[A different approach--a new instrument for expert assessment of disability stages?]

A New Tool for Expertising Nursing-Care Need? Since the introduction of the long-term care insurance in April 1995 criticism of the mode of expertise used to assign a particular nursing status to a patient has not ceased. Nursing status is required to receive monetary benefit from the long-term care insurance. According to the code of social law (SGB XI) nursing status is based on the total amount of time in minutes a care-needing person requires help to perform certain activities of daily living (ADL). This time-based classification is the bone of contention. As the currently used classification instrument has not been validated and is not reliable, it has been the aim of the present study to introduce a more objective mode of expertise. In our study we used the Barthel-Index as an instrument that allows to assign nursing status to a person in agreement with the person's respective ability to fulfil ADL. In a prospective study 252 patients were examined by the raters of the MDK Bavaria (Medical Service of Health Insurance) according to the SGB XI and the Barthel-Index. On the basis of the Barthel-Index and a certain discriminatory function more than 86% of the patients were assigned the same nursing status as with the normally used mode of expertise. Most of the differing results were borderline cases between two levels of nursing status. The new mode of expertising results in a more balanced distribution of different levels of nursing status. Therefore, the Barthel-Index in combination with the discriminatory function is as effective as the normally used mode of expertising. It is a valid and reliable instrument which could well replace the mode of expertising used so far.