The care service is a legal obligation of municipalities, yet in practice it is accompanied by many myths and misunderstandings. The lecture reminded attendees what exactly this service includes, what it does not, and why it runs up against the limits of funding and training. Clear rules and fair funding are the key to safe help at home.
What care is not: boundaries and safety in the field
A care worker in the field must not perform medical procedures, such as wound care; even if she is a trained nurse, her employment contract binds her to the role of a care worker. She does not perform massages; there is a difference between applying a cream and massaging. The service is not just meal delivery, and the care worker does not provide legal or other professional advice. She helps with medications according to the agreed procedure and also monitors fluid intake, but in the home environment control is harder than in a facility.
The care worker is not an employee of the client or the client’s family; the provider assigns the work and contractual rules apply. Off-the-books arrangements, stepping outside the plan, or paying “under the table” for tasks she is required by law to perform are unethical and risky. Emotional attachment (e.g., “you are like my mother”) can cause harm when the service ends or the worker is replaced. Maintaining boundaries protects both the client and the care worker.
Funding, quality, and training: where it breaks down
Recipients have the right to choose a provider and to the preservation of human dignity, but the system runs into the pressure of “immediate” help when being discharged from hospital. If the municipality does not manage to issue a decision in time, billing is based on economically justified costs: approximately 12 € per hour, around 15 € per hour on weekends. With extensive, round-the-clock support, costs can climb into the thousands of euros per month, on the order of up to four thousand. This is a substantial burden for families.
According to the lecturer, the discussion about quality focuses on the top of the pyramid, while the foundation — stable funding — is missing. Training care workers is costly: you have to pay the staff member attending the course, her substitute in the field, and the trainer. Without resources and incentives, it is difficult to develop specialization for specific needs, for example in Alzheimer’s disease. The Recovery and Resilience Plan focused on quality, but without investments in the foundation the desired results cannot be sustained.
