LOGO

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

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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.

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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

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

SCIENCE GOES PUBLIC! is an innovative format of knowledge transfer in Bremen and Bremerhaven. Topics are presented publicly in 30 minutes in selected pubs and bars to a wide-ranging audience. The SOCIUM Research Centre for Inequality and Social Policy is participating this time with two contributions: Wanda Schwarze-Wippern and Christof Wittmaack will give a talk on "Nur fordern, wenn's foerdert?" at 1st Class Suidice (Friedrich-Ebert-Str. 53-55, 28199 Bremen) on 4 November 2021 at 8:30 pm, Sebastian Jürss will talk on "Da klafft 'ne Gerechtigkeitsluecke einfach auf" at Gondi (Langemarckstr. 249, 28199 Bremen) on 11 November at 8:30 pm.

The junior research group "The 'Activating Welfare State' – A Political and Social History of German Social Policy, 1979-2017" and the research project "GEVOAB - Ideas of Justice held by Recipients of Unemployment Benefit II" are funded by the Federal Ministry of Labour and Social Affairs within the framework of the Interdisciplinary Social Policy Research Network (FIS).

From mid-September until mid-March 2022, Dr. Özden Güdük will be a guest researcher at the Department of Health, Long-Term Care and Pensions. Özden Güdük is an assistant professor in the Health Science Faculty at Yuksek Ihtisas University in Ankara, Turkey. She has worked in the healthcare sector in different positions and organizations for more than 20 years. Lately, she has been working on the topic of home healthcare services in Turkey. This topic includes the patients who need long-term care and their caregivers/relatives and the organizational structure that provide the services for them.

As it is known, all countries – specially developed countries – have been facing the negative consequences of aging that cause intense demand for caregiving. When countries are compared according to their aged population, Turkey seems a little luckier than most developed countries such as Germany, Japan, and Italy. However, this picture is about to change dramatically. The elderly population and the number of dependent elderly have been increasing year by year in Turkey. Like other countries, Turkey makes an effort to provide such services both effectively and financially. One of the effective ways for this is considered "the long-term care insurance system".

Özden Güdük’s research project aims to examine the long-term care insurance used in Germany and compare it with the system in Turkey. She intends to be able contribute to the development of long-term care services in Turkey at the end of the project.