1. Public reporting, expert standards and indicators – different routes to improve quality in German long-term care London, 21 May 2009 Dr. Andreas Büscher Institute of Nursing Science at the University of Bielefeld

2. Overview Long-term care in Germany Principles for quality development and assurance LTC reform in 2008 Expert standards External quality control Public reporting

3. Social insurance and security in Germany Sickness Insurance Pension Insurance Five Pillars of Social Security Accidental Insurance Unemployment Insurance Long-term care Insurance Social Assistance Obligatory Insurance Scheme Principle: 50% employer/ Employee Appr. 20% of employee‘s salary Universal insurance coverage

4. Key data on long term care system

5. Joint agreement on quality principles Negotiated and agreed by stakeholders (self-regulation) Basis for external quality control by Medical Boards Guidelines and recommendations for internal quality development Structure, process and outcome criteria Results of quality tests by Medical Boards reveal problems in direct care (pressure sore prevention, food and fluid intake, incontinence care and gerontopsychiatric care)

6. LTC reform in 2008 Concerns about quality Three different measures on quality of services: –National expert standards –Expansion of external quality control –Introduction of public reporting system Implementation of an arbitration board

7. LTC reform in 2008 Procedure developed by German Network for quality development in Nursing Existing National Expert Standards: –Pressure sore prevention –Discharge management –Pain management –Fall prevention –Promotion of urinary continence –Care for people with chronic wounds –Nutrition management for ensuring and promoting oral nutrition in nursing

8. LTC reform in 2008 External quality control on a yearly basis and without announcement Refinement of control guideline Development of public reporting system based on control guideline covering the areas of: –Nursing and medical care, care of residents with dementia, social and everyday life support and housing, food and domestic aspects in nursing homes –Nursing care, activities prescribed by a physician, quality of the organisation an grade of service

10. First results of public reporting (May 2010) More than 7.000 reports 4.700 reports published Appr. 1.000 reports under review Appr. 1.000 reports awaiting additions from providers Appr. 280 reports with blocked publication, awaiting court decision

11. Conclusions Development of indicators has been commissioned for institutional long-term care Development of indicators also needed with regard to home care Attention needs to be given to recipients of cash payments and quality of care in the lifeworld setting Improvements and refinement of public reporting system to be expected LTC quality meanwhile involves different stakeholders and the public debate is ongoing

12. Institute of Nursing Science At the University of Bielefeld Post Box 10 01 31 D - 33501 Bielefeld Tel. +49 521 106 - 6880 Fax +49 521 106 - 6437 andreas.buescher@uni-bielefeld.dehttp://www.uni-bielefeld.de/IPW