Specialists and helpers in geriatric care – A critical consideration
The distinction between specialists and helpers in German elderly care is of central importance for the quality of care and the social self-image in dealing with older people. Especially in recent years, the system of nursing professions has changed fundamentally and is now the focus of a controversial debate. The developments in this areanot only raise questions about professionalization and qualification, but also show how profound social appreciation, economic interests and political control mechanisms intertwine.
The origins of the qualification structures
In order to understand the current situation, it is worth taking a look back and shed light on the emergence of the professional structures in geriatric care. Originally, the training to become a geriatric nurse was an independent, demanding path that taught well-founded theoretical and practical qualifications over several years. With the introduction of the generalistNursing training, which brings together nursing, pediatric nursing and elderly care, the previous specialization was abandoned in favor of an overarching approach. This change should actually increase the attractiveness of the professional field and enable the staff to be deployed more flexibly. At the same time, the constantly increasing need for nursing staff led to theAccess hurdles were lowered more and more. As a result of demographic change, the growing number of people in need of care and the looming lack of qualified personnel, a vacuum was created that was increasingly filled by people without extensive specialist training.
The rise of the nursing assistants and the consequences
This process meant that more and more career changers and lateral entrants found their way into care. They do not complete training for several years, but go through different lengths of qualification measures that can range from a few weeks to a few months. The contents of these courses are not standardized, but are supported by the respective providers of the nursing homesgiven. Financing is often done through educational vouchers, state subsidies or labor market policy measures. This is how a new group of nursing staff was born, who are officially referred to as helpers, assistants or nursing assistants, but do not have a nationwide job title. This approach is often sold as a success politically: theEmployment rate is rising, the unemployed are integrated, and the homes’ supply gaps are closed in the short term. But this development is not without risk.
The problematic effects of helper dominance
The proportion of helpers in the total workforce in Heimen has grown significantly in recent years. The number of helpers is increasingly exceeding that of the specialists, which turns the original balance upside down. The distribution of tasks is shifting: Helpers take on activities that would actually require comprehensive training. The boundaries between theblur qualification levels. From a pragmatic point of view, this seems understandable, because the care of the residents must be ensured. But in practice, this leads to a gradual deprofessionalization of the entire professional field. Professional care, which is dependent on in-depth knowledge of medicine, hygiene, pharmacology and psychosocial care, isthinned out. Empathy and commitment are not enough when it comes to recognizing complex clinical pictures, doses of medication correctly or reacting appropriately in emergency situations.
The consequences for quality, safety and job satisfaction
The consequences of this development are serious. The quality of care is demonstrably reduced when poorly trained personnel take on tasks for which comprehensive expertise is actually required. Mistakes in medication administration, misjudgments of symptoms and lack of documentation are just a few of the risks. At the same time, the pressure on the remaining specialists whoincreasingly faced with organizational tasks, medical decisions and administrative effort. They often have little time for direct, human attention to the residents. This leads to frustration, overload and a falling job satisfaction. The attractiveness of the profession suffers, which further accelerates the downward spiral.
The economic and political background
The shift to more helpers and fewer skilled workers is no coincidence, but the result of targeted political and economic decisions. Nursing homes, especially those under private ownership or under the control of investors, benefit significantly from lower personnel costs financially. Helpers receive less wages, have lower claims and are easier to replace.Since they also do not have their own professional representation, they lack the opportunity to fight for better working conditions or higher salaries. This system favors short-term economic interests while the long-term consequences for society are ignored. Public perception is through positive employment statistics and apparently solvedsupply problems deceived. In reality, people’s care is increasingly being degraded to mass-produced goods that can be saved and postponed at will.
Social impact and the question of appreciation
The crisis in geriatric care reflects a deeper social problem: The lack of appreciation for the elderly and for those who care for them. In a performance-oriented society, efficiency, productivity and economic benefits count. Old people who are dependent on support are all too often considered a burden. At the same timethe commitment of the nurses is not appropriately rewarded, neither financially nor socially. Statements like “You only do the simplest work” are an expression of a failed perception that misjudges the complexity and responsibility of the nursing profession. Those who decide to have a qualified training will hardly be rewarded – on the contrary, less training often means lesssalary and lesser reputation. The result is a dramatic loss of motivation, which directly affects the quality of care.
The growing complexity of everyday care
The requirements in nursing homes are constantly increasing. The residents are getting older, often have multiple illnesses and need intensive medical care. Nursing is no longer just a question of basic care, but includes demanding medical, organizational and communicative tasks. The documentation becomes more extensive, the coordination with doctors more complex,And responsibility grows. At the same time, the personnel key remains low and the relationship between specialists and helpers continues to deteriorate. In many institutions, the specialists are so busy that they can hardly fulfill their core tasks. Often they become pure coordinators, while helpers take on direct care – a development thatfundamentally changed.
The consequences for the health system and society
These developments are not limited to elderly care. A similar picture is also evident in the hospital sector: overburdened nursing staff, falling qualification levels and increasing risks for patients. Residents are increasingly being hospitalized with the smallest medical problems because there is neither sufficient specialist staff nor medical care on siteis. These unnecessary hospital admissions burden the health system, lead to avoidable complications and further intensify the nursing shortage. A vicious circle is formed: The less qualified staff, the worse the supply, the greater the burden on the overall system.
An appeal for more professionalism and social change
The situation in geriatric care is an expression of a social imbalance. A rethinking is needed that goes beyond short-term solutions and economic interests. Care must again be recognized as a demanding, valuable and highly qualified profession. Only with clear qualification standards, better working conditions, reasonable pay and socialThe downward trend can be stopped. The dignity of older people and the performance of the caregivers deserve protection, recognition and support. Otherwise, care threatens to degenerate into a pure cost factor, with fatal consequences for all those affected – and ultimately for society as a whole.
