Time and again, such headlines appear: "Carers killing residents" or "scandal in the nursing home - residents tormented and underserved". Every time there is an outcry of the population, every time politicians and experts make statements. But what leads to violence against people in need of care? Murder and manslaughter are not commonplace in old people's homes and nursing homes; aggression against carers is also at home. When and where does the violence in the care begin?
Habituation to changed life situation
Around 2 million people are currently in need of care in the Federal Republic of Germany. Those in need of care are faced with a completely new life situation. He has to give up his independence, depending on the degree of his need for care, and relies on the help of others in coping with everyday life. Frustration and anger to aggression are not uncommon, at least in the initial phase.
With these emotions of the patient, the staff must be able to handle as well as with the physical limitations that make up the need for care. In addition, the relatives: They often feel guilty because they can no longer care for their family member at home or want. These three groups meet when a person becomes dependent on care. All are embedded in the care insurance system, which primarily focuses on economic aspects of care.
What is violence?
Outright aggression against those in need of care, including murder, robbery and fraud, are rare despite all sensational reports. Nevertheless, there is this violence and it announces itself sometimes early: According to a study by the Witten psychiatric professor Dr. med. Karl Beine chief physician of the St. Marien - Hospitals in Hamm and chair holder for psychiatry at the University of Witten / Herdecke there is a nursing a "cynical solidification" compared to the profession, which is relatively far before the actual act in a muddled language and self-isolation within makes the working group noticeable.
One way to anticipate and prevent violence in care is to walk in a working atmosphere, where the clinical staff can also talk openly about his aggressive fantasies. However, such a culture of open pronunciation is barely discernible in health and care facilities.
However, violence in care is usually much more subtle and is often not understood as aggression. Violation of the sense of shame, lack of nutrition, hygienic neglect, verbal attacks and physical attacks in all shading are on the list of charges.
The unauthorized fixation, demonstrably even more frequent at night than during the day when the people in need of care are tied up, is a de facto deprivation of liberty under the Criminal Code. Even if patients are illegally used or given a ban on speech and attention is withdrawn, aggression is involved.
In many cases, these derailments are unaware. The burden of daily task management leaves employees in many care-oriented care facilities not enough time to respond individually and intensively to the protégés. Old, sick people need help and personal attention. In many cases the relatives are unwilling or unable to be this contact person. Therefore, there should be much more time and staff for the individual care of the patients in the nursing homes.
But the charge of (albeit subtle) violence against the old has a facet that is often overlooked in public discussion. The homes and nurses have a commitment to care, which they usually enjoy. But what should they do if, for example, an old and a demented person refuses food with their hands and feet? What if the patient can not wash himself in the stool and urine and can not be washed? How do you deal with patients who mob and attack their roommates or nurses?
High dark figure
The exact extent of acts of violence in nursing homes is unknown. However, the number of unreported cases is estimated to be very high by the Kuratorium Deutsche Altershilfe (KDA), the German Association for the Care of the Elderly (DBVA) and the Sozialverband Reichsbund (RB), which joined forces in 1998 in a joint initiative against violence in nursing homes. Exact numbers or investigations are not available. For fear of reprisals, the affected victims, their relatives and employees often remain silent.
At the end of 2001, the UN Committee on Economic, Social and Cultural Rights, based in Strasbourg, criticized the German nursing homes. From Strasbourg it was said that up to 85% of German residents were malnourished, one in three suffers from dehydration, because too little liquid is administered.
The medical service, as a home inspection of health insurers on the move, sees the existing quality deficits not as isolated cases, but as a structural problem. The Medical Service itself is in the criticism of the home director: He is responsible for the classification within the long-term care insurance and thus directly for the funds that are available to the homes for care.
Exhaustion, overwork, lack of qualification
Exhaustion, overwork and inadequate training of nursing staff are the first causes of maladministration in geriatric care. The number of demented and mentally ill residents is increasing steadily and will continue to increase over the next few years.
The fluctuation of the staff is very high: only a few stay longer than 5 years at work, because they are not up to the physical and mental demands. The 50% share of skilled workers specified in the Home Personnel Ordinance is seen by experts as only a lower limit. According to their assessment, a quota of at least 60% would be necessary to significantly relax the situation in German homes.
Above all, however, a qualification of the home staff in the field of "psychiatry" is missing. The German professional association for geriatric care has itself already made the demand for further qualification in psychiatric gerontology. A new "round table" set up by the Federal Ministers Renate Schmidt (family and seniors) and Ulla Schmidt (health) in 2003 to improve the level of nursing care should deal with quality aspects of care in old age by 2005, even though the law for quality assurance in the care since 2002 has come into force.
The establishment of the round table encounters incomprehension for many participants, since in their opinion the specifications are already adequately described with the new law. Far more important is a fundamental reorientation in the goals and intentions of elderly care that puts quality of life and respect for individuality in old age at the top of the list.