I was in Berlin, Germany, last week and did some research into their long-term care system during my visit. I was curious about how it might be different or similar to ours, given the country’s national healthcare program.
Briefly, the German system has public and private healthcare insurance options and 100% of the population has coverage. That’s compared to the 28 million Americans without insurance and the 48% of Americans between ages 19 and 64 who are underinsured1. Private insurers in Germany are not profit-making enterprises and people cannot be turned away for pre-existing conditions. There are caps on charges for services so that healthcare is still affordable even when medical needs increase. They have better health outcomes than the U.S., and at significantly lower costs.2
The system has financial incentives for exercise and regular medical checkups, rather than cost-prohibitive copayments that can lead to delays in medical attention.
Long-term care insurance
About 79 million of Germany’s 82 million people have long-term care insurance, composed of 88% public and 12% private insurance.3 Payments can be used for care at home, given to professional, family or friend caregivers, or applied to one of the 12,000 care facilities in the country. If the insurance payment, along with pensions and other income, isn’t enough to cover facility costs, then families contribute or the elder applies for social assistance.
Exploring LTC in Berlin
I had dinner with Ilse Biberti, an actor and director who authored a best-selling German-language book on the six years she spent caring for her aging parents. I chatted about parents with middle-aged Germans over birthday cake at a party. And I got an informative tour of the aforementioned nursing home by Amélie Herberhold, one of its social workers.
I was staying in a friend’s sixth-floor walkup apartment. This wasn’t an anomaly; there were walkup apartments all over the city. “What do the old folks do?” I queried everyone I met. The answer: “They put a chair on each landing and they take their time.” This sounded very much like apartments in New York City, with elders somehow managing to walk up too many stairs until it’s no longer possible.
Journalist Johannes Buck shared an idea he had come across for those unable to reside alone. Multiple families bring their older relatives to live together in one home and then share the care for all of them as a collaborative effort. The concept of cooperative family responsibilities could be a welcome step on a continuum of care for some organizations or communities in the U.S.
Author Ilse Biberti considered a care home for her parents but when she didn’t find one that she found acceptable in terms of costs and services provided, she took time off from work to help them. While this process was undoubtedly partially eased due to the German system of paying family caregivers, the social isolation of caregiving and the challenges of re-entering the workforce are similar to the situation in the U.S., where 69% of working family caregivers have to adjust work schedules, reduce hours or take a leave of absence in order to provide care.4
As I wrote in “7 powerful ways to deliver family-centered care,” when facilities address the needs of stressed family caregivers, they can improve care quality and increase their attractiveness to adult children who are likely to be the ones choosing a residence for their aging parents.
My evening at the nursing home common-room turned theater-in-the-round was encouraging. The play used memory cues to elicit stories of each performer’s youth and focused on their strengths and individuality. It was an excellent example of how innovative programming for those with memory loss can generate enthusiasm among workers and enhance a facility’s presence in the community.
The subsequent tour of the nursing home revealed L-shaped individual rooms (double rooms were available for couples) with private bathrooms and enough space to park an electric wheelchair (to be used after passing a driving test). The monthly rates remain the same for residents even when their care needs intensified, and the government pays the escalating fees for increased services. Needless to say, the turnover of residents in the facility was low.
Like most countries, Germany foresees difficulties maintaining its system given the anticipated growth in the aging population. They also have problems similar to the U.S. with staff turnover in LTC facilities.
The takeaway
I was impressed with many aspects of the German healthcare system: the focus on prevention, universal health insurance, extensive long-term care insurance, the funding for family caregivers that allows more elders to remain at home, and the stability of nursing home costs for residents.
After years of watching short-term rehab residents struggle as much with their insurance coverage as with their health problems, I think there’s a lot we can learn from the German system.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her award-winning website at MyBetterNursingHome.com or her new website at EleanorFeldmanBarbera.com.
