Interview on nursing reform: "nursing is the mega-topic"

The federal government celebrates its care reform as a great success. Today the cabinet approved the first stage. But care expert Ralf Suhr emphasizes in an interview with this site: With four to five million people in need of care in the future, this reform will not be the last.

What the nursing reform promises from January onwards in terms of performance – it will really be a relief for those being cared for and caring for?

Ralf Suhr: For one thing, the reform brings real improvements in performance. In a first step, the benefits of long-term care insurance are to be increased by up to four percent in order to counteract the progressive loss of purchasing power. This is not dynamization, as many demanded, so no automatic adjustment. In 2017 it will then be checked whether a further increase is necessary.

On the other hand, the legislature is also planning to make long-term care insurance benefits more flexible. This would take better account of people’s individual needs. For example, family carers in the future will be able to determine much more clearly how they want to combine these with the relief services – so-called short-term care and preventive care. This improvement is very important for family caregivers and the right step to strengthen home care. Because the majority of those in need of care are cared for at home, which can be extremely stressful for the relatives who care. 

As a physician and health scientist, Ralf Suhr worked in clinics and research. After switching to consulting, he took care of the optimization of care and the definition of care standards, for example in university clinics and large hospitals. Since 2009 Suhr has been chairman of the board of the non-profit foundation Center for Quality in Nursing in Berlin.

In a second step, the care reform wants to focus more on the problems of people with dementia, for example through more care levels. To what extent does this help the demented people and their relatives?

Suhr: The new definition of the need for long-term care is currently being tested in practice. It is planned to convert the previous three care levels into five care levels. The idea behind this is to no longer assess the deficits in the assessment, but rather the skills that a person has retained. In addition, the need for care should be measured regardless of whether a person needs help due to physical or cognitive limitations. This means that people with dementia and their relatives who care for them will in future receive more benefits from long-term care insurance.

What about other people who will have an increased need for care in the future, for example those living alone??

Suhr: To date, this group has not received sufficient attention. But she is particularly threatened by loneliness and poverty – especially if the care setting is endangered, for example, by an additional illness. We have to adapt to this by including volunteering, for example. Care can also be borne by the extended family, which includes neighbors and friends. That is why politics must create the possibilities for this, especially at the local level. Volunteering also needs structural and financial foundations. Here dementia-friendly communities are already pioneers. 

You address volunteering. Others call for caregivers to be paid better. What is the right way to recruit enough staff?

Suhr: Both are equally important. In all probability, the number of people in need of care will increase from 2.5 million to four million people by 2050. At the same time, those who can care are becoming fewer and fewer. There is therefore a considerable gap that cannot be closed by one measure alone. The nursing profession must become attractive again for more people. This includes fair pay for the nursing staff, but also the offer of professional development opportunities. Anyone who can no longer lift heavily can still provide good advice, for example. Nevertheless, the number of specialists alone will not be sufficient and must be supplemented by relatives and volunteers. Caring for the elderly is also a task for society as a whole.

What, however, no reform has taken into account so far is that the prevention of the need for long-term care must be given greater focus. We now know that movement can halt the need for long-term care or at least slow down its progression. However, measures to promote physical activity are still far too rarely used in nursing practice. This is why the ZQP (Center for Quality in Nursing) has been providing an overview of effective exercise programs for some time, which inpatient facilities can easily integrate into everyday care.

With the reform, the contributions to long-term care insurance are increasing in order to save money for the care of the baby boomers. Do you believe that this money actually gets through to those around 50 today?

Suhr: If you want to finance sustainably, you have to build up reserves. And these have to be safe from politics. Everything that is discussed in terms of demographic change must also be thought of in terms of intergenerational equity.

The long-term care reform is decided by the federal government at a time when the long-term care insurance has a record reserve. How do you explain this fact, which at first glance seems absurd?

Suhr: "Record reserve" is relative. It is true that there are surpluses. But they cover the expenses for about three months.

If this reform is now decided and comes into force – everything will be fine?

Suhr: A longer life expectancy is generally a positive thing. Those who are 60 years old today can usually think in good health how they will shape the next 30 years. At the same time, we are faced with the real challenge of providing good care for more and more people in need of care. This is not a problem that policymakers can consider done with this reform. We will constantly have to take further steps, care is the mega topic of the future.

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