The grass is always greener elsewhere. With the eternal neighbor and European rival, France has a habit of comparing. More square, more efficient, more hard-working, the citizens of Goethe's country would be all of these things at the same time, which gives Germany a reputation as a good student from whom it would be good to learn lessons. Especially since with a lower birth rate and therefore an aging population, it is facing the full force of the challenge of old age. So, how do we react to this one across the Rhine? Who is considered dependent there, and what is the status of the offer to these people?
The status of dependent person includes in Germany, unlike France where we speak of dependent elderly people, people of all ages. It also includes people with disabilities. Dependent people are grouped into five groups, the Pflegegrad 1 to 5, depending on their degree of dependence. This is based on the loss of autonomy and impairment of faculties, without specifying the causes, in order to guarantee equal access to care for all dependent people, regardless of the origin of their loss. autonomy (cognitive, physical, psychological, etc.). From this classification determined by medical expertise depends the level of benefits.
Age nevertheless remains a determining factor, especially since the prevalence of elderly people in medico-social establishments makes them unwelcoming to younger dependent people. Thus, if between the ages of 75 and 79, only one person in ten needs help, and one in five between the ages of 80 and 85, it concerns two thirds of individuals over 90, half of whom are welcomed in establishment. In 2015, the dependent population represented 2.9 million people, i.e. 4% of the population, of which a third were cared for in establishments - a share that is growing with the aging of the population:dependent people over 80 years should represent 12% of the population in 2060.
This major challenge of aging, given the costs of care, was also viewed with pessimism in 2018:that year, the investigative magazine Der Spiegel dedicated its front page to the "catastrophic" care of the elderly, at home and in retirement homes, Germany letting them completely down, according to him.
The German system relies heavily on family ties. Thus, priority is given to home care and assistance by relatives who benefit from a status in their own right, that of "near caregiver". Nearly half of dependent people are thus cared for only by relatives. Cash benefits from long-term care insurance funds remain paid only to people in a situation of dependency, caregivers being able, however, to claim compensation in the event of a loss of salary resulting from their investment with the person being cared for. .e. This investment is not taken lightly and many caregivers themselves deplore physical and psychological suffering, loss of part of their private life, reduction in their professional activity... although this dedication is above all chosen by attachment to the person, and much more rarely undergone by economic pressure.
When caregivers are no longer enough, service providers take care, at least in part, of home care for dependent people. These include both support services, particularly for daily tasks such as shopping, cleaning or cooking, and home care, in this case administered by health professionals who have entered into agreements with the insurance funds.
This system allows a large proportion of German seniors to stay at home and thus preserve a measure of independence. This is based on the wealth of Germany. Many, for example, opt for carers residing 24 hours a day in the patient's home. This labor generally coming from Eastern Europe is then entirely the responsibility of the patient and his relatives. Only a little over a quarter of people in a situation of dependency stay in a medico-social establishment.
When home care is no longer possible, the level of dependence being too high and representing too great an investment in time and money, or too great a danger for the patient, it is then necessary to resolve to consider staying in a medical structure. social, unfortunately too often carried out reluctantly and painfully perceived as the "last step". Where the Altenheim , retirement home, focus on social integration, the Pflegeheim above all offer care, which makes them the equivalent of our EHPADs. Like them, they can be private or public structures, in which the stay can be temporary or permanent. And like home service providers, they make agreements with insurance funds.
These establishments are subject to the legislation of each Land making up the German federal state. Thus, differences exist within the territory, each of the Länder having its own legislation and funding its own initiatives. This responsibility lies with the various ministries in charge of Health, and their respective approaches are subject to review by Commissions on Dependency.
One of the German specificities is the obligation to take out long-term care insurance. This is not covered by our French Social Security – the old-age risk corresponding to the coverage of retirement – although the Sécu contributes in France to the financing of medical costs. In Germany, on the other hand, long-term care insurance is attached to the Krankenkasse , health insurance funds. The majority of Germans therefore subscribe to it automatically, and private policyholders are required to add one.
These funds contribute to the financing of medico-social services on a flat-rate basis:the higher the degree of dependence, the greater the contribution. The rest of the costs, which relate to accommodation and food, are the responsibility of the resident and/or his relatives. To these are sometimes added "investment costs", when these are not covered by the local authorities, concerning for example the renovation of buildings. All these costs borne by patients amounted on average in 2020 to around 2,000 euros per month. When neither the patient nor his relatives are able to cover them, the Sozialamt (social assistance) then intervenes. By way of comparison, the long-term care insurance funds contribute up to 2005 euros monthly for people falling under Pflegegrad 5 , the highest of the five.
Entering Pflegeheim is then voluntary:except in cases of insanity and on the order of a guardianship judge, the patient cannot in principle be forced to move in. Finally, other alternatives are experimented with and encouraged, in particular moving into community and self-managed establishments, for example using only their own home help services. However, these remain in the minority, as do temporary or day/night stays in Pflegeheim .
