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Doctors newspaper online, 08.07.2019
Problem Case Demographic Change
How can older people be well looked after in the future? For example, a symposium called for a dense network of geriatric rehabilitation centers.
By Petra Zieler
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SCHÖNEBECK. Every 30 kilometers an ambulatory geriatric rehabilitation center. At least that requires nationwide acting geriatric experts. By 2050, the number of people in need of care is expected to rise to five million. Nursing costs: around 50 billion euros.
"I wonder how calmly the policy is facing demographic change," Dr. Burkhard John, family physician, Geriater and board of the KV Saxony-Anhalt (KVSA). "We now have to set the course to master the challenges ahead," he said during a conference organized by the Center for Social Innovation in Saxony-Anhalt.
Experts from Bavaria, Baden-Württemberg, Mecklenburg-Vorpommern and Saxony-Anhalt were invited. Under the motto "Better at home than at home" they discussed opportunities to avoid need of care.
"We are the land of long life," Health Minister Petra Grimm-Benne said a bit whimsically. "With the demographic development (Germany's highest average age), Saxony-Anhalt is a pioneer for other federal states." Innovative solutions are in demand. Example of integrated forms of care on which many older people are dependent.
But to achieve this, sectoral boundaries would have to be overcome. This would consider Grimm-Benne in the planned state hospital law. "In Saxony-Anhalt, we raised sister Agnes from nationwide baptism. We should also set an example for the good on-site care of older people. "
Train
Everyday Skills
In Schönebeck, at the same time the residence of the Minister, there are already many good examples. John, together with colleagues and supported by the Provincial AOK, established an ambulatory geriatric rehabilitation complex more than 20 years ago. Doctors, therapists, and nurses work hand in hand to train and promote everyday skills. The goal is to stabilize the often multimorbid patients so that they can continue to live in their own home.
In 2002, the urban housing company Schönebeck began to create alternative forms of housing for older tenants. Currently, more than 50 percent of tenants are pensioners and more and more are interested in the now 13 self-organized housing groups, in which there are generous community areas in addition to their own living areas. A nursing service can be requested as needed.
More outpatient rehabilitation
The largest and probably the oldest ambulatory geriatric rehabilitation center with 40 places and about 450 patients per year is called Casana and is located in Mannheim, Baden-Wuerttemberg. Doctor and manager Oliver Haarmann's vision is that outpatient rehabilitation by 2050 will be the standard and will significantly reduce nursing-related time. Ninety-five percent of its patients are already assigned by primary care physicians (mostly by clinics elsewhere).
"Only contract doctors," he says, "are able to signal rehab early and thus prevent hospital admissions." Casana 2007 by the way as nationwide e rste institution of a contract under SGB V complete with all statutory health insurance .
But why is it that such good examples are so prevalent across the board, especially since the effectiveness of geriatric complex treatments has already been proven in studies? In Schönebeck, the experts from KBV, the Federal Association of geriatric specialist practices (BUGES) and the Federal Geriatric Association agreed that "rehabilitation before care" and "outpatient inpatient care" require a closer cooperation of all actors.
Existing structures must be strengthened, new ones created. Their demand they summarized in the Schönebecker theses for intensified geriatric care together. The aim is a networked and graded geriatric care structure for outpatients – semi-stationary – inpatient – nationwide.
It is true that older and elderly patients are cared for in high quality and (still) comprehensively by primary care physicians. But the complex treatment of geriatric patients with clearly limited everyday skills must follow a holistic, integrative approach – from prevention to rehabilitation. However, there is an urgent need for a change in the Social Code.
The claim to near-resident, intensified geriatric care in the therapeutic team should be anchored there just as in the catalog of benefits of the statutory health insurance.
The experts estimate that around 1500 geriatric specialist practices nationwide (costing around 750 million euros) are needed to stop or reverse the current shortage or misuse.
I wonder how calmly the politicians are facing demographic change.
Dr. Burkhard John Chairman of the Board of the KV Saxony-Anhalt
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