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The Federal Ministry of Health and the Long-Term Care Directorate (LTC)
In the field of long-term care, the Federal Ministry of Health is responsible for the legislative process: the drawing up and monitoring of bills of law and draft ordinances. In the case of long-term care, the initiative for bills of law is the almost exclusive prerogative of the Executive – in this case, of the Federal Ministry of Health. The latter monitors the implementation of the Long-Term Care Act with the aim of ensuring its efficient implementation and, to this end, exerts its influence on the federal Laender and the competent associations and organisations in the field. This is eminently important in the wake of major reforms. Furthermore, the Federal Ministry of Health monitors the financing of the Long-Term Care Fund, in particular the compensation fund, and is responsible for the corresponding statistics.
In order to further the devel-opment of service provision, the Federal Ministry of Health has pilot projects and research projects con-ducted, by issuing invitations for research bids. In the past, these have included the development of con-struction projects in the area of geriatric care, whereas nowadays the projects affect, to a greater extent, care provision structures and care quality issues (development of a new definition of 'the need for long-term care', and measuring the quality of results in in-patient facilities). Surveys are also conducted at regular intervals. Within the framework of German reunification, a major programme was set up and im-plemented to secure financial assistance for investment in long-term care facilities in the new Federal Laender. This programme is still underway today.
Within the Federal Ministry of Health, the 'Long term-Care' Directorate is responsible for performing the above tasks. The Direcorate comprises five divisions that are responsible for the following:
- Basic questions regarding the long-term care insurance
- The insured community, benefits and services, contributions, social security of carers
- Medical and nursing aspects of long-term care
- Long-term care contractual and reimbursement law
- Financial aspects of the long-term care insurance, pilot programmes, financial assistance.
Some 30 persons work in the Directorate.
The concrete supervision of the Act's implementation by the long-term care funds is the responsibility of the Federal Laender and the Federal Insurance Office, which is under the legal supervision of the Federal Ministry of Health in this area.
The LTC funds
The long-term care insurance funds – as insurance companies under public law – offer their services on a statutory basis and therefore must ensure appropriate long-term care for insured persons in the form of statutory benefits and services. As these funds do not maintain their own facilities, nor supply benefits and services themselves, they conclude care and remuneration contracts with individual carers, with the institutions managing nursing homes or those providing out-patient care services. Every care facility, which fulfils the requirements, is legally entitled to be allowed to provide care services. As a result, facilities under municipal, non-profit or private ownership co-operate alongside each other.
The Laender
The Laender are responsible for providing efficient long-term care structures and for financing investment in the long-term care facilities; the ongoing operating and nursing care costs are to be paid by the persons in need of long-term care or their financing institutions.
