Care Determining the quality of care services

High-quality care promotes and preserves good health, well-being and life quality for people in need of care. The care and nursing support must meet the needs, wishes and expectations of the care recipients.

What are the quality features of a service?

Good care services for the provision of care at home are characterized by professional expertise, a sensitive and respectful attitude toward the care recipients and the appropriate involvement of all parties.

Further important quality criteria for outpatient care services include the following:

• Qualification: nursing staff have the relevant qualifications and training for their job.
• Reliability: agreed appointments for care services are observed. Any delays are reported in a timely manner.
• Communication: all communication between the care service, the care recipients and their relatives is understandable and marked by respect.
• Accessibility: the care service is easily accessible in the case of inquiries and emergencies, and directly responds to care recipients’ needs.
• Transparency: the care service provides clear and comprehensible information about services, costs and contractual conditions.
• Documentation: the care services provided are fully and accurately documented.

The guide “Outpatient care – identifying good professional care” (“Ambulante Pflege – Gute professionelle Pflege erkennen”) published by the Center for Quality in Care (Zentrum für Qualität in der Pflege – ZQP) provides practical tips on what care should be like in various situations (available in German only).

What are the basic elements of good care?

The diverse requirements of good professional care are based on expert standards for care as well as specific ethical principles such as the International Code of Ethics for Care Professionals or the Charter of Rights for People in Need of Long-Term Care and Assistance. The legal framework conditions are anchored in the German Social Code, for example. Care services also have to comply with further national and state regulations. These include the observation of certain hygiene regulations, which can be monitored by the local health authority.

The care services firstly use internal quality management processes to conduct their own checks of whether the extensive quality requirements are fulfilled. Care services are also inspected by external bodies on an annual basis. This inspection is required by law and is performed by either the Medical Review Board (Medizinischer Dienst – MD) or the inspection service for private health insurance providers (Careproof).

During the inspection, the inspectors interview employees, survey a number of care recipients selected at random and review care documentation. The quality is looked at in various areas. These include:

• the quality of the care itself: are individual wishes considered? Are risks such as potential dehydration due to a care recipient not drinking enough identified? And are the people affected and their relatives informed about these?
• the quality of the medically prescribed services: for example, is medication administered in line with prescriptions?
• the quality of the general services and organization: for example, is a cost proposal created prior to contract conclusion?

The interviews with the people who are cared for by the care service include questions such as whether they entered into a written care agreement and whether the care service can be contacted and is available to provide services when needed. The inspections are intended to have an advisory character and to help the care services improve their quality.

The results of the quality inspections can be found online on long-term care insurance providers’ websites. These reports, sometimes also referred to as transparency reports, provide independent and neutral information about care quality.

You can directly search for the quality reports for certain facilities on the following portals:
•Care Navigator (Pflegenavigator) from the Federal Association of Public Health Insurance Companies (AOK-Bundesverband)
•Care Guide (Pflegelotse) from the Association of Substitute Health Insurance Funds (Verband der Ersatzkassen – VDEK)
•CareFinder (PflegeFinder) from the Federal Association of Company Health Insurance Funds (Betriebskrankenkassen – BKK)

At present, the quality reports still assess care criteria using the “school grade system”. All care services receive an overall grade calculated based on the grades obtained for the different care criteria. With this grading system, good grades in unimportant criteria can balance out bad grades in important criteria. This leads to most care services receiving similar care grades, which largely lie in the very good and good range. As there is little focus on the grades in the individual areas, the grading system has been increasingly criticized in recent years.

The decision was therefore taken to revise the grading system for the quality of care services. The aim is for it to be easier to separately assess the grades for the individual quality criteria. The inspection results should be clearer and therefore more comprehensible.

The new grading system for the quality of care services is currently still in the revision phase. This involves the new system being scientifically tested to determine how well the quality of care services can actually be measured in practice.

People are not always able to choose between different care services, especially in the case of last-minute inquiries or in certain rural areas. In addition to the lack of skilled workers in the care sector, this is partly down to increased demand: the number of people in need of care in Germany has been continually rising for years. Many of them want to be cared for in their own home with the support of a care service.

If it is possible to choose between different care services, people should start by considering what specific support services are needed and to what extent. Based on this, various selection criteria can then help them find a suitable care service.

In addition to the quality assessment of a care service, the personal contact with the carer, the proximity to the care recipient’s home and the range of services offered by the care service are also important. Care recipients’ wishes and needs should always be considered when care is provided. People in need of care and their relatives can also obtain an initial impression in an introductory meeting with the relevant care service.

Further information about choosing a suitable provider can be found in our article “Non-cash care benefits: care service support”.

The website of the Consumer Advice Centers provides a detailed checklist for use when selecting a suitable care service.

As in all areas of life, conflicts can arise in relation to care. A good care service therefore has clear rules on how to deal with errors or complaints. This should make possible to quickly and constructively resolve any problems that arise. Sometimes, these can be no more than a misunderstanding that can be quickly cleared up through a conversation. You should therefore discuss the problem with the employee involved in a factual manner as soon as possible. If the care service does not respond to your criticism appropriately, you can contact an official authority.

Further information can also be found in our article “Deficiencies in long-term care – who can I turn to for help?”

Information about dealing with billing issues involving care services can be found on the Consumer Advice Center (Verbraucherzentrale) website.

There are several advisory services able to assist with questions relating to the quality of care. One important point of contact is the local care support point. This offers individual consultations and assists with questions about care services and quality aspects.

You can search for care support points near you in the database provided by the Center for Quality in Care (ZQP).

The Medical Review Board can also assist with questions on the quality of care services.

Some Consumer Advice Centers also offer legal advice and information about care. They can provide support with contractual issues and complaints.