[The second stage of the Nursing Insurance Act and its effects on the institutional care within welfare for the elderly].
OBJECTIVE
The intention of the recently introduced compulsory nursing care insurance in Germany has been to support patients as well as relatives, and to reduce the burden on the social insurance system in financing professional services. In this study we examine the consequences of the 2nd stage of this legislation upon the care in old people's homes.


METHODS
The investigation covered 5 institutions comprising two components: 1) Analysis of the records kept by the administration (N = 369), and 2) analysis of the volume of nursing care in a sample of N = 121 (including basic care as well as psychosocial support) provided by the staff over a period of 14 days.


RESULTS
The required volume of basic nursing care (SGB XI) determines the classification of patients according to their need for nursing. Although by law the amount of nursing in stage 0 should be none, nevertheless 20 minutes of basic care in average are provided each day here. In stages II and III the observed nursing-time exceeded the allowed values slightly. In stage III realized nursing was far below the legal provision, although the private co-payments were highest.


CONCLUSIONS
The agreement between nursing providers and nursing insurance aiming at comprehensive care, under the given circumstances cannot be executed satisfactorily. This is true especially for stage III patients in old people's homes.
Laaser
U
U
Fakultät für Gesundheitswissenschaften, Universität Bielefeld. u.laaser@health.ibs.uni-bielefeld.de
Röttger-Liepmann
B
B
Breckenkamp
J
J
Herwig-Stenzel
E
E
D000368:Aged; D005858:Germany; D006299:Health Services for the Aged / Q000458:organization & administration*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D007355:Insurance, Nursing Services / Q000191:economics* / Q000331:legislation & jurisprudence*; D012946:Social Welfare