Home-based care provision within the German welfare mix

Area of Science:

• Health Policy and Social Gerontology
• Socioeconomics of Care Services

Background:

• Germany introduced universal long-term care insurance (LTCI) in 1995/96 to support care dependency while containing costs.
• The LTCI scheme aimed to facilitate 'ageing in place' by supporting family care and expanding market-based professional services, offering user choice.
• This study examines the interaction between formal and informal care within the LTCI framework, including service organization, regulation, and types of care.

Purpose of the Study:

• To analyze the interplay between formal and informal care provision under Germany's long-term care insurance (LTCI) system.
• To investigate the organization, regulation, and service mix of formal care within the LTCI framework.
• To evaluate the development of care provision based on user orientation, quality, and comprehensiveness, and the conditions of care workers.

Main Methods:

• Institutional analysis of long-term care insurance (LTCI).
• Comprehensive literature review.
• Analysis of representative statistics on care provision and care workers.

Main Results:

• The LTCI system largely favors family-based care, placing a significant burden on informal caregivers and highlighting socioeconomic inequalities in service utilization.
• Formal care services have developed through a combination of government strategies, user-driven demand for services outside the LTCI framework, and regulatory efforts.
• Care work shows a dual trend: increasing employment and a qualified workforce alongside deteriorating working conditions.

Conclusions:

• Germany's LTCI has fostered a family-centric care model, creating challenges for informal carers and exacerbating socioeconomic disparities.
• The development of formal care services is complex, influenced by policy, user needs, and regulation, with mixed outcomes for care workers.
• The study underscores the need for policy adjustments to balance formal and informal care, improve working conditions for care professionals, and address socioeconomic inequalities.