Sozialforschungsstelle Dortmund Zentrale wissenschaftliche Einrichtung Workshop May 20th 2015, University of Toronto Dr. Monika Goldmann, Dortmund Skills in Residential Long-Term Care Some recent Developments and Debates in Germany

Agenda 1.Trends influencing the German system of long-term care and the development of competencies and skills 2.Occupational situation in German residential care and recent debelopments 3.Division of labour between the different groups of workers in nursing homes  (New) demands on workers in residential care 5.Some prospects

Trends influencing qualification and skills of care workers  Rapidly aging society with growing number of old age people  State policy: “Home care before institutional care” Reasons: cost reduction – preference of many old people  Rise of the average age of residents to 82 years; significantly shortened length of residence: 1994: 50 months : 31 months, 20% less than 6 months  Growing number of residents with a migrant background  Growing demands on service and quality of care by residents and their relatives  Growing demands on quality management by the funding insurances and the medical service  Permanent changes in health and care policies 3

Qualification of elder care workers  Qualified elder care workers Three years of training: 2100 hr in specialised schools, 2500 hr practical training in care facilities (comparable to licensed practical nurse)  Assistant elder care workers /care assistants one year of training in vocational school including on-site training  Care aides 6 weeks of training  Dementia carers 160 hours theoretical training, two weeks of practical training 4 Nurses in medical care have a completely different qualification scheme. They can work as elderly care workers in nursing homes. Elderly care workers cannot work in hospitals.

Example for skill requirement Incident: 84 year ols Mrs. Schmidt has hardly been eating and drinking during the last days:  Identify the situation: What is lading her behavior?  Reflection/self reflection Special expertise: e.g. on dementia  Causes/special symptoms/stages  Environment Institutional setting Medication biography  Legal principles supervision? fundamental rights involved? care contract rules of the employer  Ethical dilemmas  Possible methods to solve the problem  ………… 5

Division of Labour Strictly regulated fulfillment of tasks and divided responsibilities versus Overlapping tasks and clear responsibilities Both trends can be found in practice But promising practice organisations seem to have  Clear responsibilities but a very low level of division of labour in the care teams  Care managers who take part in the chores of every day life  Assistive personnel which is integrated in the team and fulfill certain qualified tasks under supervision  Apprentices, who are integrated into the teams and participate in the work under supervision 6

(New) Demands on workers in residential care  Integrate new/modified care concepts (De-institutionalisation of care homes) Create more home-like situations/normality in the institutional setting (e.g. common shared units),  Organise partnership with the local community Neighbourhood contacts.(kindergarten, schools, associations)  Involve relatives and friends of the residents in care and activities of the residents  Organise and deal with a growing no. of volunteers taking an active part in care for the residents  Train and supervise apprentices in their practical part of the three year training  Deal with hospice organisations who support the end-of-life care 7

Prospects  Increase in the number of academics in LTC  Integration of the qualification system for elderly care workers and nurses working for medical institutions is controversially debated and not decided.  Increasing necessity to provide further training/ specialized knowledge for care workers after their three-year training  Tendency to upgrade the certification and educational requirements for assistive personnel. 8 Despite financial restraints and contradicting developments in regulations the development and utilization of competencies and skills is strongly dependent on the orientation given by the management of the work-place and the participation of the workers in decision making

Sozialforschungsstelle Dortmund Zentrale wissenschaftliche Einrichtung Thank you Contact: Dr. Monika Goldmann