Nursing crisis in Germany

We actually have one of the most beautiful professions in the world. We are allowed to accompany people in joy and sorrow, but also in pain and need. That is a great responsibility and at the same time an enriching experience," says Marcus Jogerst, deputy chairman of "Pflege in Bewegung e.V." as well as managing director and house manager of the Seniorenhaus Renchen.

However," he complains, "politics ensure that caregivers exploit themselves if they want to perform their profession well." For this reason, he, along with others, founded "Nursing in Motion" in September 2016. An initiative that traces back to the activities at "Nursing on the Brink.

A look at the numbers shows that healthcare in Germany is in a critical state. According to the ver.di personnel check 2013, 70,000 additional nursing staff are needed in Germany's hospitals alone. In nursing homes, 19,000 positions subject to social security contributions are unfilled, according to findings from the Employment Agency.

The elimination of civilian service workers has hit hospitals as well as care and residential homes and outpatient care services particularly hard. The introduction of the voluntary social year could not compensate for this. Also, in no other European country does a nurse have to care for as many patients on average. In the Netherlands, there are 7 people in need of care per nurse, and in Norway even only 5.4, while in Germany it is 13.

The high staffing ratio and the fact that many nursing homes care for people with multiple care needs and dementia patients at the same time lead to a continuous overload of caregivers. The result: According to the DGB Index "Gute Arbeit 2012/2014," 77 percent of employees in health and nursing care cannot imagine being able to work until retirement. The sickness absence of nursing staff is also significantly above the average of all employees at 19.6 days compared to 13.7 days, according to the TK Health Report 2013.

The statistic is led by work absences due to mental illnesses. At the same time, the demand for professional care is increasing on the other side with the aging population. The Federal Ministry of Health assumes that the number of people in need of care will rise from today’s 2.7 million to 4.7 million by 2060—assuming that age- and gender-specific care rates remain unchanged. A relaxation of the precarious situation is not in sight. However, Jogerst is convinced: "That doesn’t have to be!

Mr. Jogerst, is care in Germany too expensive?

Actually, care in Germany is even relatively inexpensive. The question should rather be: Why does the Federal Republic of Germany spend so little money on care? Germany invests only 0.15 percent of its gross domestic product in care, placing it, along with countries like Bulgaria (0.14%), at the bottom ranks in Europe. For comparison, Sweden invests 2.2 percent of its gross domestic product.

Is gross domestic product the right comparison of spending?

It is even the only permissible one. We must view our wages in the overall context. The gross domestic product reflects the overall wealth of a society, taking into account the total wage level.

Why do such high costs nevertheless fall on individuals or families for care?

That's due to the system. With the introduction of long-term care insurance, we have established a system that places too much financial responsibility on families.

What needs to change to make care affordable?

We will not be able to avoid either introducing comprehensive long-term care insurance or real tax financing. It cannot be that people who work hard, some of whom have postponed their family planning to later years, are also being exploited when it comes to caring for their relatives.

Especially since benefits for people without any income come from social assistance anyway.

You're right. So it's doubly unfair. Every social insurance was introduced to relieve individuals of relatively high risks and to compensate for them in society. With long-term care insurance, we were led to believe it was a success model. But it is not. Japan is 15 years ahead of us in demographic development and has implemented a similar insurance. The system is currently collapsing in Japan. It would be very important to spare us from that.

What do you suggest?

We need a real system change - away from health and nursing care funds towards a citizen insurance and unified fund.

In many places, there is also talk of too much bureaucracy in care. Would "less bureaucracy" also be a solution?

Less bureaucracy is certainly a measure that needs to be considered. In caregiving, a problem is often identified, which is then supposed to be solved with another bureaucratic regulation. However, the measures implemented are not examined. The question of success and the cost of it is not even asked. Ultimately, we keep coming back to the staffing shortage for many problems. This major issue is also attempted to be addressed through bureaucratic measures. Working in the care sector often takes on Kafkaesque characteristics. One can only wonder how little the responsible parties recognize or want to recognize the overall context. For example, regulations on minimum staffing in areas are issued, but do not result in an increase in staffing levels.

Could you explain that in more detail?

A good example is the quality inspections of the medical service of health insurance companies. The staffing ratios do not meet the required measures at all. So things are manipulated, deception occurs, and in the end, all facilities receive a top grade. No one has ever checked how much staff would be necessary to implement all these demands.

Subject: Staff Shortage. You just mentioned it. Especially in the area of "care," we have a significant shortage of skilled workers. What needs to change to attract more young people to enter the care profession?

We need significantly higher staffing ratios! We have known for a long time that the staffing ratios for the required performance are about 30 percent too low. Increasing the staffing ratios will reveal the true extent of the nursing shortage. But only then can we start attracting young people back into the profession. If it continues like this, we will "hit a wall," and getting the car "ready to drive" again will definitely be more expensive.

But it's not just the staffing ratio that's unrealistic. Caregivers are also particularly poorly paid. Service to the machine is valued more by Germans than service to people. Why is that?

The professional group of nurses has always been poorly organized in Germany. Many feel that they are not adequately represented by the union ver.di, and in fact, ver.di has achieved nothing for nursing in the past 20 years. The balance sheet of union involvement is devastating: hardly any wage increases and constant job cuts amid increasing demands. That is the recipe for driving people out of the profession.

What do you think needs to change in this regard?

Ultimately, an intervention in tariff autonomy and self-administration is inevitable here. The cost bearers – health and long-term care insurance funds, social welfare agencies – obstruct nearly every improvement for caregivers. Recently, an improvement in staffing ratios demanded by employers in Baden-Württemberg was once again boycotted by the cost bearers. I think it won't work without the government taking a tough stance. However, this would mean injecting more money into the system and imposing significantly stricter requirements on the cost bearers. A union solely for caregivers would be a right first step.

famPLUS - Together for your personal PLUS!