[Persons requiring long-term care: Recommendation and utilization of rehabilitative therapies].

In Germany all members of the statutory health insurance are also compulsory members of the nursing care insurance which financially supports nursing care at home and in nursing homes. Benefits are provided dependent on a standardized medical examination performed at the home of the applicants by trained physicians or nurses of the health insurances' medical service (MDK). The benefits are granted to those persons who are limited in the performance of activities of daily living due to physical, cognitive or mental disorders. In the German Code of Social Law regulating the long-term care system, one important entitlement is "rehabilitation before long-term care". It aims at maintaining life of disabled persons in their familiar surroundings as long as possible. Up to now in the nursing care insurance this aim has been implemented insufficiently. The objective of this study was therefore to investigate the frequency of suggested ambulatory rehabilitation, which is recommended by the MDK at the examinations, and the following prescription of ambulatory rehabilitation, issued by an office-based physician. The database included the medical examinations of the years 2001 to 2002 linked to a random sample of persons insured in a statutory sickness fund in the German federal state of Hesse. Nursing care-related information including recommended rehabilitation therapy was derived from the medical examinations. Insurance data provided information on prescriptions. Data of 7,840 persons could be analyzed. Rehabilitative therapy was recommended in 15% of the nursing care applicants, mostly physiotherapy (ca. 90%). Persons receiving the recommendation were mainly male, they were younger, were more disabled, had less often a diagnosis of the ICD-10 chapter "symptoms and abnormal clinical and laboratory findings" or "mental and behavioral disorders", live less often alone and were more restricted in their motion compared to persons without recommendation for rehabilitative therapy. Only 55.3% of the persons with a recommendation for physiotherapy and only one-third with a recommendation for occupational therapy or logopedics received a prescription for the respective therapy in the following three months after examination. The age younger than 80 years, professional care, no home care, and-as the strongest item-preceding therapy were positively related to receiving a prescription. These findings show that disabled persons have the capability for prevention and rehabilitation, but it is used in only half of them. One possible reason might be the financing of the remedies, which burdens the budget of the health insurance, where instead the nursing care insurance benefits from the possible delay of the utilization of nursing care.