LOGO

The TCALL project* was officially launched at the Bremen Town Hall on 3^rd April, 2023, where the Senator for Social Affairs, Youth, Integration and Sport welcomed the project partners, among them academics, practitioners and other actors from the care and policy sectors. By setting up teaching units in three model care homes in Bremen, the project has initiated the creation of new innovation and transfer structures in long-term care. The prospective aim of the project is to disseminate these structures, so that new technical and digital as well as structural and process management developments can be tested, evaluated and implemented – in Bremen and throughout Germany.

The 9-year project, funded to the tune of €16m. by the German Federal Ministry for Education and Research (BMBF) and coordinated by Prof. Heinz Rothgang (Department of Health, Long-Term Care and Pensions at SOCIUM, University of Bremen), unites the expertise of the following actors in the long-term care sector in Bremen:

Scientific partners:

• Prof. Heinz Rothgang, SOCIUM, University of Bremen
• Prof. Karin Wolf-Ostermann and Prof. Ingrid Darmann-Finck from the Institute of Public Health and Nursing Research (IPP), University of Bremen
• Prof. Karsten Wolf from the Centre for Media, Communication and Information Research (ZeMKI), University of Bremen
• Prof. Claudia Stolle, Nursing Research and Advisory Centre at the Bremen University of Applied Sciences
• Prof. Matthias Zündel from the Integrated Health Campus Bremen (IGB)
• Bremen Centre for Nursing and Care Education
  
  

Practice Partners:

• Johanniterhaus Bremen (St. John’s Association care home)
• Two care homes of the Caritas Association Bremen

The kick-off was attended by representatives from all the partners involved, and especially the staff from the participating care homes, as well as other stakeholders from the care and policy sectors. Statements were given by Anja Stahmann (Senator for Social Affairs, Youth, Integration and Sport), Tim Cordßen-Ryglewski (State Counsellor to the Senator for Science and Ports), Prof. Maren Petersen (Vice President for Teaching and Studies), Dr. Sabina Schoefer (Vice President for Digitalisation at the Bremen University of Applied Sciences) and Prof. Heinz Rothgang (Professor at the University of Bremen and Project Coordinator). The event was rounded off with interactive elements and an informal get-together.

* (Transfer Cluster of Academic Long-Term Care Teaching Facilities, in German: Transfercluster Akademischer Lehrpflegeeinrichtungen in der Langezeitpflege

You will find further contributions to this event here:

https://gesundheitscampusbremen.de/presse/auftaktveranstaltung-projekt-tcall/
https://www.butenunbinnen.de/nachrichten/forschung-bremen-pflege-100.html
https://www.sat1regional.de/pflege-der-zukunft-erste-akademische-lehrpflegeeinrichtung-in-bremen-eroeffnet/
https://www.weser-kurier.de/deutschland-welt/bremen-forschungsprojekt-soll-altenpflege-verbessern-doc7pm6vvta65s6s9tf34n

/veranstaltungen/gesundheitspolitisches-kolloquium/

The kick-off event at Karlsfeld on 19^th December 2022 marked the beginning of a pilot project on long-term care for tomorrow, a joint initiative of SOCIUM and the Fraunhofer Institute for Integrated Circuits (Fraunhofer IIS) together with the Korian Foundation for Long-Term Care and Aging with Dignity (Korian Stiftung für Pflege und würdevolles Altern) as well as Korian Deutschland GmbH.

The pilot project has been awarded a budget of approx. 7m euros, of which half is provided by the Bavarian State Ministry for Health and Long-Term Care. Korian Deutschland is funding not only the cost of building and reconstruction work to the tune of 2.5m euros, but is also giving a further 1m euros over a period of 3 years to increase staffing levels. With this funding it will be possible to implement and test a scientific method for the standardized calculation of staffing requirements in long-term care, developed in a major project conducted by the University of Bremen from 2017-2020, commissioned by the self-governing body of long-term care insurance providers.

The present project was inaugurated by Klaus Holetschek, Bavarian State Minister for Health and Long-Term Care. In his speech, he declared: “Improving long-term care is a key issue for the future. We need to ensure that people in need of care are treated with dignity, but also that working conditions for care workers are improved. We must set the course now to provide comprehensive, humanitarian long-term care for tomorrow. The Bavarian State Ministry for Health and Long-Term Care considers the Project ‘Long-Term Care 2030’ forward-looking, and it is hoped that it will bring us sustainable insights for the long-term improvement of residential care in and beyond Bavaria.”

Elisabeth Scharfenberg, Chair of the Korian Foundation, added: “We, the Korian Foundation, are delighted over the inauguration of the project ‘Long-Term Care 2030’ at the Korian nursing home in Karlsfeld. With scientific support, we shall over the next three years be implementing a modernized concept that will effectively facilitate the daily work of care workers, support them in their routines and hence also benefit those in need of care.”

For the 3-year duration of the project, quantitatively and qualitatively needs-based and digitalized long-term care will be implemented and tested in realtime at the nursing home in Karlsfeld. With a significantly higher proportion of care assistants in the staff mix, the modernization of the nursing home using digital care technology (such as sensors, AI, service robots or data-based process management) and an innovative staffing schedule will be tested and evaluated. “In this way, needs-based and skills-oriented, digitally supported processes can be developed in the daily routine to enhance both the life quality of the nursing home residents and work satisfaction among qualified carers”, emphasized Professor Heinz Rothgang, University of Bremen.

 “The development, implementation and integration of new processes and ‘smart’ technologies to ease the workload for care workers present considerable challenges both for the developers and the users”, stated Dr. Thomas Wittenberg from the Fraunhofer Institute. In order to identify and evaluate the appropriate technologies (such as intelligent beds, data glasses, voice recognition or robotic systems for reducing workloads in long-term care), researchers of the Fraunhofer Institute in Erlangen will contribute to the project with their expertise. In close cooperation with the careworkers, they aim to develop new procedures for recognizing, analysing and interpreting stress points in care processes by means of wearable sensors, and put solution approaches into practice.

 In view of the urgent need for reform in residential long-term care, the nursing home at Karlsfeld should serve as a best-practice model for skill-based care in a digitalized home, and deliver valuable, transferable findings not just for Bavaria, but also for the whole of Germany. “The interplay and the triad of additional staff, building infrastructure and the application of technology make ‘Long-Term Care 2030’ a holistic, future-oriented project. If we want to make long-term care sustainable and viable for the future, we must not think in inflexible categories,” said Dr. Marc-Alexander Burmeister, CEO of Korian Deutschland GmbH. The objective is rather to evaluate the whole project holistically in terms of quality of care, and to tailor modular guidelines that other nursing homes can use as implementation blueprints.

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

The popularity of terms like “post-truth” or “alternative facts” seems to indicate conflict about the reality of reality. Consequently, the debate on “alternative facts” is dominated by psychological and epistemological inquiries. These perspectives however do not suffice to understand why “alternative facts” have such unsettling effects on public discourse. Nils Kumkar’s new book therefore investigates alternative facts from a sociological, communication theory perspective: What is fought about and what is agreed upon when alternative facts are shaping the debates? What is their communicative function?

In case studies from the debates on the Corona pandemic, climate change, and the crowd size of Donald Trumps inauguration ceremony, the book shows that “alternative facts” should not be understood as fragments of parallel epistemic universes, to which relevant parts of the population have supposedly relocated. Rather, they function as discursive smoke bombs in polarized debates. Their central function is not to make people believe in the wrong things, but to protract the communication of the agreement on a given situation and thereby delay decision making. They do not contribute to the construction of alternative realities, but rather to situational disorientation, allowing to keep going – against better judgement.

Despite the widespread concerns about a “crisis of the middle classes”, we know surprisingly little about what actually is in crisis: What is the normalcy supposedly irritated by this crisis? Nils Kumkar, Stefan Holubek, Karin Gottschall, Betina Hollstein, and Uwe Schimank have taken up this question. They conducted biographic-narrative interviews with members of the middle classes and compared them with biographic accounts of members of the upper middle- and lower classes. They show the conduct of life of the middle classes to be shaped by three distinct, implicit ideals of the good life: an orientation towards community, professional pride, and economic status improvement. Even though all of the interviewees indeed do and had to engage in practices of status-work throughout their life, their experience of challenges and chances nevertheless differs significantly, depending on which of these ideals they deem “worth living for” – an insight that might prove central for understanding how the middle classes react upon the different crises society is facing today.

Webpage of the Publisher

Open Access EBook

This is a consortium project involving the High-Profile Area of Health Sciences of the University of Bremen, the City University of Applied Sciences, Bremen, and the Apollon University of Applied Sciences in Bremen, which entails the appointment of six doctoral students who will be supervised by professors from all three universities. SOCIUM will be represented by Professor Dr. Heinz Rothgang.

The overarching objective of this cluster is to make a local contribution to the implementation of the WHO’s objectives of the “Healthy Cities” conceptual framework in Europe. This conceptual framework embraces an international vision of good governance, the reduction of health inequalities and the integration of health, or health promotion measures, in all sectors of society. One key aspect of this is the establishment of interdepartmental cooperation within the local authorities to incorporate health promotion into urban development. An equally important aspect is the creation of an efficient system of healthcare provision in which different health occupations are integrated and work together on an equal footing.

For the duration of the funding period the research cluster will investigate and assess Bremen’s health profile, thereby taking into account Bremen’s particular characteristics and strengths relating to Health Sciences; participate and collaborate in drawing up proposals; and, finally, present a concept for the sustainable promotion and implementation of integrated healthcare structures in Bremen. The practical work is divided up into six doctoral positions, awarded in April 2022.

The coordination of the research cluster and the integration of results from all the projects will be carried out by a postdoctoral member of the project team. A concept will also be developed for integrated, small-scale monitoring that combines the areas of health, social and environmental policy, and tested using data from Bremen for decision-making support in cross-sector cooperation for sustainable, climate-friendly and healthy urban development.

The research data center Qualiservice has again been granted funding by the German Research Foundation (DFG). The priorities for the coming term will focus on the expansion of services for archiving and provisioning research data as well as information offers and continued discussions on research data management. In the coming funding phase, ethnographic researchers will also be supported in archiving challenging data formats such as social media data and audio-visual data.

The German Research Foundation (DFG) approved another funding period for the years 2022-2024. This success is the result of an intensive cooperation with the Scientific Information Service Social and Cultural Anthropology (FID SKA) at the Humboldt-Universität zu Berlin. The research data center Qualiservice participated in the renewed application from the FID SKA, which has now been approved by the DFG. The aim is to expand Qualiservice as a German-wide specialist repository for qualitative ethnographic research data and provide adequate solutions for the often highly sensitive research data. In the future, other data formats, in particular multilingual research data, social media data and audio-visual data, will be archived in a secure environment and made available for further use in research and teaching. Due to the manifold legal, ethical and methodological requirements for archiving these kind of research data, the main focus will be on exploratory approaches to archiving possibilities. Legal and technical examinations will be coupled with information offers and continued discussions on research data management with professionals in the anthropological disciplines. With regard to the National Research Data Infrastructure (NFDI), the FID SKA is involved in the KonsortSWD via Qualiservice and can thus feed important discussions back to the ethnographic researchers.

Qualiservice is pleased to deepen and expand its work and services for further three years and to serve anthropologists as reliable infrastructure partner.

Further information:

https://www.qualiservice.org/

https://www.socium.uni-bremen.de/home/en/

https://www.ub.hu-berlin.de/de/literatur-suchen/fachinformationsdienste/ssg-volks-und-voelkerkunde/ssg-volks-und-voelkerkunde.html (German only)

https://www.uni-bremen.de/en/

Contact:
Professor Betina Hollstein
SOCIUM – Research Center on Inequality and Social Policy University of Bremen
Tel.: +49 421 218-58512
E-mail: betina.hollstein@uni-bremen.de

Kim Hongsoo, Professor of Health Policy and Aging at the Graduate School of Public Health, Seoul National University in South Korea, arrived in Bremen last week for her second 3-month research stay with the Department of Health, Long-Term Care and Pensions at SOCIUM. Altogether three visits are being funded by the Alexander von Humboldt Foundation. Her first trip to Bremen was in December 2019, the second visit was scheduled for December 2020 but had to be postponed till now due to the pandemic. Her third stay is planned for December 2022.

Kim Hongsoo is a researcher in the field of long-term care systems in South Korea, Japan and Germany in a comparative perspective. She has already collaborated with the CRC 1342 Project Group A04, “Global Developments in Health Care Systems and Long-term Care as a New Social Risk” on the publication of two papers (see below for details). Further publications are to follow.

Kim Hongsoo will stay in Bremen until the end of March 2022.

Publications:
Hongsoo, Kim; Jeon, Boyoung; Frisina Doetter, Lorraine; Tamiya, Nonako; Hashimoto, Hideki, 2021: Same same but different? Comparing institutional performance in the long-term care systems of Japan and South Korea, in: Social Policy & Administration, Online first, doi:10.1111/spol.12761, 19.08.2021.

Fischer, Johanna; Hongsoo, Kim; Frisina Doetter, Lorraine; Rothgang, Heinz, 2021: Social long-term care insurance: An idea traveling between countries?, in: Nullmeier, Frank; González de Reufels, Delia; Obinger, Herbert (Hg.), International Impacts on Social Policy. Short Histories in a Global Perspective, Global Dynamics of Social Policy, Cham: Palgrave Macmillan, (im Erscheinen