Project

Long-term care in Germany is facing major challenges in terms of quality and supply assurance. Skilled staff shortages play a central role in this context and are also at the centre of this research project. We examine long-term care supply under binding capacities from five interlinked perspectives to better understand both, the direct effects (e.g., reduced quality due to staff shortages) and indirect effects (e.g., increase in informal family care, increase in the length of hospital stays or shortage of inpatient care).

While Perspective 1, as the basis for the next steps, examines the extent to which the prevailing shortage of personnel and, in particular, the shortage of skilled workers influences the supply of nursing care, Perspective 2 is devoted to the question of how the deployment of personnel influences the quality of nursing care. The results allow conclusions regarding an appropriate ratio of skilled workers and the question of whether personnel capacities are actually decisive for the quality of care or whether other factors (e.g. personnel mix, digitization or remuneration system) are decisive. Building on this, Perspective 3 asks how much available capacities influence the demand decision. Here, we calculate welfare losses that result from a non-optimal choice due to binding capacities. In Perspective 4, we use the special case of the need for long-term care following a hospital stay to examine whether the lack of personnel increases the length of stay in a hospital in cases when professional (nursing home) care is required afterwards. Perspective 5 provides an initial evaluation of the introduction of the single room quota in nursing homes with respect to demand and supply as well as prices, thus allowing an assessment for or against a nationwide introduction of this capacity-relevant regulatory measure.

The aim of the project is to identify causal relationships at a high scientific level and to make a socially and politically relevant contribution to research. The results will provide a comprehensive picture of the effects of the shortage of skilled workers on various supply-side and demand-side outcomes. The aim is to inform health policy-makers about the problem of insufficient capacities in long-term care, but also specifically about current reforms of single rooms or staff quotas.

We use the nursing care statistics of the statistical offices of the Länder, routine data from insurance companies and information at district level from the Federal Employment Agency and other sources as a data basis. In order to measure causal effects, we use, among other methods, difference-of-differences analyses and two-stage instrumental variable estimators. The instrumental variables partly stem from previous work and the literature, while some are developed and tested in the project.

Project start:
01. December 2022

Project end:
31. October 2024

Project management:
Dr. Dörte Heger

Project staff:
Anna Werbeck, Lea Bergmann, Henrik Bergschneider

Funding:
Deutsche Forschungsgemeinschaft