[Financing Regional Dementia Networks in Germany: Determinants of Sustainable Healthcare Networks]

OBJECTIVES

Analysis of practice-based financing concepts in German dementia networks (DN); Provision of sustainable financing structures and their determinants in DN.

MATERIALS AND METHODS

Qualitative expert interviews with leaders of 13 DN were conducted. A semi-structured interview guide was used to analyse four main topics: Finance-related organization, cost, sources of funding and financial sustainability.

RESULTS

DN were primarily financed by membership fees, earnings of services provided, public funds and payments by municipalities or health care providers. 63% of the DN reported a financial sustainability. Funds to support the interpersonal expanding, a mix of internal and external financing sources and investments of the municipality were determinants of a sustainable financing. Overall, DN in rural areas seemed to be disadvantaged due to a lack of potential linkable service providers.

CONCLUSION

DN in urban regions are more likely able to gather sustainable funding resources. A minimum funding of 50.000 €/year for human resources coordinating the DN, seems to be a threshold for a sustainable DN.

Influence of living situation on vulnerable elderly: focus on nutritional status

OBJECTIVES

We compared the nutritional status of elderly people living in two different settings (shared-housing arrangements and home-living arrangements).

DESIGN

For this secondary analysis, a cross-sectional study was performed.

SETTING

For the home-living setting, home-dwelling elderly people from Hamburg, Germany who were participants in a prior study were included. For the shared-housing arrangements (SHA) setting, we used baseline data from the WGQual Study.

PARTICIPANTS

The sample from the home-living setting comprised patients who were discharged from a geriatric rehabilitation clinic within the six months prior to data collection. The sample from the shared-housing arrangements comprised all residents that lived in SHAs.

MEASUREMENTS

Nutritional status was examined by administering the Mini Nutritional Assessment (MNA). Cognitive status was measured by the Mini Mental State Examination (MMSE).

RESULTS

Overall, 142 individuals participated in this study. Statistical analysis showed differences in both overall MNA scores and MNA assessment scores. Significantly more participants from the SHA setting were at risk of malnutrition compared to the home-living setting.

CONCLUSION

Screening and assessment of nutritional status and prevention interventions should be considered in SHA settings.

[Shared-housing arrangements for care-dependent people in Germany. A literature overview of structures, outcomes and quality management]

A main factor for the development of shared-housing arrangements (SHA) was the wish of more self-determination in old age. Since January 2013 SHA is government-funded through the "Pflege-Neuausrichtungs-Gesetz" (PNG). Yet, an overview of the situation of SHA in Germany is not available. Therefore, a systematic literature search (databases CareLit, CINAHL, GeroLit, PubMed) was conducted in order to identify publications regarding resident- and care-specific characteristics, resident-related health outcomes and setting-specific quality management systems. The currently available knowledge in these fields is not exhaustive and further research is needed. The results indicate that care in SHA is not more efficient regarding residents' quality of life than in institutional care settings. Valid studies regarding the quality of care provision in SHA and conceptual basics concerning quality assessment are widely lacking. Thus, the goal of expanding SHA within the framework of the PNG has to be accompanied by in-depth health services research.

[Housing Project 'Living Independently with Intensive Support (WmI)': The Scientific Evaluation]

BACKGROUND

In Germany, people with multiple severe disabilities caused by brain injuries, are predominantly cared for in permanent residential living facilities. In 2009 the Fürst Donnersmarck Foundation (FDSt) launched a new housing project - supported living accommodations (SLA) - for this group of people. Residents from a permanent residential living facility (Fürst Donnersmarck House, FDH) are offered the opportunity to move into 2 newly built SLA with a 24/7 individual support of a social pedagogic staffs as well as nursing care. The aim of the study is to compare the changes of residents' social and health related outcomes in the SLA group as compared to the group remaining in stationary care.

METHODS

In a prospective longitudinal study (2009-2011) residents of the FDH are surveyed using standardized self- and proxy-rating instruments. Times of measurement are shortly before moving into the SLA (baseline, t1) and at follow-up after 6, 12 and 18 months after relocation (t2-t4). Additionally to residents' socio-demographic data, health outcomes including ADL functioning (EBI), quality of life (WHOQoL-Bref, EQ-5D), need of assistance (HMB-W), social inclusion/perceived disability (WHODAS II), anxiety and depression (HADS) and social contacts were evaluated.

RESULTS

40 residents could be included into the study, 29 of them moved into 2 SLA. The underlying neurological causes of the handicap were mainly sequelae of acuired damage of the central nervous system during adult age. Residents are on average 46.2 years old and predominantly male (65%). During the study the perceived dis-ability (WHODAS II) increased statistically significant but we could not show differences between groups (p > 0.05). Changes in functional and cognitive everyday abilities, fear, depression and quality of life (WHOQoL-Bref, EQ-5D) could not be shown (p > 0.05). The perceived sense of -mastery (Pearlin Mastery Scale) increased statistically significant and showed more positive developments by tendency in SLA. Everyday activities in SLA increased to a large extent.

CONCLUSION

Some positive but no overall effects of moving into SLA can be shown. It is remarkable that the serious changes of living conditions do not lead to less QoL or more anxiety in this vulnerable group of people but resulted in increasing external contacts and greater mobility. Social pedagogic support offers the residents the chance to bear a more self-determined life and to participate actively in new social networks.