Care services for the elderly in Germany. Infrastructure, access and utilisation from the perspective of different user groups

The discussion paper analyses the development of the home-based, semi-residential and residential care infrastructure since the introduction of the long-term care insurance. The presentation is supplemented with a review of local area low-threshold offers. The accessibility and claims on available service offerings are discussed from the perspective of different groups of elderly people. The results are based on the analysis of statistics and reports as well as interviews with experts. The research confirms the expansion of home-based care services since the introduction of the longterm-care insurance as well as the modernisation and increasing diversification of residential care facilities that had already begun in the 1980s. The increasing number of nursing-home admissions points to problems in the care of the elderly in their homes. The expansion and conceptual approach regarding the semi-residential offers has been revealed as one deficit. In addition, there are not enough offers and a marked regional disparity in the low-threshold service area that could supplement care arrangements in the area of socialand leisure activities and also unburden family members. As solutions are discussed the establishment of transitional care services after discharge from hospital, the promotion and financing of care offers in the area of social and leisure activities and the implementation of specific offers for elderly people with dementia respectively for their family carers. The claims which are made for specific care insurance benefits show the clear influence of gender, social status, ethnicity and living conditions. This applies not only to the choice of the actual offers and the role of informal care within the family framework but also to the possibility of complementing care needs that are not covered by care insurance benefits with private means. Furthermore, there are regional influences that are also predominant in the care situation of the elderly.