Workforce issues in home- and community-based long-term care in Germany

The study addresses staffing and workforce issues for home- and community-based long-term care in Germany. It is based on a study aimed at developing staffing recommendations for home-care provider organisations. The study was commissioned within the regulation of the German long-term care act. Following an exploratory literature search on staffing issues in home- and community-based care qualitative interviews with 30 experts in home care were conducted. In addition, time needed for different interventions in homes of people in need of care (n = 129) was measured. Ethical approval for the study was obtained. The literature on the topic is limited. In Germany, no fixed staff-to-client ratio exists, but staffing is determined primarily by reimbursement policies, not by care recipients' needs. The results of the interviews indicated that staffing ratios are not the main concern of home-care providers. Experts stressed that general availability of staff with different qualification levels and the problems of existing regulation on services and their reimbursement are of higher concern. The measurement of time needed for selected interventions reveals the huge heterogeneity of home-care service delivery and the difficulty of using a task-based approach to determine staffing levels. Overall, the study shows that currently demand for home-care exceeds supply. Staff shortage puts a risk to home care in Germany. Existing approaches of reimbursement-driven determination of staffing levels have not been sufficient. A new balance between staffing, needs and reimbursement policies needs to be developed.