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Experience in applying legal conditions according to the nursing insurance regulation--ambulatory rehabilitation, nursing aids and nursing care eligibility



Experience in applying legal conditions according to the nursing insurance regulation--ambulatory rehabilitation, nursing aids and nursing care eligibility



Gesundheitswesen ) 59(3): 168-173



The Statutory Health Care (Nursing) Insurance in Germany, called "Pflegeversicherung (PVG)", financially supports nursing care at home and in nursing homes. If suggested by an authorized examining person (MDK), it provides access to ambulatory rehabilitation and to various aids to facilitate nursing care of patients cared for at home. Also, the PVG mandatory requires the visit by a nurse every three to six months (nursing care checkup) if the patient is cared for by family members without support of professional nursing services. Little is known about the realisation of the suggestions given by the examining person from MDK and about the realisation of the nursing care checkup in actual practice. Our study tried to find answers to these questions. For this purpose, we visited 150 patients at home and asked them about rehabilitation efforts, whether the recommended additional aids had been supplied, and whether nursing care checkups had been successfully performed. For 41 patients, rehabilitatory exercises were suggested, but only 7 were actually realised. 89 patients were supposed to receive various aids, but only 31 were actually delivered. Whenever rehabilitation was performed, it was nearly without exception thanks to the initiative of relatives supported by their private doctor. Nursing care checkups should have been performed in 80 patients, but had been realised in only 11 cases. The care providing relatives considered such "care checkups" to be ineffective, costly and useless. The nonfinancial services granted by the PVG were not translated into reality in most instances, and if so, it was due to efforts of relatives and private doctors, not to efforts of the statutory bodies. Apparently this task was more than these bodies could handle during this early phase of services by the PVG. Therefore, the private doctors (family doctors) should be informed of the results of the examination done by MDK. The need for the nursing care checkup should be reconsidered.

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Accession: 046036065

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PMID: 9206545


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