Basic care The concept of basic care refers here to a set of services offered by the caretaking insurance center. This includes all the activities related to body, body care, nourishment, mobility and prophylactic measures, therefore caretaking services in accordance with Social Code (SGB) XI. Note: the ambulatory care according to SGB V also includes services called basic care
Body care Die Hautpflege (einschließlich Gesichtspflege) ist Bestandteil der Körperpflege und zählt somit zur Grundpflege. Das Schminken wird nicht als Gesichtspflege gewertet. Zur Körperpflege zählt auch das Haarewaschen. Es ist Bestandteil des Waschens, Duschens oder Badens. Alleiniges Haarewaschen wird der Verrichtung "Waschen" zugeordnet. Ein ein- bis zweimaliges Haarewaschen pro Woche entspricht dem heutigen Hygienestandard.
Body care Washing refers to the washing of the entire body, but also to parts of the body, especiallyin the sink or in the bed, using a larger bowl. The washing process also includespreparation before and after, washing the entire body and wiping.
Showering Showering means washing the entire body in the shower; this process includes preparation before and after, washing the entire body and wiping.
Bathing Bathing means washing the entire body in a bathtub where the person can sit or lie down. This process includes preparation before and after, washing the entire body and wiping.
Dental care Dental care includes the proper preparation, such as placing the toothpaste on the toothbrush and/ or opening the recipients (toothpaste/ mouthwash) as well as the brushing and the denture cleaning and mouth hygiene, that is washing the mouth with mouthwash and the mechanical cleaning of the mouth.
Combing and shaving This includes combing or brushing the hair, depending on the haircut. Hairdressing (such as using hair-curlers) or haircutting is not included in basic care. But if the nursed person wears a wig, he/she will be assisted in combing it and putting it on. Shaving (including the mustache of a woman) includes dry or wet shaving, depending on the preference.
Emptying the urinary bladder and intestines This includes the control of urination and feces, cleaning and maintaining artificial objects (urostoma, anus praeter). Other activities included in here are handling, arranging clothes before and after using the toilet, intimate hygiene as well as washing after urination or defecation, cleaning the toilet seat or the bowl or changing/ emptying the urine bag. It includes applying and changing the incontinence products, even if they are dirty with feces. In this case another caretaker might be used for washing and getting dressed
Preparing food for swallowing This preparation means the last measure before putting the food in the mouth, for example chopping the food into small pieces, taking the bones out, dipping food in liquidin case the person as trouble chewing or swallowing and also filling up the glasses.
Eating process This means eating food in any form (solid, paste, fluid) and administrating special food by means of feeding probe, including the cleaning of the probe, using cutlery or other tools (for example dishes for disabled people, special cutlery) for taking the food to the mouth. It also includes persuading the nursed person to eat and drink if he/ she is not able to do that (for example in the case of children with cystic fibrosis, depending on the age or in the case of psychically – geriatrically affected persons).
Individual wake-up and going to bed This involves, beside mobility, the individual decision related to the periods for staying up, resting and sleeping, going to bed or waking up at appropriate times. Getting up of the bed, for example for going to the bathroom/ toilet seta is considered as caretaking included in the section „standing up” (as transfer). Going to bed means moving one’s body for lying down and ends when the person lies down (for rest or sleep). All the supporting actions for this movement are considered assistance. The frequency is depending on the individual needs of rest and sleeping.
Moving in / moving out The activities that are performed for moving during day/ at night are considered basic care measures, depending on the frequency, even if moving is not an activity in accordance with Art. 14 par. 4 SGB XI.
Getting dressed/ undressed The activity of getting dressed represents taking off the pajamas and putting on the clothes for day time. The activity of getting undressed represents taking off the regular clothes and putting on the pajamas. Getting dressed and undressed includes, beside the basic handling, the following activities: buttoning and unbuttoning clothes, opening and closing bolts, taking off and putting on shoes, choosing clothing (depending on the season, the weather), taking clothes out of the wardrobes and drawers.
Walking Walking does not mean only the body capacity to go on its own. More than that, it includes the body’s capacity to move to a certain direction ordered by reason (for example in the case of disoriented persons). The necessity for assistance in walking may start from the sitting position or end in the same position. Walking may also mean going in wheelchair, for the persons who use wheelchairs.
Standing (Transfer) The transfer is included in the need for assistance. It might involve moving in a wheelchair / armchair onto the toilet seat or transfer from the bathtub to the shower chair.
Climbing stairs Climbing stairs up or down related to housekeeping is included in housekeeping assistance. Climbing up the stairs is walking on the stairs of a house/ apartment. No other in basic care is so dependant on the nursed person’s home as climbing stairs.
Going in and out of the house The caretaking activities out of the house include only those which are necessary for living of the nursed person and which involve going out of the house. Among these are going to the doctor’s consulting room for therapy purposes or participating to therapies prescribed by the physician, such as dialysis, oncologic or immunity procedures, physical therapies, ergo-therapies, voice therapy, speech and language therapy.
Prophylaxis The caretaking services might be performed by the family or by a competent person (also combining the two) by using an ambulatory care unit.
Special nursing is a subchapter of the medical care (according to Art. 92 par. 1 al. 2 no. 6 SGB V and par. 7 SGB V).The sponsors in this case are not the medical insurance centers, but the caretaking insurance centers. Thus it cannot be required by the patient – as the caretaking stage – but it is done exclusively in accordance with the doctor’s prescription if it is medically necessary. It requires the approval of the insurance center. The ambulatory medical care is performed in the home of the insured person or of the family and it includes:
1. Special nursing All the treatment measures recommended by the doctor for curing diseases, for preventing the diseases from getting worse or for painkilling and they are performed by specialized nurses.
2. Basic care Daily activities such as:
- o Instructions for basic care
- o Using the toilet/ training for continence
- o Nourishment
- o Body care
3. Housekeeping = = all the activities necessary for keeping the house, such as :
- o errands
- o changing and washing clothes
- o cleaning the place
- o taking out the garbage
- o preparing meals
- o dishwashing etc.
- • aspiration
- • instructions for medical care
- • respirator, usage and monitoring
- • washing the bladder
- • measuring blood pressure
- • measuring glycemia
- • treating decubitus
- • draining, verification and feeding
- • enema, digital emptying of bowels
- • liberation of liquids
- • infusions
- • inhaling
- • injections and preparing injections
- • instillation
- • applying the cooler
- • catheter
- • catheter of the urinary bladder for deviating the urine
- • monitoring the patient
- • stomach tube, introduction and change
- • administrating medicines
- • applying the PEG tube
- • psychiatric medical nursing
- • dental care
- • tracheal canals, changing and care
- • venous catheter (Port), care
- • bandages
Housekeeping normally includes all the activities to take care of the nursed person’s home. Along with the basic care, it is part of the Social Code (SGB) XI and it belongs to the house care. The sponsor is the caretaking insurance center. Housekeeping includes:
- This chapter refers to the planning, informing and purchasing food, cleaning products and body care products, information on the products being bought, the places to buy them from, depending on the season and quantity, increasing the money value (being aware of the price) as well as information on the eatability and shelter life of food products and their correct storage. This category also includes purchasing food products that are necessary for keeping a diet.
• Cooking It includes the entire process for preparing food and planning the menu (for example determining the diet food products and monitoring calories) for healthy nourishment depending on the age and living conditions. This also includes using the technical devices, assessing the quantity and the boiling time, considering the hygiene rules.
• Cleaning up the place This includes cleaning the floor, furniture, windows and electrical household devices in the home of the nursed person. This means also knowing the cleaning products and devices; making the bed.
• Dishwashing The dishwashing is done manually or using the dishwasher, depending on the situation.
• Changing and doing laundry and clothes Here includes sorting textiles, washing, arranging, ironing, repairing and putting clothes in the wardrobe and changing linen.
The caretaking services may be performed by the family or by a competent person (it is also possible in a combined way) in an ambulatory care unit.
Important! The housekeeping need level is also important for determining a caretaking stage. Along with the basic care duration, the entire caretaking period is calculated.
§ Art. 39 SGB XI
Incapacity of caretaking – replacing care This right appears when the person who does the caretaking (beside a caretaking unit) can no longer do that because of his/ her vacation, illness or other reasons. After all, the reason is irrelevant. During the period of incapacity of care, it is granted half of the caretaking premium which was granted before it, for maximum 4 weeks depending on the calendar year. The indemnity for incapacity of caretaking is paid for maximum 42 calendar days per calendar year. The expenses of the caretaking insurance center may reach 1 612 Euros per year if the caretaking incapacity is substituted by caretaking personnel. If the short term care indemnities have not been exhausted, maximum 50% (806 Euros) may be used also in case of caretaking incapacity.
24 h caretaking Insanity is an incurable degenerative disease of the brain and more and more people suffer from it because of the aging of the society. This disease is the most often met reason for the need for care and permanent nursing in a home.
Ambulatory care of a patient suffering from insanity Taking care and nursing an insanity suffering patient is difficult, tiring and stressing for the care taker. It is a 24 hours job. The reason for this is the physical integrity of the patient (excepting for the final stage patient) as compared to the „other” cases of caretaking. Thus, these patients are active, possibly also at night, they have the tendency to go “walking” around the house, to go running, to have depressions, they experience fear, nervousness, they become aggressive or do not recognize dangers, etc. At first, caretaking means only surveillance and assistance, then the need for care becomes greater and greater in terms of body care, nourishment and using the toilet.
Emergency call In order to install a device for emergency calls, a phone connection and an electricity connection are necessary. The emergency call system is made of two pieces: a basic device and a radio transmitter. The basic device is connected to the existing phone. It is set in a central place in the apartment. The small radio transmitter is worn on a necklace or at a bracelet, without being quite obvious somewhere upon the body. In case of emergency one can press the emergency button from the basic device or from the transmitter. Thus the connection is made in a few seconds to the emergency call central. Irrespective of the place where the person is in his/ her home, the connection to the central is made immediately after pressing the button. The central operator immediately sees on the computer screen the origin of the call and all the important data that the person has mentioned, such as residence, contact person, information on illness and medicines, etc. . And if the person is no longer able to talk, for example in case of a stroke, the central operator asks for help, notifying the contact person and the doctor on call.
Emergency call – costsFor the connection to the emergency call system, a single connection fee is normally perceived. The exact costs for it may be found out from any supplier you want. In addition a monthly tax is perceived amounting to approximately 18.00 Euro. This tax includes the monthly rent for the basic device and the portable transmitter, the permanent access to the central, taking the emergency call and introducing the help measures in case of emergency. The emergency call system is a recognized technical support in accordance with the laws concerning caretaking. This is why for the clients with a caretaking stage, the monthly fees and the single connection tax are paid by the caretaking insurance centers in most of the cases. In addition, the suppliers of these services offer various packages for these services. T contents and the costs may vary and can be found directly from the supplier of yochoice.
Consultancy activities The consultancy activities are determined in accordance with Art. 37.3 SGB XI. If you receive caretaking allowance, but no caretaking unit is involved, the counseling meetings are obligatory – the so-called visits for quality ensuring. The consultancy activities give you and us the insurance that the caretaking is being performed. The period of time between these counseling meetings is 6 months for the caretaking stages I – II, and for the stage III, the consultancy takes place every three months. During the meeting you tell us about your experience and we give you some advice. Thus we can assist you, for example in the case of a great need for care. . Very often, the persons doing the caretaking do not have the time to deal with things not involving care. During the consultancy activities, you may discuss with you your wishes, needs and concerns, whether it is about assistance in making the daily life easier, modifying the bathroom or avoiding falls.