The majority of people with long-term care needs remain at home; family members mostly care for their relatives. With rising demands and dependency, professional services are included more often in a lot of home care arrangements
. Most often this is home care or counseling. Utilizing a nursing service not only relieves the family caregiver but might also alleviate the feelings of guilt perceived by the care recipient
. Utilization of professional services may also increase to create a stable care atmosphere and avoid moving to institutionalized care – thus reducing stress upon the care recipient.
Day care and self-help groups gain less attention among the care dependents and his or her family. There are high rejection rates among all services ranging from one in six for counseling to two in three for day care.
The rejection of guidance and training was approximately twice as high as the utilization implying that the families doubt the helpfulness of such services or other barriers exist. These barriers may include access, finances, or lack of a recommendation by a professional/specialist. The same trend was identified for self-help groups. In this case the rejection was nearly twelve times greater than utilization. Perhaps the reason for this is that time and resources to organize supplemental care are limited. Only when individuals anticipate that the service will be of some benefit they will put effort towards overcoming the barriers
We see high rejection rates for day care, even higher among women than men. The reasoning behind this trend could be traced back to the personal history of men. While men are accustomed to being away from the home for their typical work, older women more often worked at home and have shown to use less services offered by institutions which take place away from their known surrounding.
Besides the high rejection rate for some of the services, the potential future use shows the opportunity for families to increase professional support in the future. Potential future care may provide a feeling of security for the families. When the situation gets more complex they have opportunities to include more professional services into the home care arrangements. The issue that arises is that the care dependent and/or their families may wait too long to involve services with the situation bearing the risk that it can only be stabilized in an institutional setting.
Potential use for four out of the seven services was higher than utilization.
The highest potential future use is seen in short-term care. Almost every third respondent answered that he has not used this service so far but that he might do so in the future.
Although all individuals require more than three hours of daily support, their use of services varies from absolutely no utilization to low or heavy utilization; with women significantly using more services than men. One reason might be that most of the husbands have died and children usually have other duties such as work or care for their own children.
Discussion of the regression analysis
As the Andersen Model suggests, some need characteristics in our study were found to have a significant effect on utilization. Only four out of eleven need characteristics we integrated in our model significantly increase the chance for professional healthcare service utilization.
The strong dependency of people with high-level care needs dominate the regression model. When the care dependent doubts the availability of the family caregiver for future assistance, it decreases the chance of utilizing professional support services in the ambulant setting. A reason for this might be, that if the health of the primary caregiver is getting worse the home care arrangement as a whole is questioned. There might be a higher probability of relying on institutional care because professional support at home cannot replace the support of a family caregiver.
Because of their dependency, the absence of a caregiver, or fear thereof, causes anxiety in people with long-term care needs
. There are probably various reasons for utilizing professional services when there is emotional distress. One wish might be to protect the family caregiver from further exhaustion due to support provided by professional services.
Age is a predisposing factor according to the Andersen Model, but in the context of long-term care it can also be rated as a further need characteristic as it normally increases the difficulties in daily living. Difficulties are due to debility of sight or a hardness of hearing which increases dependency in daily living. As one gets older these limitations due to rising age occur and in addition the likelihood of suffering from one or more chronic conditions increases. Resultantly, the probability that the individual will utilize more services increases which is evident in this study.
In contrast to age, gender does not show a significant correlation but it was shown that women use more services than men. The care modalities and health-related factors were more sensible predictors of utilization
Seven out of eleven need characteristics did not show such a significant impact. This does not fully support the Andersen Model but underlines research attempting to work with this model in the context of long-term care. Needs are not constant and one need can be very demanding one day and totally subordinated the next day. The situation of families in long-term care arrangements is not stable but due to the context of multi-morbidity and high dependency it varies a great deal and bears major challenges. We confirmed that age increases utilization
; additionally, the strains of long waiting times for help and support and the health condition of the primary caregiver has to be taken into account for rising utilization
. When the Andersen Model is adapted to home care arrangements in long-term care it is necessary to not only look at the care dependent but take into account the family perspective with special attention to the primary care giver.
This study reveals that despite the involvement of a professional service in four out of five home care arrangements, many services have high rejection rates.
Further research is needed to understand the barriers leading to the high rejection rate. Strains in home care arrangements will be reduced only if services are developed according to the needs of the care dependents and their families, especially emotional strains. Emotional support can also be provided from professionals
. As we know, family members balance the profit they might receive in daily life before they allow professionals to enter their home
. For some services we see high potential future rates of service utilization. The potential future use might even be higher when the care recipient or the family member is in a situation where they must begin to use a certain service that they did not utilize before due to progress of the illness or changes in the caring arrangement itself and reacts with informing and, after that, using a special service that he or she might not have known before. For those services the low-level first access has to be organized because intensifying the utilization of a known service is easier than integrating a new one. If professional support can be easily expanded, it can help to stabilize situations and institutional care is less often the only and last opportunity for caring for people with high-level long-term care needs. However, the professional services have to react upon the specific needs of the care dependent and their families. Such need-analyses have to be taken into account when developing, caring, and supporting concepts as well as shaping the design of services. By utilizing home care services, seniors are not only able to improve their functional abilities but also the use of their own resources, resultantly promoting independency
As this is the first study in this specific context, there is only limited data the findings can be compared to. The BARMER GEK is only one, yet the biggest health insurance provider. Data obtained from BARMER GEK is in comparison to other public health insurance data the most representative of the German population
The combination of multi-professional research teams with qualitative and quantitative research experience, epidemiologic knowledge, and a phenomenological perspective is necessary to understand the barriers and needs of long-term care patients and their families
. Furthermore, professionals must collect additional information regarding specific needs and promote early inclusion of professional services. Early use of professional services not only assists in avoiding institutional care but releases family caregivers from strains and overwhelming responsibilities, as well as relieving care dependents from feelings of guilt. This is not only an implication for Germany. To deal with the demographic developments of industrialized countries, and the rising number of long-term care patients, an allocation of more resources towards professional care may be necessary. The results are useful for long-term care planning purposes in politics and for the future design of supporting services.