[Social security in the aged requiring nursing care--a review of status and perspectives]

Our current approach in the case of elderly people requiring nursing and care--namely, provision of supplementary social assistance benefits when old-age pension amounts are insufficient and if the incomes of children and grandchildren are below certain levels--is turning over 70 percent of all persons in residential care into recipients of rather modest amounts of pocket-money. Their financial provision for old age, built over decades, becomes null and void. In the case of home care, small invalid care allowances are granted to cater for additional needs, amounts, however, which are adequate neither to cover for the expenses involved nor to properly honour the caretaking efforts incumbent on the relatives. This reveals two decisive shortcomings in our present system for helping persons in need of care: benefit and service provision give undue priority to residential service delivery, instead of enhancing the necessary extension of community-based or ambulatory services; the current societal distribution of financial burdens is not compatible with the requirements of a publicly organized scheme for protection against general life-hazards that could hit everyone and should therefore be borne jointly. The article sets out the above situation through examples illustrating the various life situations of people needing nursing and care, and discusses three alternative approaches to achieving social security and protection: to extend health insurance coverage to non-curable/non-rehabilitable conditions; to create a separate social insurance branch to cover the life risk of needing nursing and care; and to initiate federal legislation for introduction of tax-financed, flat-rate invalid care allowances proportional to the care intensity required, while establishing user charges in the case of residential care services.(ABSTRACT TRUNCATED AT 250 WORDS)