Nach dem Pflegestärkungsgesetz II: Eine alternative Interpretation der Probleme und ein Plädoyer für potenzialorientierte Reformen

Abstract

Abstract:The German long-term care insurance has been introduced 20 years ago and recently reformed, but is still subject to criticism. A continued decline of informal care-giving is indicated by a decreasing percentage of people who receive cash benefits for informal care. It renders the political goal of strengthening informal care unachievable, even though it would contribute to the financial sustainability and a more encompassing approach to care. Referring to socio-demographic developments, the author suggests a capability-oriented policy strategy aiming at the mobilization of resources within the social proximity of the affected elderly. Such a strategy would not only contribute to reduce costs, but would also increase quality of life and public legitimacy. As part of such an approach policy instruments will be discussed that aim at activating and facilitating informal care.

Long-term care and intermediary structures for frail older people: Switzerland and Germany in comparison

“…This trend has been accompanied by considerable change in family structures arising from fewer children (or childlessness) and more short-term relationships instead of formal marriage, further reducing the familial reservoir of potential carers. Consequently, cash-for-care arrangements continuously lost ground over the past two decades, and it will be a major challenge to sustain the level of informal care in the existing LTC structure (Kehl, 2016a). This makes the political goal of strengthening informal care almost unachievable.…”

“…Approaches designed to mobilise complementary resources for care and support, and new alliances between different actors in neighbourhoods and wider communities (service providers, real estate management, local administrations, etc), have been discussed (Heinze, 2017). The dissemination of such approaches would contribute not only to reduced costs, but also to a better quality of life and the greater public legitimacy of LTC policies, since people in need of care prefer to stay at home for as long as possible (Kehl, 2016a(Kehl, , 2016b. Intermediary structures, such as local support centres for carers and new forms of community-based living providing assistance in case of need, as well as care leave opportunities, are part of these new policies.…”

“…Between 1997 and 2016, the share of day and night care services in total LTCI usage days increased from 0.3% to 2.8%, the share of respite/ short-term care increased from 0.3% to 0.8%, and the share of special 'vacation care' (Urlaubspflege) increased from 0.2% to 4.5%. The increase arises because fewer carers feel able to care (alone) 24/7 (and, instead, need assistance more often) and because care arrangements increasingly involve more people -for example, non-family members or men -who contribute only small amounts of time (Kehl, 2016a). The availability of services as a legal right, and relative financial certainty through social insurance benefits, has helped build a stable market and increase the use of services.…”

“…The culture and welfare literature shows that Swiss people avoid holding the state responsible for familyrelated social risks and accept market solutions (Pfau-Effinger, 2008b). A further explanation may be that the strong discourse on the welfare mix, co-production Table 4 here and the role of civil society in Germany has promoted non-professional solutions to care (Kehl, 2016a(Kehl, , 2016b. Intermediary structures in both countries aim to support self-help and selforganising, the reconciliation of work and family life, and welfare choice, but they may serve different functions in the LTC architecture and thus lead to different results.…”