Department of Gerontology, University of Vechta, Vechta, Germany.
Health Soc Care Community. 2012 May;20(3):274-82. doi: 10.1111/j.1365-2524.2012.01057.x. Epub 2012 Mar 29.
With the introduction of long-term care insurance (LTCI) in 1995/96, Germany established a universal long-term care scheme within a cost containment framework to provide public support in defined situations of care dependency. The scheme aimed to promote ageing in place with an emphasis on public support for family care provision as a precondition. A further aim was the expansion of market-oriented professional care services to offer users a choice between family and professional care provision and care providers. The focus of this study is on the interplay of formal and informal family care provision within the institutional framework of LTCI, as well as the organisation, regulations and mix of different types of formal care services. In a first step, an examination of the interplay of formal and informal care provision shows the largely family-oriented care strategy, the burdened situation of informal carers, the mix of rationalities of service use and their interrelationship with socioeconomic inequality. In a second step, an analysis of the organisation of different types of formal services reveals paid care provision that emerges in the interplay of politicians' strategies to develop professional care services within the framework of LTCI, bottom-up strategies of users to increase the range of services outside the framework of LTCI and efforts of politicians to regulate the latter. Basic orientations of care provision underlying the development process such as user orientation, quality and comprehensiveness guided the process and are used to analyse the development. Finally, the discussion of the situation of care workers reveals a contradictory picture with increasing employment opportunities, a comparably well-qualified workforce and worsening employment conditions. Empirically, the research is based on an institutional analysis of LTCI combined with a literature review and representative statistics.
1995/96 年引入长期护理保险 (LTCI) 后，德国在成本控制框架内建立了一项普遍的长期护理计划，为特定的护理依赖情况提供公共支持。该计划旨在促进就地老龄化，并强调以家庭护理提供为前提的公共支持。另一个目标是扩大面向市场的专业护理服务，为用户在家庭和专业护理提供之间以及护理提供者之间提供选择。本研究的重点是长期护理保险制度框架内正式和非正式家庭护理提供的相互作用，以及组织、法规和不同类型正式护理服务的组合。在第一步中，对正式和非正式护理提供的相互作用的考察表明了以家庭为导向的护理策略、非正式护理者的负担过重的情况、服务使用的合理性组合及其与社会经济不平等的相互关系。在第二步中，对不同类型正式服务的组织的分析揭示了付费护理服务的出现，这是在政治家发展长期护理保险框架内专业护理服务的策略、用户在框架外增加服务范围的自下而上的策略以及政治家规范后者的努力的相互作用中出现的。护理提供的基本方向，如用户导向、质量和全面性，是发展过程的基础，并用于分析发展情况。最后，对护理工作者状况的讨论揭示了一幅矛盾的画面，即就业机会增加、劳动力相对素质较高和就业条件恶化。从经验上看，这项研究基于对长期护理保险的制度分析，结合文献回顾和代表性统计数据。
