Care under pressure in Germany – 2/3 of those in need of care are looked after at home

Germany’s population is becoming overaged. The number of those in need of care is rising dramatically and there is already a shortage of care professionals: where the number of people in Germany in need of care had still been 2.3m in 2010, the federal government’s latest Care Report is assuming a figure of 3.5m in Germany 2030 and 4.5m in 2050. Dementia-type illnesses like Alzheimer are becoming more widespread and are increasing the complexity of the task of providing sufferers with adequate care. 2/3 of those requiring care are still attended to at home. The Care Report mentions the challenge of promoting and maintaining immediate family’s willingness to provide care, supporting them as needed, and strengthening the commitment of volunteers.

We asked Frau Brigitte Bührlen, chairwoman of the foundation WIR! Stiftung pflegende Angehörige e.V. about the current situation:

Brigitte Bührlen
Brigitte Bührlen, Quelle: Stiftung Pflegende

What do caregiving relatives generally have to contend with?

Caregiving relatives are not involved in political decisions that affect their strenuous daily nursing routine. We have never really reformed our traditional system, founded on 19th century family structures. Only new and professional carers have been added. Caregiving relatives have no legal right to payments or to have their say - even though they bear the brunt of the work.

What benefits are available to those in need of care and their relatives?

There are numerous “individual pots” and federal arrangements with no transparent information for those concerned. The most important ones are care allowances for home care, non-cash care benefits, burden-relief monies, care-assistance allowances, allowances for home-environment improvement measures, nursing aids and support for caregivers’ social security, partial-inpatient day and night care, short-term care, and transitional care. When a particular degree of need of care has been established, the person requiring care can obtain benefits from the nursing insurance fund. If the person is given care at home, the care allowance is paid to the person in need of care. This does not give caring relatives any legal claim to payment or transparent integration into the overall care process, however.

Are the currently available services wisely coordinated with one another and how do I obtain them?

An information brochure published by the Federal Ministry of Health (BMG), for example, provides details about the adopted measures and care services.

Those concerned are often completely unaware of the benefits available to them. These measures are also developed from an administrative and provider perspective. Their meaningful and practicable application is not called into question. The persons concerned must adjust to what is offered, not the other way round. Local welfare and care centres can help, but they are chronically understaffed and do not know all the existing services.

Nursing-home accommodation is often the last resort, but to take care of parents in addition to one's own occupation is often not possible and multiple burdens arising from care obligations are not sustainable in the long-term. What are the solutions?

We should completely redraft the care system. In Scandinavia, care has been declared the responsibility of the state and is funded from tax revenues. A case manager deals with the needs and organises the care. If desired and as befits their own resources, relatives can handle (sub-)areas of the care themselves against payment.

For Germany and as an initial step, I would like to see the introduction of case managers and emergency assistance that is reliably at hand when poorly coordinated nursing measures fail at short notice.

Must politics improve involvement of caregiving relatives?

Absolutely! Politicians passed care into the hands of free enterprise and self-administration on the principle of supply and demand. As soon as business interests are paramount, however, it is no longer those affected that matter, but efficiency and profit. The question of responsibility must be clarified as well: in Germany, no government protection or control mechanism exists in care matters.

Caregiving relatives as well as disabled people and those in need of care must therefore be represented in every advisory body and be able to control what the money in Germany is spent on.

What can relatives do themselves to improve the situation?

I encourage caregiving relatives to bring their interests and wishes directly into the structures of politics. We are a large and relevant group of the population and must network better.