Means and Resources
Enabling, allocating and funding human resources
(new) job profiles in LTC
COUNTRY / LOCATION: Germany
Keywords: dementia, social services, care homes, innovative LTC legislation, qualification programme
Keywords: dementia, social services, care homes, innovative LTC legislation, qualification programme
Implementation of everyday assistance in institutional dementia care
Summary
In the German LTC system relevant service gaps in dementia care have been identified, especially regarding daily activities. Problems result from narrow legal definitions of care needs and time constraints in the delivery of care. Older people with dementia often suffer from undersupply of services, especially if their physical capacities are not highly restricted. Additionally, as care staff work on tight schedules, service delivery often fails to allow for (sometimes time-consuming) activation of clients – and therefore care home admission can cause a loss of everyday capacities. Companionship in daily routines and community-based services offering support are especially underdeveloped.
A new German law introduced in 2008 improves social care for institutionalised older people with dementia. The Long Term Care Development Act (Pflege-Weiterentwicklungsgesetz, § 87b SGB XI) establishes the provision of everyday assistance for care home residents suffering from dementia as an additional set of tasks requiring specific qualifications. An innovative job description of “everyday assistance” has been introduced to support clients in daily activities, allowing them to maintain everyday abilities for as long as possible (e.g. leisure activities and daily routines). Additional LTC insurance budgets allow care homes to employ staff for complementary services. In practice, the recruitment, qualification, and employment of assistant caregivers occurs in regionally different forms with presumably quite different outcomes, and there is as yet no standardised national qualification programme. The example presents one of the more comprehensive and established curricula, taught by an educational institution that recruits mainly via regional employment agencies.
In general, “everyday companions” seem to be widely accepted by care staff.
What is the main benefit for people in need of care and/or carers?
Everyday assistance supports people in need of care to maintain their activities of daily living for as long as possible (e.g. leisure activities and daily routines). Therefore it allows care home residents to take a greater part in community life.
What is the main message for practice and/or policy in relation to this sub-theme?
Everyday assistance represents an innovative link between institutional and community care and can be understood as an attempt to improve holistic client-centred approaches within the multiprofessional LTC network.
Why was this example implemented?
Shaped by a tradition of rather narrow (and somatic) legal definition of care needs, German LTC services have been accessible primarily to older people with physical handicaps. The growing subgroup of older people with mental disorders, especially persons with dementia, who often maintain good physical capacities but nevertheless need support in daily activities, are structurally undersupplied with services. The latest LTC legislation, the Long-term Care Development Act of 2008 (Pflege-Weiterentwicklungsgesetz) addresses this problem by introducing several new options for better financed and organised dementia care. The introduction of everyday assistance (§ 87b SGB XI) represents one of these options. People with dementia in care homes will benefit especially from this innovation. Although care home residents already received professional care, there was a widely recognised service gap in offering continuous and trustful support and companionship in order to maintain daily activities as long as possible. Especially time pressures and other practical constraints created a scenario where the need for comprehensive care and support was strongly pointed out by care professionals – but no one knew who should be in charge of it practically. Here, everyday companions help to ensure residents’ self-determination and support them in participating in community life. The new budget options for care homes also offer incentives to develop more comprehensive and innovative care concepts for older people with dementia.
Description
The new law establishes additional budgets for care homes to provide additional assistance and supported activities to their residents with “significant attendance needs”. Details about recruitment, qualification or employment of potential everyday companions are not specified but left to actors at the state or community level, e.g. care providers, municipalities or education and training organisations. The concept of everyday assistance is widely accepted, but there is scepticism about putting it into practice since there are no qualification standards yet. One example of a comprehensive qualification programme is IQA – Innovative Qualifikation in der Alltagsbegleitung, which offers a 1,000-hour curriculum of theoretical and practical training over a period of about 7 months. As part of the training, participants are obliged to complete around 400 hours of internship in LTC organisations. The qualification programme is run by education institutions certified for LTC. The explicit training objectives are to qualify participants to work “between care and therapy” and to be in charge of a field where no other care professional is responsible: to structure and shape the everyday lives of older people with dementia. Employment options include care homes, respite and day care organisations, geriatric and geropsychiatric hospital wards or assisted living arrangements.
The new job profile of everyday assistance is also promoted by employment policy as a qualification allowing the long-term unemployed to enter a career. The cost of the qualification is therefore borne by the regional employment agencies.
What are/were the effects?
Offering everyday assistance in terms of additional staff for complementary social services can help to intensify dementia care for care home residents. Everyday assistance seems to have positive effects on satisfaction and quality of life of dementia patients and their relatives. It also significantly relieved the work burden of care home staff, allowing for better care for other residents.
Initial (exploratory) empirical research (IMPALA study: standardised interviews with 121 graduates of the aforementioned qualification programme) indicates that everyday companions are typically women around the age of 50. They generally work in the field they are trained for (rather than inappropriately compensating nursing shortages, as had been suspected). Reported tasks are mostly conversation, individual or group activation, support in food intake, going for walks, accompanying shopping trips or doctors’ visits. They report mostly good working relationships with care staff. About two third are employed by residential or nursing care homes, the remaining subgroup work in day care, specialised geropsychiatric institutions or assisted living arrangements. Employment contracts are often part-time and temporary.
What are the strengths and limitations?
Strengths and Opportunities
- In general, the new job profile of everyday assistance has potential to close a relevant service gap in social support for daily activities for older persons with dementia.
- The innovative qualification and new employment options for long term unemployed and/or low-skilled individuals represent a positive side-effect promoting social inclusion of this group.
- Everyday assistance seems to be appreciated by care staff, since their workload is usually high and shortages in LTC service delivery are widespread.
Weaknesses and Threats
- Certain constraints provoke scepticism and limit the success of the concept in practice.
- Everyday companions are explicitly not trained for nursing and social care tasks, and there is some concern about a process of de-professionalisation in nursing and social care – encouraged by growing numbers of low-qualified assistant staff in the labour market.
- There is as yet no nationwide standardised qualification programme and certification. Consequently, everyday companions perform with varying service quality. Some LTC organisations criticise the low qualifications of the new staff members or the legislation/LTC policy that suggests employing low-qualified assistants. They assert the need for well qualified and specialised professionals to work with people with dementia and indicate a conflict of interests between LTC quality and employment policy.
- Working conditions for everyday companions are mostly precarious: Employment contracts are often temporary and not secure.
- Overall, it seems to be crucial that candidates for everyday assistance apply voluntarily for qualification rather than being forced by employment agencies, and that they pass through a standardised programme (the extent of which is to be determined).
Credits
Author: Anja DieterichReviewer 1: Thomas Emilsson
Reviewer 2: Tasos Mastroyiannakis
Verified by: Marina Glauche
Links to other INTERLINKS practice examples
- Accreditation of educational programmes and specialised activities for LTC services
- Bridging the gap between nursing home and community care (the Skævinge Project)
- Governing the building process of care innovation for Alzheimer patients and their families: the MAIA national pilot project
- Meeting centres for people with dementia and their informal caregiver(s)
