LOGO

Senator for Social Affairs, Youth, Integration and Sport welcomed the project partners

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

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

Prof. Rothgang and Team at SOCIUM are Partners in Flagship Project “Long-Term Care 2030”

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.

 

 

 

 

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

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

44 / 5.000 Übersetzungsergebnisse Corona: integration into routine care

Exactly two years after the start of its publications, the group of authors presents its 6th ad hoc statement on SARS-CoV-2/CoViD-19 and calls for the immediate integration of corona care into routine medical care. Tests without cause should be stopped; instead, symptoms and diseases should be clarified using standard medical procedures. The outpatient-inpatient gap in the care of sick infected people must be closed through energetic efforts in order to show support and, if necessary, to enable regulated hospitalization. The vulnerable groups are to be defined more precisely under the conditions of their vaccination status, and among the diverse questions in social and psychological care, more attention should be paid to the needs of institutionally cared for patients in hospitals and nursing homes and, for example, the farewell of the deceased should be given a dignified framework.

Seven demands are made in this regard. "The end of the pandemic will not be televised", a pandemic does not end suddenly, but requires complex compromises and therefore requires strong, experienced political leadership. Since many measures have been introduced without valid justification, the difficulty now is to explain their termination without reference to the cessation of these reasons. Politicians face the difficult task of shaping this phase of the end of the pandemic.

Contact:
Prof. Dr. Gerd Glaeske (verstorben)

Funded by the State of Bremen until 31.12.2025

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.

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

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

Dr. Özden Güdük will compare German and Turkish long-term care systems in her study

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.

 

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. Özden Güdük will compare German and Turkish long-term care systems in her study

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.

We are pleased to welcome Özden Güdük to the department and look forward to an interesting and mutually beneficial exchange of knowledge and expertise.

Pandemic as a complex system, control of the epidemic using indicator-sets, children and adolescents in the corona pandemic, politics and democracy under pandemic conditions

The 8th theses paper expands the tried and tested tripartite division of epidemiology, prevention and social policy by a preceding chapter, which proposes a conceptual understanding of the epidemic that differs from the common, biological-linear view. A total of four topics are dealt with:

• The pandemic as a complex system,
• Control through indicators and development of indicator sets,
• Children and adolescents in the corona pandemic,·
• Politics and democracy under pandemic conditions.

 

Theses paper 8 tries to gain more perspective, primarily by proposing a concept for understanding the pandemic, secondly by proposing a set of indicators suitable for controlling, thirdly by further deepening the knowledge of the children and adolescents in the pandemic, and fourth, by attempting political interpretation to bid.

Summary:
The proposed concept is that the epidemic should be seen as a complex system. The individual persons represent the elements of the system, the infection as a form of interaction, the infection processes as a result of virus, host and environmental properties according to the rules of this interaction, that are indeed present in complex systems, but are not visible. Success-oriented handling of an epidemic requires knowledge of its essential characteristics (attractors, e.g. age dependency), the expansion of knowledge through iterative interventions (e.g. evaluation of school closings), and as the basis of all efforts, social self-confidence and openness to different approaches.

A concrete proposal for a multidimensional indicator set for control is presented, which, based on the draft of the German Hospital Society, focuses on age stratification and a reporting rate specified according to vaccination status, comorbidity, socio-economic factors and positivity rate along with test frequency. Outcome indicators such as hospitalization (also specified according to comorbidity and vaccination protection), intensive care and the need for ventilation are also used. However, a political line in the transition to multidimensional control systems is currently not discernible.

During the pandemic, children and adolescents made a significant contribution to society and, in doing so, accepted serious disadvantages themselves. In all measures that will apply in the future, your best interests must be given priority.

Instead of linearity and subordination, autonomy, ambiguity or VUCA (variability, uncertainty, complexity, ambiguity) are the words that have to be implemented in politics today.

Contact:
Prof. Dr. Gerd Glaeske (verstorben)

Prof. Dr. Philip Manow
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 7
28359 Bremen
Phone: +49 421 218-58580
E-Mail: manow@uni-bremen.de

The group of authors supplements the statements from theses 4 and 6.1 on intensive medicine care


Contact:
Prof. Dr. Gerd Glaeske (verstorben)

Prof. Dr. Philip Manow
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 7
28359 Bremen
Phone: +49 421 218-58580
E-Mail: manow@uni-bremen.de