[Financing Regional Dementia Networks in Germany: Determinants of Sustainable Healthcare Networks]. / Finanzierung regionaler Demenznetzwerke: Determinanten einer nachhaltigen Finanzierung am Beispiel spezialisierter Gesundheitsnetzwerke.

OBJECTIVES: Analysis of practice-based financing concepts in German dementia networks (DN); Provision of sustainable financing structures and their determinants in DN. MATERIALS AND METHODS: Qualitative expert interviews with leaders of 13 DN were conducted. A semi-structured interview guide was used to analyse four main topics: Finance-related organization, cost, sources of funding and financial sustainability. RESULTS: DN were primarily financed by membership fees, earnings of services provided, public funds and payments by municipalities or health care providers. 63% of the DN reported a financial sustainability. Funds to support the interpersonal expanding, a mix of internal and external financing sources and investments of the municipality were determinants of a sustainable financing. Overall, DN in rural areas seemed to be disadvantaged due to a lack of potential linkable service providers. CONCLUSION: DN in urban regions are more likely able to gather sustainable funding resources. A minimum funding of 50.000 €/year for human resources coordinating the DN, seems to be a threshold for a sustainable DN.

Knowledge management in dementia care networks: a qualitative analysis of successful information and support strategies for people with dementia living at home and their family caregivers.

OBJECTIVES: Stakeholders involved in community dementia support services often work on their own and without coordination with other services. These circumstances can result in a lack of information and support for people with dementia and their family caregivers at home. To increase the coordination between existing support services, so-called 'Dementia Care Networks' (DCNs) have been established. Most of the tasks that are performed in DCNs are based on communication strategies. Therefore, knowledge management (KM) is a key process in these networks. However, few studies have focused on this topic. This study attempted to evaluate KM strategies in DCNs across Germany as part of the DemNet-D study. STUDY DESIGN: A qualitative interview study design was used. METHODS: Qualitative data were collected during single and group interviews with key persons associated with thirteen DCNs. Interviews were audiotaped and transcribed, and a structured content analysis was conducted. The framework for the analysis was derived from a KM model. RESULTS: Information dissemination strategies for people with dementia and their informal caregivers based on actively established contacts appear to be more successful than passive strategies. General practitioners often play a key role as external gatekeepers in initiating contact between a network and a person affected by dementia. In this context, case managers can help integrate external stakeholders, such as general practitioners or pharmacists, into DCNs using different KM strategies. The systematic development of common objectives under an agency-neutral leadership seems to be an important aspect of successful KM within DCNs. CONCLUSIONS: The findings reported here can help DCNs optimize their KM strategies for generating tailored information and support services for people with dementia living at home and their family caregivers. In particular, the identified potential knowledge distribution barriers and facilitators will be of practical use to DCN stakeholders.

[Low-threshold support services for people with dementia--the viewpoint of volunteers]. / Niedrigschwellige Betreuungsangebote für Menschen mit Demenz aus der Sicht der Betreuungskräfte.

AIM OF THE STUDY: The aim of the study was to investigate the perspective of volunteers on low-threshold support services. The volunteers were asked to estimate their engagement in care and the constitution of these services in considera-tion of their employment position. METHODS: In an explorative cross-sectional study we collected data using standardised questionnaires in 2 regions of North Rhine-Westphalia (Germany). The analysis was descriptive. RESULTS: The results show that the employment position differed: half of the volunteers were really honorary involved. The others were regularly salaried. In general all volunteers searched for a meaningful and fulfilling activity and benefitted from it. The aspects related to the constitution of the services (concerning the services in general, with organisational character, concerning the behaviour of the volunteer) were all important. The most important aspect was the needs of the people with dementia. These estimations hardly differed according to the employment position. CONCLUSION: The volunteers involved in low-threshold support services show a high commitment. They hold a lot of potential but they also have to be defended from excessive demands. Because of the salaried employment of the volunteers, the services providers have a planning reliability and can offer a continuous care. Thus shows a tendency towards a professionalisation of these voluntary workers.

[People with dementia in acute hospitals. Literature review of prevalence and reasons for hospital admission]. / Menschen mit Demenz im Akutkrankenhaus. Literaturübersicht zu Prävalenz und Einweisungsgründen.

People with dementia who are hospitalized depend on hospital care that is tailored to their particular needs. However, the current structural conditions and standardized care plans are often opposed to the needs for familiarity and orientation that people with dementia have. For the development of dementia-specific care concepts, it is important to know the proportion of persons with dementia who are hospitalized as well as the diagnosis that leads to hospital admission. The results of the literature review show prevalence estimates of 3.4-43.3%. The probability or risk of hospitalization for persons with dementia is between 1.4-3.6 times greater than it is for non-dementia persons. In addition, the reasons for admission are different. People with dementia are more frequently hospitalized due to infectious diseases, fractures, or nutritional disorders than non-dementia persons. Based on these results, one can hypothesize that there is a need for cross-sectoral care approaches, since these indicate the necessity for further research in order to establish a reliable database.

[Quality management in ambulatory care nursing and inpatient nursing in Germany. Specifics and current trends]. / Qualitätsmanagement in der ambulanten und stationären Pflege : Aktuelle Entwicklungen und Besonderheiten.

In principle, quality management in nursing care follows the concepts used in medicine. Occasionally, professionals develop quality requirements and pursue quality improvements by using various tools. Specific features in Germany's nursing care are related to the binding character of seven so-called expert standards and to mandatory, external quality assessments that began in 2009 and will be conducted and published yearly. Preliminary results of these assessments show that both home health agencies and nursing homes provide on average good quality nursing care. However, assessments also revealed a huge demand for improvements concerning the quality criteria and the procedures used to calculate the results. Currently, nursing scientists, providers of care, and long-term care insurance companies are controversially discussing that matter.

[Home care counseling for recipients of cash payments in the German long-term care insurance]. / Häusliche Pflegeberatung für Geldleistungsbezieher in der Pflegeversicherung.

Beneficiaries from the German long-term care insurance living at home have the option between cash payments and care-in-kind services. For those who opt for cash payments, there is an obligation to receive expert advice and 'counseling visits' by a professional nursing service at least twice a year. Although more than 2 million of these 'counseling visits' are conducted each year in Germany, hardly anything is known about these visits and whether they are useful for care recipients and their family caregivers. The purpose of this project was to gain insight into the 'counseling visits' in order to develop a useful approach for the performance of these visits. Data collection took place in two regions of Nordrhein-Westfalen (North Rhine-Westphalia). Data were collected using a questionnaire on the general performance of the visits, the perception of care recipients and their family members, and from the perspective of the nursing services. Additional qualitative interviews were conducted with family caregivers and nurse managers. Based on the findings, a family-oriented approach for home care counseling was developed and evaluated in 80 home care arrangements. The findings reveal that despite several efforts the usefulness and quality of the counseling visits basically occurs by chance. The family-oriented approach allowed for a better understanding of the home care arrangements and offered a solid ground on which to base recommendations and advice.

The invasion paradox: reconciling pattern and process in species invasions.

The invasion paradox describes the co-occurrence of independent lines of support for both a negative and a positive relationship between native biodiversity and the invasions of exotic species. The paradox leaves the implications of native-exotic species richness relationships open to debate: Are rich native communities more or less susceptible to invasion by exotic species? We reviewed the considerable observational, experimental, and theoretical evidence describing the paradox and sought generalizations concerning where and why the paradox occurs, its implications for community ecology and assembly processes, and its relevance for restoration, management, and policy associated with species invasions. The crux of the paradox concerns positive associations between native and exotic species richness at broad spatial scales, and negative associations at fine scales, especially in experiments in which diversity was directly manipulated. We identified eight processes that can generate either negative or positive native-exotic richness relationships, but none can generate both. As all eight processes have been shown to be important in some systems, a simple general theory of the paradox, and thus of the relationship between diversity and invasibility, is probably unrealistic. Nonetheless, we outline several key issues that help resolve the paradox, discuss the difficult juxtaposition of experimental and observational data (which often ask subtly different questions), and identify important themes for additional study. We conclude that natively rich ecosystems are likely to be hotspots for exotic species, but that reduction of local species richness can further accelerate the invasion of these and other vulnerable habitats.