www.Heimverzeichnis.de: Certified quality of life in nursing homes

www.Heimverzeichnis.de was initiated in 2006 when compulsory examinations by the Medical Review Board of the Health Insurance Funds were still only performed at irregular intervals and focussing almost exclusively on the quality of care. The website was meant to add to their findings by developing quality standards in the dimensions of:

1. personal autonomy (e.g. the right to a self-determined way of life, freedom of decision in care issues or autonomy in financial matters),
2. participation (e.g. in social and political life, or co-determination in care home management) and,
3. human dignity (e.g. the right to intimacy and private sphere, or the freedom of choice in the final phase of life).

The overarching philosophy is to bridge gaps between the perspectives of management and staff on one side and the residents on the other. While for the former the care home is a workplace demanding a professional attitude, for the latter it includes a private sphere where they are “at home”. The target groups of the example are:

• older people whose desire for quality of life need to be respected,
• next of kin who want to be sure that their dependent older relative will feel well and be humanely treated when trying to find an adequate care home and, 
• managers of care homes who want to provide high quality services and get marketing incentives in return.

The example was initiated by a voluntary association, representing and defending the interests of older people in need of inpatient and outpatient care (BIVA, Bundesinteressenvertretung der Nutzerinnen und Nutzer von Wohn- und Betreuungsangeboten im Alter und bei Behinderung). Together with a research institute they developed the concept for the website project, at the time of reporting still funded by the Ministry for Nutrition, Agriculture and Consumer Protection.

The criteria for quality of life in residential care were developed as a joint venture by the project initiators, representatives of care homes, seniors’ associations, health insurance funds and institutions for consumer protection, all of them active in promoting and implementing the project.

The assessments of quality of life are carried out by volunteers, who are usually already experienced with issues of residential care through their professional or voluntary work. They are trained for their task in a two-day workshop with a final examination and start their work under the supervision of experienced peer volunteers. The managers of care homes under assessment are asked in return to fill in a feedback form to also ensure quality standards in the assessments.

The project has been running since 2007 and has at its disposal a total budget of €1.1 million for 4 years. The highest share of the budget is invested in covering the expenditures of the volunteers and the development of the website. At the end of 2011 the website will have to be independent from public funding and generate its own income. Still organized on a non-for-profit basis, it is planned to charge a fee of €450 for the annual certificates from each participating nursing home. For more information in German see: www.Heimverzeichnis.de

The website contributes to the development of quality of life in residential care in various ways:

• The assessment criteria are publicly accessible so interested care homes can get prepared accordingly.
• Care homes which have passed the examination use the certificate and respective labels to advertise their success in their own communication at local level and on their homepage, thus disseminating the broadened perception of quality.
• The assurance of quality of life in terms of personal autonomy, participation and human dignity is becoming a decisive factor in the selection of residential care providers; www.Heimverzeichnis.de is meanwhile (October 2010) used by 20,000 different visitors per month with a rising tendency.

No systematic evaluation has been performed to measure what direct impact the website has had by now on the quality of life in care homes. But there is some indication about respective developments: care home associations directly encourage their members to participate in order to prove their high standards in offers and services, acting as an internal “push factor”. Homes which do not pass the inspection in the first step are informed about the reasons why they failed and advised on how to improve. About one half of those who had failed make use of this offer and re-register for the assessment.

It can be assumed that quality development could be accelerated if the website is able to reach a critical mass of at least one fifth of all care homes in Germany (approx. 2,000) in the course of 2011 before the funding will end. Then there will be a strong push towards managers to get certified or otherwise to risk criticism about not having passed the examination and not addressing issues concerning quality of life as much as their competitors who are published on the website. However, evidence of sustainability has yet to be achieved. In October 2010 only 1,100 homes were certified to provide quality of life assessments or had registered for the assessment process.