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

Area of Science:

• Gerontology
• Health Services Research
• Social Policy

Background:

• Home- and community-based long-term care in Germany faces significant staffing and workforce challenges.
• Current staffing levels are primarily driven by reimbursement policies rather than the actual needs of care recipients.
• Limited existing literature addresses specific staffing issues in this sector.

Purpose of the Study:

• To develop evidence-based staffing recommendations for home-care provider organizations in Germany.
• To investigate the factors influencing staffing in German home- and community-based long-term care.
• To analyze the adequacy of current reimbursement policies in determining appropriate staffing levels.

Main Methods:

• Exploratory literature review on staffing in home- and community-based care.
• Qualitative interviews with 30 experts in the German home-care sector.
• Measurement of time required for various care interventions for 129 care recipients.

Main Results:

• Home-care providers prioritize staff availability and qualification levels over fixed staff-to-client ratios.
• Existing regulations and reimbursement structures present significant challenges.
• Significant heterogeneity in service delivery complicates task-based staffing calculations; demand currently exceeds supply.

Conclusions:

• The current reimbursement-driven approach to staffing is insufficient for meeting the needs of home-care services in Germany.
• A critical staff shortage poses a risk to the sustainability of home care.
• A new framework balancing staffing, care recipient needs, and reimbursement policies is urgently required.