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Over- and undersupply in home care: a representative multicenter correlational study

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Abstract

Background/aims

Quality assurance and funding of care become a major challenge against the background of demographic changes in western societies. The primary aim of the study was to identify possible misclassification, respectively over and undersupply of care by comparing the Barthel Index of clients of home care service with the level of care (Stage 0, I, II, III) according to the statutory German long-term care insurance.

Methods

In 2012, a multi-center point prevalence study of 878 randomly selected clients of 100 randomly selected home care services across Germany was conducted. According to a standardized study protocol, demographics, the Barthel Index and the nurses’ professional judgment—whether a client requires more nursing care—were assessed. Associations of the Barthel items and professional judgment were analyzed using univariate (Chi-square) and multivariate (logistic regression and classification-regression-tree-models) statistics.

Results

In each level of care, the Barthel Index showed large variability e.g. in level II ranging from 0 to 100 points. Multivariate logistic regression regarding possible under- and oversupply revealed occasionally fecal incontinence (2.1; 95 % CI 1.2–3.7), urinary incontinence (2.0; 95 % CI 1.1–3.6), feeding (1.7; 95 % CI 1.0–2.9), immobility (0.2; 95 % CI 0.1–0.6) and to be female (1.8; 95 % CI 1.2–2.6) to be statistically significantly associated.

Conclusion

The variability in Barthel Index in each level of care found in this study indicated a large general misclassification of home care clients according to their actual need of care. Professional caregivers identified occasional incontinence, help with eating and drinking and mobility (especially in female clients) as areas of possible under- and oversupply of care. The statutory German long-term care insurance classification should be modified according to the above finding to increase the quality of care in home care clients.

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Conflict of interest

We certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Author information

Authors and Affiliations

  1. Department of Health and Nursing Science, Institut für Gesundheits-und Pflegewissenschaft, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13359, Berlin, Germany

    Nils A. Lahmann & Simone Kuntz

  2. Centre for Quality in Care Foundation, Berlin, Germany

    Ralf Suhr

  3. Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Jan Kottner

Authors
  1. Nils A. Lahmann
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  2. Ralf Suhr
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  3. Simone Kuntz
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  4. Jan Kottner
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Corresponding author

Correspondence to Nils A. Lahmann.

Additional information

N. A. Lahmann and R. Suhr shared first authorship.

Box 1 level of care

Box 1 level of care

For the assignment to a specific level of care, the requirements can be distinguished:

  1. 1.

    Basic care regarding nutrition, mobility and hygiene

  2. 2.

    Household assistance (e.g. cleaning up the room, shopping food and cook the meal, etc.).

Stage of care

Benefits in Euro

Minimum time

Care requirements

Level 0 (with dementia)

225

45 min daily

Care and observation necessary

Level 1

450

Daily 90 min

Minimum of support in two areas of basic care + household assistance

Level 1 (with dementiaa)

665

  

Level 2

1,100

3 h/day → to assume that 2 h/day for basic care

Minimum three times daily assistance in basic care + household assistance multiple times/week

Level 2 (with dementia a)

1,250

  

Level 3

1,550

5 h/day → to assume that 4 h/day for basic care

Five times a day support + household assistance multiple times/week

Level 3+

1,918

 

Additional support at night (usually only in nursing homes)

  1. aAdditionally care and observation because of cognitive condition necessary

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Lahmann, N.A., Suhr, R., Kuntz, S. et al. Over- and undersupply in home care: a representative multicenter correlational study. Aging Clin Exp Res 27, 209–219 (2015). https://doi.org/10.1007/s40520-014-0267-2

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  • DOI: https://doi.org/10.1007/s40520-014-0267-2

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