title: [Empirical analysis of expert social medicine assessment of disability based on the decision of the Federal social court].
abstract: Objective assessment of need for nursing care should be based on well defined criteria. In 1993, the Federal German Social Court ("Bundessozialgericht", BSG) has given criteria for identifying individuals in permanent need of very intensive nursing care ("Schwerpfledgebedürftige"), who qualified for benefits granted by the Germany statutory health insurance system at that time. The criteria were primarily based on the number of activities of daily living for which the applicants were in need of help. The criteria were largely, but not entirely, consistent with previously established criteria employed by the Medical Service of the Health Insurances ("Medizinischer Dienst der Krankenversicherung", MDK), who was responsible for the assessment. An analysis of 4185 examinations carried out by MDK in the region of Augsburg in 1991-1993 showed that the majority of judgments were in agreement with the criteria given by BSG. However, individuals with psychiatric disorders or symptoms were often rated by MDK as being in permanent need of very intensive nursing care even if BSG criteria were not fulfilled. Exclusive judgement of nursing dependency on the basis of single activities of daily living appears to be inadequate for this group of persons.
authors.affiliation: Abteilung Epidemiologie, Universität Ulm.
authors.forename: H
authors.initials: H
authors.lastname: Brenner
authors.forename: U
authors.initials: U
authors.lastname: Kliebsch
authors.forename: H
authors.initials: H
authors.lastname: Siebert
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D004608:Eligibility Determination / Q000331:legislation & jurisprudence; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005260:Female; D015577:Geriatric Assessment; D005858:Germany; D006801:Humans; D008134:Long-Term Care / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D012943:Social Security / Q000331:legislation & jurisprudence*
vernacular_title: Empirische Analysen zur sozialmedizinischen Begutachtung von Pflegebedürftigkeit vor dem Hintergrund eines Urteils des Bundessozialgerichts.