Complements or Substitutes? Young Germans' Experience and Expectations with Financing Sources for Long-Term Care.

Financing long-term care is a growing challenge in aging societies. To address this challenge, Germany created public long-term care insurance (DPV) more than 25 years ago. Germans still need to prepare for their own care throughout their life course to supplement public insurance. This study presents descriptive statistics and multivariate regression analysis to examine young Germans' experiences and expectations of the relationship between the DPV and private financing sources. We base our analysis on a proprietary data set of young Germans (16-39 years old) that oversamples those with caregiving experience and East Germans. We find that public long-term care insurance is a substitute for rather than a complement to other financing sources. Specifically, many young Germans do not count on public long-term care insurance to finance care. Instead, they see private funding sources as substitutes for long-term care insurance. Those who count on private long-term care insurance are between 48 and 70% less likely to count on DPV benefits. Experience with care increases the likelihood of young Germans expecting future public benefits by factor of six or 18, depending on the specific care familiarity. Young Germans are also more likely to count on future generations to support their own care than they expect themselves to support the care of their parents through the DPV. Given that the DPV provides basic universal insurance that requires some complementary private income sources, our findings suggest that young Germans, who will need to build some of these income sources throughout their careers, are underestimating the value of the DPV and overestimating their own ability to pay for long-term care. Policymakers will need to reduce the political risks to the DPV and increase young Germans' savings over the life-course to address this imbalance.

[Community-based housing communities : Inventory, qualitative classification and recommendations for action]. / Ambulant betreute Wohngruppen : Bestandserhebung, qualitative Einordnung und Handlungsempfehlungen.

According to the will of the German legislator, community-based housing communities are supposed to help implement the pluralistic welfare in mixed care settings and strategies in the structure of long-term care. They follow the principle of shared responsibility, which is characterized by the co-productive cooperation of professionals, working relatives and volunteers. The inventory of residential communities with ambulatory care, which was carried out on behalf of the German Federal Ministry of Health, was based on the concept of hybridity for a qualitative classification of the different types of housing communities. The results of the nationwide inventory in Germany showed that the degree of hybridity of housing communities has positive effects on the aims and values, which are pursued with housing communities with respect to cooperation in communities, self-determination of residents, the social relatedness of the residents and nearby care.

[Sheltered living groups : Hybrid form of care services in legal conflict situation]. / Ambulant betreute Wohngemeinschaften : Hybride Versorgungsform in rechtlicher Gemengelage.

Sheltered living groups are enjoying great popularity in Germany. They represent an alternative to home care on the one hand and to nursing homes on the other hand. Under German law they face a conflict situation and must fulfil many legal requirements, which confront the foundation and operation with legal barriers. The legal situation and legal practice vary significantly from one federal state to another. Infrastructure development of sheltered living groups as local care services can be found within a helpful governance of advisory structures. The different legal requirements, which apply to sheltered living groups in Germany are outlined in this article. The hybridity, which characterizes sheltered living groups is also connected with a hybrid legal framework of regulations.

[Law and the phase of life old age]. / Das Recht und die Lebensphase Alter.

In spite of the greatly increased role, which the law attributes to the design of individual life styles and living of elderly people, there is no special legal area known in the German legal system, such as "rights of the elderly", which is the case in the field of the youth law. Special legal regulations covering the concerns/issues of elderly people were always considered to be in danger, as they may have the potential to discrimination, either in a positive or negative way. Due to this fact, the rights of the elderly can be described as synthetic and are subject to constant changes, as can be observed within the pension act. The legal areas and legal regulations, which are of particular importance for the life style and living situations of elderly people are presented. The legal need for action regarding the special protection of vulnerable elderly people is discussed and in the further course utilized for a conception of "rights of the elderly".

Effectiveness of a multifactorial intervention to reduce physical restraints in nursing home residents.

OBJECTIVES: To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes. DESIGN: Cluster-randomized controlled trial. SETTING: Forty-five nursing homes in Germany. PARTICIPANTS: Three hundred thirty-three residents who were being restrained at the start of the intervention. INTERVENTION: Persons responsible for the intervention in the nursing homes attended a 6-hour training course that included education about the reasons restraints are used, the adverse effects, and alternatives to their use. Technical aids, such as hip protectors and sensor mats, were provided. The training was designed to give the change agents tools for problem-solving to prevent behavioral symptoms and injuries from falls without using physical restraints. MEASUREMENTS: The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention. Secondary outcomes were partial reductions in restraint use, percentage of fallers, number of psychoactive drugs, and occurrence of behavioral symptoms. RESULTS: The probability of being unrestrained in the intervention group (IG) was more than twice that in the control group (CG) at the end of the study (odds ratio=2.16, 95% confidence interval=1.05-4.46). A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG. No negative effect was observed regarding medication or behavioral symptoms. The percentage of fallers was higher in the IG. CONCLUSION: The intervention reduced restraint use without a significant increase in falling, behavioral symptoms, or medication.

[Case management in long-term care--the task of individual related and family-oriented support for people in need of care and its realization through the reform of long-term care insurance]. / Case Management in der Pflege - Die Aufgabe personen- und familienbezogener Unterstützung bei Pflegebedürftigkeit und ihre Realisierung in der Reform der Pflegeversicherung.

The introduction of standardized Case Management structures to improve coordination and cooperation of all involved in care, such as cost units, service providers, voluntary organizations, families and the different occupational categories involved in nursing, is the main concern of the current reform of German long-term care insurance. In this article, demands on Case Management in care are enunciated and the basics found in expert talks, needed for efficient support of care, assembled. In doing so, the role and function of Case Management is differentiated, the different levels (case, organizational and system levels) distinguished and options and conditions needed to settle such an organization are introduced.