The Medical Ministry of Health Insurance Companies (MDK) is an authority responsible for regulating the quality of care facilities. The agency works closely with federal regulatory bodies on the approval and monitoring of nursing homes, and provides them with information derived from their findings. As part of a training initiative, Linda Bänisch, who works in public administration for the federal state of Brandenburg, was tasked with creating a decision-making aid for the selection of a nursing home. More specifically, she was to develop a catalog of criteria for realistically evaluating a nursing home. This could also be used in the future by volunteers at the regional seniors’ advisory council as an analytical instrument. Prof. Dr. Bärbel Held, director of the Steinbeis Transfer Institute of Economics, assisted the project with her scientific expertise.
Since 2009, the MDK has been rating nursing homes on a 1 to 5 scale (similar to the German school grading system). The ratings serve to inform customers, maintain transparency, and simplify the process of selecting a nursing home. At the same time, they should act as a catalyst of improvement in quality at these facilities. The ratings are awarded according to the following criteria: care and medical support, dealing with residents with dementia, social support and nature of daily activities, living quarters, meals, housekeeping and hygiene. They are also based on a resident survey.
But what seems promising in terms of consumer protection and transparency on first glance elicits cause for concern. The MDK care rating system continues to bear the brunt of criticism from facilities, which claim that the evaluation process is a major inconvenience with minimal benefit to residents.
The federal average lies at 1.2 for stationary facilities. The state of Brandenburg received a 1.1. Residents tend to give their own care facilities the best ratings. Overall, the evaluations of the various facilities are very good and hardly differ from one another. As such, they offer little aid to future residents and their families during the selection process.
Few disagree with the fact that the rating system needs an overhaul. The problem is that the ratings do not differ enough among the various care facilities and, therefore, provide little helpful information to potential residents and their families. This is also underscored by a total of 10,323 records taken by the Verband der Ersatzkassen e. V. (association of health insurance funds) information platform. Precisely for this reason, Bärbel Held and Linda Bänisch set out to develop an additional aid for care home selection and to implement it in practice.
The new decision aid works like a cost-benefit analysis. The scoring model makes it possible to set priorities for stakeholders taking part in the assessment. The company tries to gain an understanding of the stakeholders’ underlying interests within an overall socio-ecological context and reconcile the needs of the various target groups. The new criteria catalog pays close attention to the interests of the care home residents and the care attendants.
The main goal of the catalog is to paint a realistic picture of the quality of a care facility. For this purpose, certain target criteria (major targets) were assigned. The target criteria of the residents and the care attendants were gathered in a brainstorming session and entered in corresponding templates. During this process, Linda Bänisch made sure that the target criteria meet standards for optimal care and assistance in care facilities and take the interests of the residents and employees into consideration.
Each target criteria was supplemented with questions in order to simplify the subsequent evaluation for residents and employees. The questions for the “care” criteria, for example, were as follows: Do you receive adequate care from a care attendant? Does he/she have enough time for your physical care? Are your care activities discussed and scheduled with you? Is a care attendant available for you when you need one?
The residents and employees of various facilities were surveyed and the results fed into the scoring model. The result was a highly differentiated depiction of care home quality with not one of the homes analyzed receiving a “very good”.
The new evaluation method includes a criteria catalog that enables a more realistic evaluation of a care home. As such, it offers another decision aid for the selection of care homes in Brandenburg, in addition to the MDK transparency report. The criteria catalog shows the quality of care homes from the user perspective and shows a comprehensible, realistic picture.
Linda Bänisch transferred the scoring model data into Excel for use by the seniors’ council during trainings. Now, after a 12-week accustomization period, and with the support of social workers and supervision from the LASV (the Brandenburg office of social work and elderly care), the volunteers of the seniors’ council can interview residents and employees with prepared survey forms and enter the results into the cost-benefit analysis.
Prof. Dr. Bärbel Held
Steinbeis Transfer Institute Institute of Economics (Berlin/Dresden)
Linda Bänisch