Gohde J
Präsident des Diakonischen Werks der EKD, Diakonisches Werk der EKD e. V., Reichensteiner Weg 24, 14195 Berlin, Germany.
Z Gerontol Geriatr. 2005 Aug;38(4):256-61. doi: 10.1007/s00391-005-0320-z.
Further development of nursing care insurance must consider both ethical aspects and scarcity of resources. An economy that serves human life has two principal targets: safeguarding the basis of existence and extension of the fulfillment of life. From an ethical perspective welfare and personal responsibility have to be equilibrated by promoting individuality and self-responsibility and maintaining relatives' willingness to become a caregiver. Discussing the role of prevention and rehabilitation in nursing care it is argued that the legally committed primacy of prevention and rehabilitation over care has still not been put into practise due to unresolved problems at the interface of health insurance and nursing care insurance as well as at the interface of inpatient and outpatient providers. Moreover, it seems necessary to strengthen prevention and rehabilitation in the context of care. A comprehensive understanding of individual demands for help, support, and care requires a revision of the common definition of need for care in terms of activities of daily living which neglects particularly psycho-social needs. Case management is a suitable approach to provide adequate and coordinated support as a prerequisite for quality of life in people in need for care. Overcoming compartmentalization of inpatient and outpatient sectors and crosslinking of services are described as essential challenges for future provision of nursing care insurance. Intensification of counseling and advice for patients and relatives, extension and diversification of local providers, upgrading of ambulant services, daily care and short-term care, diversification of nursing homes and other housing arrangements, further development of hospices and palliative care, and acceptance of institutions for the elderly as indispensable components of the future care system are discussed as specific tasks in the further development of nursing care insurance.
护理保险的进一步发展必须兼顾伦理层面和资源稀缺性。服务于人类生活的经济有两个主要目标：保障生存基础和拓展生活满足感。从伦理角度看，必须通过促进个性与自我责任，并保持亲属成为照料者的意愿，来平衡福利与个人责任。在讨论预防和康复在护理中的作用时，有人认为，由于健康保险与护理保险的衔接以及住院和门诊服务提供者之间的衔接存在未解决的问题，法律规定的预防和康复相对于护理的首要地位仍未得到落实。此外，在护理背景下加强预防和康复似乎很有必要。要全面理解个人对帮助、支持和护理的需求，就需要修订基于日常生活活动的护理需求的常见定义，因为该定义尤其忽视了心理社会需求。个案管理是一种合适的方法，可为有护理需求的人提供充分和协调的支持，这是其生活质量的前提条件。克服住院和门诊部门的分割以及服务的交叉连接，被描述为未来护理保险提供的关键挑战。加强对患者及其亲属的咨询和建议、扩大当地服务提供者并使其多样化、提升门诊服务、日托和短期护理、使养老院和其他住房安排多样化、进一步发展临终关怀和姑息治疗，以及接纳老年机构作为未来护理系统不可或缺的组成部分，这些都被视为护理保险进一步发展的具体任务。
