads (all in German):

BARMER Long-Term Care Report 2022

Statement by Prof. Rothgang at the Press Conference

Slide presentation by Prof. Rothgang at the Press Conference

Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Research team at SOCIUM presents BARMER Long-Term Care Report 2021

The BARMER Long-Term Care Report was presented today in Berlin. It highlights in particular the effects of the most recent long-term care reforms, and draws conclusions for future developments in the numbers of care dependents, as future staffing and financial requirements are derived from the number and composition of people in need of care. By 2025 and in subsequent years the number of people in need of care will actually be around 1 million more than predicted using conventional analytical methods. The Report discusses current long-term care policy in terms of the issue of personnel requirements – especially in the light of scientific assessments on staffing needs in full-time institutional care facilities. The authors, Professor Dr. Heinz Rothgang and Dr. Rolf Müller, also provide more in-depth studies on case numbers, incidences, prevalences and care processes. The main data sources are the long-term care statistics of the German Federal Statistical Office and routine claims data provided by BARMER.

Sharp growth in numbers (oder: the number of LTC dependents)

The successive inclusion of cognitive impairments in entitlement claims for long-term care insurance benefits means that the number of beneficiaries has progressively increased since the 2010s. According to long-term care figures for 2017-2019, the number of people in need of long-term care grew by 713,000. This growth can be attributed to demographic developments in 145,000 of cases, and other effects in connection with the introduction of care grades in 568,000 cases. Projections for future growth were hitherto based on the extrapolation from current prevalences. Calculations of this kind have invariably unterestimated future figures for care dependents. Current projections, based on care prevalence figures for 2019, underestimated the number of care dependents for the year 2020 by over 6 per cent. The authors of the Long-Term Care Report anticipate that in the coming years there will be no further expansion of entitled beneficiaries by legislative means, but that the effect of the introduction of previous reforms will only gradually abate by 2025. From then on, there will be a total of around 1,000,000 more people in care of need than predicted by conventional estimates. More recent estimates point especially to more care-dependents with Care Grades 1-3, and more people in receipt of care allowances.

Demand for careworkers predicted to be three per cent higher than conventional estimates

In spite of the large number of care-dependents with low care grades, there will also be higher take-up rates in residential care than forecast by conventional means. The new figures reveal that three per cent more care workers will be needed than previously estimated. Altogether, for the year 2030, 510,000 long-term care specialists, 196,000 care assistants with a 1-2 year training programme, and 386,000 untrained care assistants will be required. That is 81,000, 87,000 and 14,000 more, respectively, than indicated for 2019 according to the long-term care statistics. In 2030, therefore, there 182,000 more care workers will be required than in 2019. One should note, however, that even today the current legal requirements for care workers in full-time residential facilities, as well as the proportionate numbers in outpatient and day-care facilities, are often inadequate.

Benefit payments in 2030 comparable to 59m. Euros at today’s prices

In the model calculation, assuming that prevalences remain constant, benefit payments (at today’s prices) will increase to 53 bn. euros by 2030 and to 70.6 bn. euros by 2050. However, as the assumption of a constant prevalence at the level of 2019 has already been disproved for the year 2020, it must be assumed that the introductory effects will level off. Under these conditions, benefit payments (at today’s prices) can be expected to grow to 59 bn. euros by 2030 and 77.4 bn. euros by 2050. These new predictions thus show a financial shortfall of a further 6 bn. Euros as early as 2030.

Training Offensive is needed

The main problem remains the recruitment of care personnel. The main challenge of care policy is to meet increased requirements. To this end, more training opportunities must be made available. Moreover, the profession must be made more attractive by offering improved working conditions and higher pay. In this way it might be possible to persuade carers to remain in employment as carers) and to gain more prospective trainees.

Download (all in German only):
BARMER Pflegereport 2021
Statement von Prof. Rothgang anlässlich der Pressekonferenz
Folienvortrag von Prof. Rothgang anlässlich der Pressekonferenz

Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Research team at SOCIUM presents BARMER Long-Term Care Report 2020

This year's BARMER Long-Term Care Report was presented today at the Conference Centre of the Federal Press Conference House in Berlin. The Report focuses this year on the analysis of stress and health status among care workers. The working time of 26,000 care workers was lost in the year 2017 due to an above-average disease burden. The Report discusses current long-term care policy with regard to the ongoing care crisis – particularly in the light of additional burdens brought on by the Corona pandemic. The authors – Professor Dr. Heinz Rothgang, Dr. Rolf Müller and Benedikt Preuß – carried out in-depth studies of case numbers, incidences, prevalences and long-term care trajectories. The figures are based primarily on the long-term care statistics for the year 2017 provided by the Federal Office of Statistics as well as routine claims data of the BARMER health insurance fund.

Workload considerably heavier in long-term care

Workloads have increased considerably in many respects for care workers. Around 92 per cent of geriatric care workers report that they often carry out their work standing up (cf. 47 per cent reported in other occupations). Seventy-six per cent of geriatric care workers report having to frequently lift and carry heavy weights (as against 15 per cent in other occupations). Working in forced postures is reported significantly more frequently (45 percent as compared to 11 per cent). Fifty-two per cent of geriatric carers report that they often have to comply with rules relating to minimum performance or stipulated times for carrying out specific tasks (as against 27 per cent in other occupations). Other pressures include frequent deadline and performance pressures (reported by 63 per cent compared to 50 per cent in other occupations); frequently having to work very quickly is reported by 53 per cent (cf. 39 per cent), and 31 per cent of geriatric care workers claim that they frequently reach the limits of their endurance (as against 16 per cent in other occupations). All these burdens are also reported to be stressful more frequently by care workers than by workers in other occupations.

Poorer Health Status among Care Workers

Correspondingly, care workers are found to be altogether in poorer health than workers in other occupations. This correlation is shown by all measurement methods used. Survey results, the analysis of outpatient diagnoses, absence rates, prescriptions and hospitalisation figures all show that care workers are more seriously affected by musculoskeletal, psychic and behavioural disorders. Though in many areas the workload is similar for qualified and for auxiliary geriatric care workers, the health status of auxiliary workers is poorer than among qualified care workers.

Very high absence rates through illness among care workers

Sickness rates stood at 7.2 per cent in 2017 among qualified geriatric care workers, and as high as 8.7 per cent among auxiliary carers; in other occupations, the sickness rate was 5.0 per cent.  The above-average working time lost through sickness is calculated by multiplying the difference in sickness rates by the number of care workers. This surplus work time lost amounts to the working time of well over 24,000 care workers in the year 2017.
On average, within the year 2017 3.9 out of 1,000 geriatric care workers and six out of 1,000 auxiliary workers are granted disability pensions, while the rate among other occupations is three per 1,000. The above-average early retirement rates led to a loss of almost 2,000 care workers in 2017. The aggregate of above-aberage sickness-related absence times and the above-average entry into disability retirement pensions corresponds to the working time of 26,000 care workers lost in 2017 alone.

There is no alternative but to hire more staff

Current employment figures in care work are inadequate to ensure both professional care and salubrious working conditions. The work intensification arising out of this leads to an excessive workload and negative health effects for employees. This situation generates increased absence through sickness, and more people changing occupations, which in turn aggravates the care crisis. The vicious circle is complete when the remaining care workers are burdened with an even greater workload. This vicious circle has to be broken to ensure sustainable, quality-assured care work – and it can only be broken by employing more staff.

Downloads (all in German only):
BARMER Care Report 2020
Statement by Prof. Rothgang at the Press Conference
PresentatIon given by Prof. Rothgang at the Press Conference

Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Authors from the SOCIUM Research Center on Inequality and Social Policy at the University of Bremen present the BARMER Long-Term Care Report for 2019

This year's BARMER Long-Term Care Report was presented today at the Conference Centre of the Federal Press Conference House in Berlin. The analysis of new living arrangements with long-term care provision is the central focus of this year’s Report. It also includes a review of LTC insurance 25 years since its inception. As in previous years, the authors – Professor Dr. Heinz Rothgang and Dr. Rolf Müller – continue to deliver in-depth analyses of case numbers, incidences, prevalences and long-term care trajectories. The data used for the Report are primarily long-term care statistics for the year 2017 and claims data provided by the health insurance fund BARMER.

Downloads:
BARMER Long-Term Care Report 2019 (in German)
Statement prepared by Professor Rothgang for the Press Conference
Presentation given by Professor Rothgang at the Press Conference

Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Authors from the SOCIUM Research Center on Inequality and Social Policy, University of Bremen, presents BARMER Long-Term Care Report 2018.

This year’s BARMER Long-Term Care Report was presented today at the Conference Centre of the Federal Press Conference Building. Its main focus this year lay on the pressures and health status of principal caregivers; but the Report also examined the effects of the most recent long-term care reforms on the provision of long-term care. The authors, Professor Dr. Heinz Rothgang and Dr. Rolf Müller, also made in-depth evaluations of case numbers, incidences, prevalences and care trajectories. The primary data basis comprised long-term care statistics for 2015, routine data provided by the BARMER and a survey of 1,862 BARMER insurees conducted especially for this Report.

Care Grades instead of Care Levels Led to Increase in the Number of People Receiving Long-Term Care Benefits

The switch from care levels to care grades as of 1 January 2017 brought with it changes in the criteria determining rights of access to insurance benefits. Cognitive disabilities are now defined as a constituent of the eligibility rulesfor  insurance benefits, and respective access barriers have been reduced. The switch from care levels to care grades has also led to a significant increase in favourable assessments. According to projections based on BARMER figures, the number of long-term care dependents increased by 17.9 % between 2015 and 2017. Around 13 percentage points are attributable to the increase in Care Levels 1 and 2.

Broadened Entitlements mean Higher Costs

The increased social long-term care insurance expenditure resulting from the reform amounted to around 7 billion Euros in 2017. On the other hand, additional revenues from the reform amounted to 2.8 billion Euros, leaving a reform-related deficit of 4.2 bn. Thanks to the prior revenue surplus and income growth, however, the actual deficit in 2017 only amounted to 2.4 bn. Euros.

Most Long-Term Care Dependents are Cared for by Relatives

In December 2017, about 2.5 m. people in need of care were cared for by a principal caregiver. Two thirds of these principal caregivers were women, one third were men. Only one third of the principal caregivers taking part in the BARMER survey in 2018 were in gainful employment. A quarter, however, stated that they had reduced their hours or given up gainful employment completely to provide care.

Formal and Informal Support is often Inadequate

As a rule, the principal caregiver has to carry out numerous tasks (e.g. apply medication, give assistance at mealtimes, give mobility support or toilet assistance). Six out of ten principal caregives would like further support in at least one of eleven areas of responsibility. In addition to this general deficit, there are problems when it comes to finding substitutes. Significantly more than half of respondents have no opportunity to find anyone who will stand in for them when they need a break.

Frequently, caregivers do not avail of services offered because they are too expensive or suspected of being poor quality, because there are no services available, or because the organisational effort is too high. It becomes apparent that the needs of caregivers cannot be fulfilled because of the structure of the services offered or because they require too much effort. This is the case for around 378,000 principal caregivers (15.3 %) in daycare, 188,000 (7.6 %) in care services, 437,000 (17.7 %) in short-term care and 379,000 principal caregivers (15.3 %) in low-threshold care and domestic help.

Principal Caregivers are Often Subject to Greater Stress and Fall Ill More Frequently

In terms of coping, 87.5% of principal caregivers claim that they can cope most or all of the time. Nevertheless, a large percentage (38.0 %) do not get enough sleep; 29.9% feel trapped in their role as principal caregiver; one in five (20.4 %) often find carework too strenuous; 22.7% of caregivers find that long-term care has a negative effect on friendships, and one in five (18.8%) has existential anxiety or fear of the future.

Caregiving relatives not only suffer from higher morbidity, they also suffer greater morbidity through their carework. At 48.7% in December 2017, the prevalence of mental illness among principal caregivers is very high. In a comparative population in terms of age structure and gender, only 42.5 % of non-caregivers is similarly diagnosed. Morbidity among principal carers has increased by 9.1 percent points over the last five years and only 5.7 percent points in the comparative group.

Future Scenarios for Principal Caregivers

Projections from the survey of BARMER insurees in 2018 suggest that in total at least 185,000 principal caregivers are on the verge of giving up long-term carework. In addition, over a million principal caregivers only want to continue providing long-term care as long as the situation prevailing at the time of the survey does not change. As, the care situation does tend to deteriorate over time, however, it cannot be assumed that this group of carers will continue to provide long-term care. All in all, then, the situation is quite alarming.

Principal caregivers would like less red tape when submitting applications, would like to be able to always contact the same expert on specific matters, would like to be better informed about long-term care insurance benefits and services and about where help can be sought. It is of prime importance to people in need of care to know where they can get help. Clearly, there is a need for the central actors in long-term care and in politics to redress the situation.

Download (in German):
BARMER Long-Term Care Report 2018
Statement by Professor Rothgang for the Press Conference 
Presentation by Professor Rothgang for the Press Conference

Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Authors from the SOCIUM Research Center on Inequality and Social Policy at the University of Bremen present the BARMER Long-Term Care Report 2017.

The 2017 BARMER Long-Term Care Report was presented to the public today at the  Conference Centre in the Federal Press Conference Building in Berlin. The special focus for this year is the diversity of needs and care situations among young people (aged 0-59) in need of long-term care. The authors also examined the effects of the more recent long-term care reforms on the provision of long-term care (LTC). The authors, all members of SOCIUM at the University of Bremen, headed by Professor Heinz Rothgang and including Dr. Rolf Müller, Rebecca Runte und Dr. Rainer Unger, also presented more detailed studies on numbers of LTC insurance beneficiaries, incidence and prevalance rates and LTC trajectories. The data base for the report comprises primarily long-term care statistics for around 2.6 m. people in need of care, the German Socio-Economic Panel Study and routine insurance data from BARMER as well as a survey among young BARMER insurees in need of long-term care carried out especially for this report.

Higher and more benefits lead also to an increase in the number of beneficiaries
The number of people in need of care has increased not only demographically, but also because of the broadened range and higher amounts of LTC insurance benefits, as more people than before have undergone an LTC assessment to test their eligibility for the new or enhanced benefits. At the same time, there is a downward trend in the prevalence of higher levels of LTC.

The need for long-term care also occurs very frequently among younger people
The need for long-term care not only affects older people. Of the 2.86 m. people documented in the LTC statistics for 2015 as requiring Care Levels I-III, 386,000 (13.5%) were under 60 years of age. Their care needs differ from those of older people in a number of ways. While the overwhelming majority of people in need of LTC are female, the opposite is true of younger care dependents. Thus, among the latter, in 2015, "only" 175,000 people in need of LTC were female, but there were 211,000 male care dependents aged 59 years and under.

Young people in need of LTC have different conditions and disabilities
Often, older people in need of long-term care are associated with conditions such as dementia and strokes. By contrast, younger people in need of long-term care are found to have a range of other conditions and disorders. Thirty-five percent of younger people in need of LTC are paralysed, 32% have impaired intelligence, 24% have epilepsy, 22% have developmental disabilities and 10% have Down's syndrome. Dementia and strokes occur much more seldom in young care dependents. Their lower age in connection with this disease spectrum leads to a higher survival rate and a higher rate of exit from LTC dependency.
Altogether, 89% of young care dependents have a degree of disability high enough to entitle them to benefits enabling participation in employment (in accordance with § 33 of the German Social Code, Book IX) and participation in community life (§ 55, ibid.). Especially for younger care dependents, coordinated cooperation between the different funding bodies is therefore crucial.

The desire for self-determined living arrangements often remains unfulfilled
Young LTC dependents often express a wish to live in group residences, supervised shared housing arrangements, their own homes or assisted living facilities for people with handicaps. There is a lack of such housing, however. Satisfaction with their living situation is highest among those who live alone (93%) and with partners (91%); it is lowest among those living in residential homes (63%). There is frequently a desire to change their present living situation. About 35% of 10-29-year-olds would like to move into residential groups or supervised shared accommodation. About half of them cannot find a suitable offer.

Provision shortfalls in short-term care and daycare
For younger people in need of LTC there is also clearly a lack of appropriate short-term or daycare provision. In the survey conducted on people aged 59 or younger in receipt of LTC benefits, roughly twice as many expressed a wish for short-term care and daycare as the number of those using such facilities. Consequently, it is clear that an additional 3,400 short-term care places and 4,000 daycare places are needed. Use is not made of short-term care and daycare arrangements in their existing forms primarily because they are not found to be age-appropriate or adapted to the disabilities in question.

Quality of care is given higher marks by young LTC dependents in facilities for handicapped people and group residences
In their assessment of the quality of care provision, young care dependents rated care homes and domestic care settings with outpatient care providers worse than care in facilities for handicapped people or group residences. This also indicates that at least in part, care provision for young long-term care dependents does not meet their actual needs (desire for more care provision of an appropriate quality in group residences and homes for the handicapped).

Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. Rainer Unger
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58553
E-Mail: rainer.unger@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Team of authors at SOCIUM Research Center on Inequality and Social Policy at the University of Bremen draws up Long-Term Care Report for BARMER GEK.

The ninth BARMER GEK Long-Term Care Report was presented to the public today at the Federal Press Conference. The report examines especially the effects of the most recent reforms in long-term care on the provision of care to those in need of it. The team, headed by Professor Heinz Rothgang and including Thomas Kalwitzki, Rolf Müller, Rebecca Runte und Rainer Unger, also scrutinized the regional differences in terms of long-term care requirements and provision structures. The data base for the report is primarily long-term care statistics for around 2.6 m. people in need of care, the German Socio-Economic Panel Study and routine insurance data from BARMER GEK, which covers approx. 10 percent of the population.

Main results of the Report:

1. The reform measures taken so far are taking effect. Under the LTC Redirection Act (PNG, 2012) and the First Act to Strengthen Long-term Care (PSG I, 2015), specifically services for people with dementia were improved, and the provision of respite and part-time care was made more flexible. Figures show a marked increase in the utilization of these services in particular. Also dental care in care homes, which was also the subject of various new regulations, has been improved.
   
   
2. The introduction of the new definition of the need for long-term care under the Second Act to Strengthen Long-term Care (PSG II, taking effect as per 1.1.2017) is a very generous, and hence very expensive, reform. It is calculated that additional expenditure will amount to more than 7 bn. Euros compared to the status quo. An increased contribution rate will generate more revenue from contributions; however, this will not suffice to cover the additional costs, even taking the surplus funds currently generated by care insurance into account. For 2017 a structural deficit of more than 3bn. Euros is anticipated.
   
   
3. In nursing homes, the increased costs mean financial relief for those in need of long-term care and their families, and also indirectly for welfare agencies; however, nursing home revenues will not increase to the same degree. Thus, the reform does not mean that nursing homes will be better staffed. If we want higher staffing rates, further reforms will be necessary in the coming years.
   
   
4. Immense differences can be observed from state to state in terms of the increased number of people in need of long-term care but also with regard care arrangements and the capacities within the formal care sector, and the extent of future gaps in the care workforce. It is clear from these discrepancies that long-term care must be conceptualized and planned at a regional or local level. 

Downloads (in German only):
BARMER GEK Long-Term Care Report 2016
Statement from Prof. Rothgang at the Press Conference on 24.11.2016
Presentation given by Prof. Rothgang at the Press Conference on 24.11.2016

Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Team of authors from SOCIUM present report on long-term care in Germany on behalf of BARMER GEK.

The analysis of home care is the special focus of this year's BARMER GEK Long-Term Care Report (Pflegereport 2015), which was presented on 17th November 2015 at the Federal Press Conference. This is the eighth Long-term Care Report drawn up by a team of authors headed by Professor Heinz Rothgang at SOCIUM, University of Bremen. In addition to the special focus topic, the authors - Thomas Kalwitzki, Rolf Müller, Rebecca Runte and Rainer Unger - also examine key developments in long-term care. The study draws on official statistics comprising about 2.6 m. people in need of long-term care (LTC), the German Socio-Economic Panel (SOEP) and routine data provided by the BARMER GEK, whose membership comprises around ten per cent of the population, as well as questionnaires from a total of 1,850 respondents.

Very few allowances claimed for home alterations, though homes of 50% of people in need of care are not barrier-free

The homes of more than half of all beneficiaries of long-term care insurance (LTCI) in Germany living at home are not barrier-free. One would therefore expect more extensive use to be made of LTCI home alteration allowances - which can amount to up to €4,000 per case - to enable people in need of LTC to stay at home as long as possible; all the more so when one considers that over 97 % of questionnaire respondents who received allowances state that this money was extremely helpful. In fact, only about 3.5 % per year of care receivers living at home (65,000) took advantage of this allowance. The six home alterations carried out most frequently were (in descending order): level-access showers, stairlifts, handrails, toilet adaptations, hand grips, ramps.

There are two main reasons why so few people apply for home alteration allowances. The first is that 72 % of the respondents had to make co-payments, which may certainly have been a deterrent for many. On 1st January 2015 the allowance was increased from €2,557 to €4,000, reducing the amount of money applicants have to pay themselves. If the increase had taken effect in 2014, only half of applicants would have had to make co-payments. The second reason is that information about the allowances is not sufficiently communicated. Only half of the respondents received the relevant information from their insurance funds, the Medical Review Board, LTC providers or care support centres (Pflegestützpunkte). About one third of respondents who did not apply stated that they had no knowledge of such allowances. Almost half of the respondents who paid for alterations out of their own pocket did not know that care insurance allowances existed. Clearly there is an information deficit in this respect.

Second Act to Strengthen Long-term Care (PSG II) - a very generous reform

The central improvement brought about by the PSG II is the new definition of entitlement to long-term care benefits. The Act is unexpectedly generous in many respects. Firstly, the new assessment procedure comprises amendments that mean more people will be eligible for care and at the same time more people will qualify for a higher care category. Secondly, of the three proposals made by the Advisory Board for the transition of people already eligible for LTC from (the old) care levels to (the new) care grades, the most generous proposal was selected. Thirdly, the benefit amounts for the new care grades have been laid down in such a way that the benefits that had expressly been defined as transitional under the Long-Term Care Redirection Act (Pflege-Neuausrichtungsgesetz) have now been made permanent - not just for persons with limited daily living skills, i.e. mostly people with dementia, but for all persons in need of LTC.

Last but not least, comprehensive provisions have been made to safeguard existing amounts of benefits. As a result, more than 95 % of those receiving care at home on the date the new legislation came into force are better off, and none are worse off. In the long run, there are only very few people who will on balance be worse off under the new system than under the old one.

Number of people in need of care growing at a faster rate than anticipated; more men in need of care than women; increase in the number of very elderly people in need of care

On the basis of the 2011 census and the recent 13th Federal Statistical Office's Coordinated Population Projection, the number of people in need of LTC by the year 2060 (2055) will have grown to 4.52 m. (4.64 m.), i.e. 221,000 (164,000) more than in earlier projections. Of the additional cases, it is assumed that 176,000 will be men and 'only' 45,000 will be women. From 2040 on a dramatic increase in the number of very elderly people in need of LTC is expected. While in 2015 around 30 % of men in need of LTC were 85 years and older, this figure will increase to around 60 % by the year 2060. There will also be a significant increase in the number of very elderly women. While in 2015 around 50 % of women in need of long-term care are aged 85 and over, this figure is expected to rise to nearly 70 % by 2060. One of the dominant issues of the future will thus be the long-term care of the very elderly and the provision of adequate care structures.

Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

In summer 2014 Rolf Müller and Heinz Rothgang were commissioned by the Senator for Labour, Women's Affairs, Health, Youth and Social Affairs in Bremen, to drawn up a report on Requirements and Supply for Traineeships in Long-Term Care.

The results out of the report on "Requirements, Supply and Prognosis for Traineeships in Long-Term Care" were presented to the Bremen State Committee on Long-Term Care on January 16th, 2015.

The report was commissioned owing to concerns that there is not enough training in long-term care. The objective was to consider the merits of a compensation mechanism for funding long-term care training in Bremen in order to avoid a shortage of skilled carers. Should such a measure be deemed necessary in order to forestall a shortage of trainee placements, the Bremen state government is empowered to impose a charge on care facilities to compensate for the cost of training allowances. In order to determine whether the demand for long-term care training can be met at the present moment and for the period until 2025, requirements and availability for the period 2014-2025 needed to be calculated.

This new report provides reliable figures and data. At present, and up until 2025, around 300-400 trainee places will be needed each year for the qualification of long-term care workers within the city state of Bremen. In 2014, however, there were well under 200 trainees in each year of training. On the basis of currently realistic assumptions, this gap will remain constant over the next 10 years. Under more favourable conditions (significantly higher growth rates and significantly reduced drop-out rates in training as well as significantly longer periods of employment in that occupation), it should be possible to reach the required number of traineeships by 2025. Before then, however, there will be a serious shortage of qualified long-term carers. In the light of current demographic trends urgent measures are required, as on the one hand there is a noticeable increase in the need for care, while on the other the potential number of available employees is expected to drop.

Contact:
Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de