21. April 2023

Regaining active powers and independence despite health restrictions is something many elderly people dream of. This month the Brandenburg Medical School Theodor Fontane (MHB) started a four-year period of monitoring a project called “SGB Reha” at twelve residential institutions of geriatric care. The project is designed to include rehabilitative measures in therapeutic care with the aim of improved care and thus better quality of life for the elderly.

The approach has so far been implemented with success at two geriatric care facilities of the Protestant church in Mülheim an der Ruhr, and the AOK Rheinland/Hamburg has taken the lead in expanding the concept. April 2023 saw the start of the project abbreviated as “SGB Reha” and funded from the innovation fund of a national panel of health experts and insurers (for more information see Innovationsausschuss des Gemeinsamen Bundesausschusses [G-BA]). The acronym stands for cross-sector geronto-psychiatric care and rehabilitation in nursing homes. Long-term aims are to stimulate reorganization at the interface between statutory health insurers (GKV) and nursing insurance, and to establish an integrated system of therapeutic and rehabilitative care as the new standard of care.

With the AOK Rheinland/Hamburg in the leading role and scientific monitoring by the University of Potsdam and the MHB, the implementation of the new concept will further be accompanied by the German Society of Geronto-Psychiatry and Psychotherapy (DGGPP) and the geriatric care organization of the Protestant church.

Prof. Christine Holmberg heads the MHB Institute of Social Medicine and Epidemiology (ISE). She points to the consistently positive resonance at the two Mülheim facilities where the concept has been designed and successfully implemented: “Individual therapies and interventions under multi-professional supervision and coordination helped to improve the mobility and independence of residents to a degree that some of them left the care institution and returned home. This is a tremendous success, which we are going to analyze for possible transfer to other facilities.” The Brandenburg Medical School developed an effects model to that purpose and conducted a joint evaluative study with the University of Potsdam. In the deployment and evaluation stage at the participating institutions the ISE will analyze and assess the concept implementation via observation over weeks and interviews with residents, relatives and staff on site. The MHB  Institute of Biostatistics and Registry Research directed by Prof. Michael Hauptmann will statistically analyze the intended real added value for residents, their families and the caregivers and assess the health economic relevance of the intervention.

Prof. Holmberg says the aim is to identify fostering and hindering factors that affect the implementation, to record participants’ perspectives and experiences and thus to learn more about the effects of the concept on the target group.

Activating capacities in care-dependent people

Matthias Mohrmann, deputy chairman of the executive board at AOK Rheinland/Hamburg, believes in enabling seniors to live largely independently as a support-worthy aspiration: “Our current system neglects existing potentials. Nursing plans adapted to individual needs with a focus on rehabilitation and recovery of lost abilities would be a change in the right direction. In many cases, residents treated in this way are empowered to return to their own home.” Based on the experience gained in Mülheim, he is convinced that society can well afford a stronger patient orientation and improved nursing care, with benefits for care-dependent people and the economy alike: “Barriers between health insurers and nursing insurers need to be removed, and it makes sense to integrate therapeutic and rehabilitative care into the nursing care insurance scheme.”

Nursing jobs to become more attractive, treatment costs to drop

The concept serves to enhance patients’ everyday skills and quality of life and make better use of existing rehabilitative potentials which are often missed out in stressful situations of daily nursing routine. Further project aims are to scale down medication and the number of hospital stays and to reduce treatment costs in general. Expected results are an improved image of nursing homes in society and higher appreciation for care-dependent persons and their caregivers. A long-term effect would be to make nursing professions more attractive.

One key to the success of the integrated care concept combining therapeutic and rehabilitative elements is that various professionals from the fields of therapy, medicine, nursing, counselling and pharmacy work hand in hand. A multi-professional team assesses a newly admitted patient’s individual situation and creates a comprehensive anamnesis as a basis for precisely defined interventions and further measures such as reduced medication.

Oskar Dierbach looks back on many years as care service manager with the Mülheim facilities. He points to the existing wealth of therapeutic expert knowledge that should find its way into the daily routines of long-term care: “Nursing staff must become part of therapeutic planning and action, so that the idea of rehabilitation, the recovery of skills and abilities will guide all activities in settings of geriatric care.” He believes that the deficit orientation in our nursing system should be replaced by an integration of all involved professionals and agents including the care-dependent individuals themselves into a care process with emphasis on rehabilitation. As a result, so Dierbach, affected patients will find new confidence to face life, employee satisfaction will rise, and cost effectiveness will improve.