Vielfalt der Pflege – nichts wird Gesellschaft und Technologie so tiefgreifend ändern

Sowohl Anzahl als auch Vielseitigkeit der Unterstützung pflegebedürftiger Menschen nehmen kontinuierlich zu.

Unaufhaltsam entwickeln sich Technologielösungen wie Smarthome, Exoskelette, Telemedizin aus dem Prototypendasein in den realen Alltag. Künstliche Intelligenz als unermüdlicher und geduldig Helfer der Medizin wird auch die Bedürfnisse hilfsbedürftiger Menschen befriedigen – vorausgesetzt die Gesundheitspolitik beschließt, nicht nur zu entscheiden, sondern auch zu planen und v.a. den Betroffenen zuzuhören.

Am Beginn jeder Strategie entscheiden Ausgangsdaten über Handlungskorridore.

Die für Österreich wesentlichen Berichte:

Österreichischer Pflegebericht 2017

Deutscher 6. Pflegebericht

Dazu die Zusammenfassung einer Stellungnahme Prof.Dr.Hrabciks als Beantwortung einer WHO-Anfrage:

Care Report Austria/German
Part 1: analysis Austria
Part 2: analysis Germany
Part 3: Conclusions, problems, needs

My report is based on the published care report 2017 from Austria and 2017 from Germany. This means, we are using the official numbers and figures.
Both reports exist only in German. Due to the length of the reports, it is not possible for me, to translate all. However, my idea was, do show you the important highlights within the report.

Part I-situation and Analysis in Austria (based on the published care report 2017 from the Ministry for Health and social affairs)

Page 9: In the introduction, there was the first surprise for me, the important role of children and youth within the family for the home care of disabled or elderly people. In more than 20% these young ones are primary responsible for the care. The mean age is 12,5 years, about 70% are female.
Page 15: The age structure of the recipients of the care allowance is shown. About 5% of the Austrian population are recipients of a care allowance. (5% of 8 Mill)
In Austria, the public support for care of either disabled or elderly people can be realised in different ways:
 Home care either by the family or with an extern 24h care person. Depending to the time qnatitiy of care it is possible to get from the regional government a care allowance. At the beginning of the procedure starts a medical and nurse expertise, to quantify the grade of care. the amount of money (financial support) is classified in seven steps.
 Nursing care in a nursing home. Primary financed by the person private, but supported by the community or totally paid.
 Palliative care units for people with chronic and incurable diseases, to enable them a best quality of life till their soon coming death
The responsibility for all these procedures are mixed between the federal level and the regional level. The recognition of persons with a need of support runs opportunistic, not organized.
On page 16: you can see the main diagnose of the cared persons

Page 18 Tab4 the main diagnose between 15-65a You see the great number of dementia 30%
Page 21 you see the three main diagnose groups, differentiated in severe of the disease and care need
Due to the life expectancy, the majority is female; in 41% is a strong suspicion for dementia.
More than 22% had fractures in their skeletal system; about 12% of them had a fracture of the femoral neck:
If you look to figures of a ambulance of an accident surgery, then you see that people over 70 have in 70% severe gait abnormality.
If you differentiate between younger and older adults, you can find:
Younger adults 3 main diagnose groups: Paralysis psychiatric diseases malign tumours
Over 65 the neurological and psychiatric diagnoses are the majority. In addition, it has also shown that we have two diagnose groups: Adipositas and Diabetes, where prevention could avoid many later incurable damages.
Not to forget also the youth disabled persons, who need permanent care: Page 23
Since 2011 a fund of the federal level supports the regional countries in their work of realising care: In 2017 about 349 Mill € had been transferred to the regional countries. These are obligated to document their care work in a care data pool.
Until 2018 yearly, organized by a public health insurance, was a permanent but announced controlling of the supported cases. In 995 was a sufficient result found. In his last report the Austrian General accounting office advised, to realise the controlling unheralded. This will start with this year 2019.
We have now 25200 running cases in 24h care supported by the public side. The number increase in the last year for 6,1%. Only in 2017 9500 new cases started.
It is also important to know, that from 2018 the former care regress for families (they had to pay a part of the needed support) was totally stopped. From 2018, all fields of care are public financed. Political discussions had started, if in Austria, a specific care assurance should be established, but it seems, that the gone way of public financing out of the budget will be continued.
From page 37 starts the quality report
Within this, you can find also interesting social facts. More than 40% of the recipients of care allowance are living alone in their home:

About 97 % are supported by their relatives:
43% from their children 18% from their husband 7,8% from their daughter in law 32% from friends, neighbours etc.
Page 40: overview of the care through family members
In the group of recipients of care allowance, the percentage of people with dementia is higher: 41% this is an increase from 16 to 17 of 3%.
From page 43 presentation of the results of quality control of the regional countries
Page 74 a presentation of the different dementia projects from the regions.
 Children and youth-disabled- are soon diagnosed and cared by their families. Nearly 100% have a clear medical diagnose and a nursing concept. These about 9000 are fully integrated in the federal and public system. There is a need for speficic care and treatment units for these youth. A realisation has late started now and will need 5-10 years to cover the needs.
 Through all age groups- youth adults to the elderly we see a strong increase of neurological and psychiatric diseases. A second problem is, that these persons are only in an opportunistic way included in our diagnose and care system.
 In addition, also the care regress has stopped, which was a great burden to many families- the financing of the needed care in its different ways is only partially covered. There is a risk that a two-class model will start.
 To realise the different models like home care, 24h care, care in nursing homes and palliative care, you need qualified medical and nursing personal. We have enough physicians, but a tremendous gap of nursing personal. Our trade chamber published one week ago a research, that in 2025 we will need 20000 care personal more than now. The problem is, that in the last 20 years the profession of nursing and care got unattractive, was less paid and our young generation now has no interest for this profession. Now in different regional countries start a few public projects to increase this attractiveness of these professions.
 Quality of care: The quality control has started, the results had been surprisingly positive.
 Not to forget, that these persons, with a care at any place need also a permanent medical support for their undercurrent or chronic diseases. This needs therefore also a system of mobile GP´s and experts, who have a mobile equipment and are willing to treat these persons. Now it function only sporadic.

 The question of medical and nursing care for elderly people and members of our society will and is a tremendous political issue and needs a permanent realisation and development.
 Our social structure in Europe, more than 40% single in age, creates also an additional problem.
 Our government has announced that the question of care will be a main issue for the running year, to increase the number of nursing schools, to create an attractive profession.
 Now the care of elderly is extremely dependent of personal coming from Eastern Europe. They do an excellent job, but their migration to Austria creates gaps in their home countries.

Part II: Care Report_ Situation in Germany

My report is primary based on the published sixth report about care in Germany.
In difference to Austria there is no yearly report, always every 5th year an overview is published. The last one exists from 2011-2015, but also including some details of the next two years 2016 und 2017.
The greatest difference to the situation in Austria is, that in Germany 1995 a public care assurance was established, financed by the fees of the citizens and out of the German federal and regional budget.
In this report, the development is shown, based also on the meantime adopted new legal regulations.
The whole report is published in German. I again will try to highlight important pages and parts of this report.
Page 3 between 2011-2015 the number pf recipients was increasing from 2011-2,3Mill 2015 2,7 Mill +17%
The expenses 2011 20,9Mrd€ 2015 26,6Mrd € +27%
The public health field of care is also an important economic factor 2003 712tsd 2013 1Mill +40%
The education places for elderly care had been grown to 68000 in the school year 2015/16
Interesting to see is also that the needed administration had speeded up. Normally a new request for care allowance will be handled in maximum 5 weeks.
It was also a main issue, to decrease the administrative burden within the care administration and offer a new documentation system. 1/3 of all nursing homes and care organisations had changed to this system and are registered.
An advising expert committee is permanent working. It had created a new medical assessment system to find the right grade of support.
In chapter, one you will find following issues:
 Requirements for elderly care
 Care of persons with dementia
 Support of caring relatives and family members

Part three: Summary: Care for elderly and disabled. Facts and Needs

Change in the familiar and social situation : between 35-45% live in their second life sector as a single. Only 35% with a partner. It looks, that between 5-10% of the population will need permanent care
 Also now, the disabled and elderly in need for care are mostly supported by their families and relatives. However, this support system is limited to the time needed for the job and also by regional distances. Each local or regional government should therefore try to start alliances with the caring relatives to enable care within the family and support the family with additional personal (p.e. for vacations) and to support with education and training.
 We are focused to the care for elderly, but not to forget the care for children, youth, and disabled persons by drug abuse. For these specific groups we have a lack of specific units,.
 The existing problems, in quantity and quality, are the same in whole Europe. Each country and government tries now, based on its budgetary possibilities and not on the needs of the persons concerned, to create assessment systems and solutions. But the needs are the same!
 Therefore exists European wide no guarantee, that persons in need of care will have access to care without any burden.
 All existing units and nursing homes are aligned to patients with somatic
problems. Nevertheless, we have to know, as newest scientific papers show, that in 10 years about 50% of the cared persons will have a dementia. This situation needs new structures and solutions.
 The care for disabled and elderly persons should be a main issue for the WHO/Euro to create: guidelines for quality guidelines for medical assessment and nursing assessment
 Care will be an important economic filed and a job chance for the next decades. WHO should observe the situation as an advocate of persons with need of care and guarantee a serious development and be a moral authority to avoid an undesirable development
 The tremendous challenge was till now often neglected from our politicians in many countries it is now time to star

Prof.Dr.Hubert Hrabcik