gms | German Medical Science

Background and Purpose: The benefit scheme of statutory long term care insurance in Germany has been expanded by recent legislation. Beneficiaries are entitled not only to receive typical nursing services (bathing, dressing etc., “körperbezogene Pflegemaßnahmen”) but also personal support and daily life assistance (PSLA, “pflegerische Betreuungsmaßnahmen”). Modified legislation led to the establishment of a scientifically supervised pilot scheme for a distinctive type of service provider (“Betreuungsdienste”) offering home services for PSLA (but no typical nursing services). Within this context, we developed instruments to assess the need for PSLA, a taxonomy of related services and criteria to measure the quality of services. In this report, we focus on whether specific categories of services show differential effects on the reduction of perceived strain (PS) and improved quality of life (QoL) of clients and family care-givers.

Methods: 49 BD, 36 nBa and 17 PD participated in the study. The 49 BD were involved in the pilot scheme and had agreed to take part in the study. From 510 nBa and 1.914 PD in geographical proximity to BD 36 nBa and 17 PD agreed to take part in the study. Clients (or their family care-givers) of these providers received questionnaires on their needs for support, kind and quantities of services received. Subjects rated the suitability of 29 single services of PSLA. For analyses presented here, data from BD, nBa and PD were collapsed. Using factor analysis, the list of single services was reduced to six categories. Outcomes were measured as differences in client’s and care giver’s PS/QoL as compared to a situation without services. Multiple linear regression models were specified to estimate the effect of the service categories on PS/QoL.

Results: Overall, 952 clients/care-givers from all over Germany took part in the survey. Subjects reported significant reductions of PS/QoL after initiation of services (p<.001). Two categories were most influential: Services that help to maintain daily routine and structure and services that support clients with administrative tasks and assist them with housekeeping (p<.01).

Conclusions: PSLA can be differentiated into separate categories, based on ratings of suitability of these activities from a client’s/family care giver’s point of view. These results can be used to guide planning of services, as specific categories of services promise to be more suitable to satisfy the needs of specific clients and their family care-givers. Furthermore, we demonstrate that two categories of services turn out to be most effective on quality of life and perceived strain. Thus, future concepts to develop and maintain a high quality of services for personal support/daily life assistance should emphasize these two categories.

Funding: This research was funded by the German National Association of Statutory Health Insurance Funds (GKV Spitzenverband).