Open Access

Who should take care of me? Preferences of old age individuals for characteristics of professional long-term caregivers: an observational cross-sectional study

BMC Research Notes201710:382

https://doi.org/10.1186/s13104-017-2717-3

Received: 15 February 2017

Accepted: 29 July 2017

Published: 10 August 2017

Abstract

Background

It is most likely that the need for long-term care increases considerably in the next decades due to demographic shifts. Thus, we aimed at identifying the preferences for characteristics of professional long-term caregivers among old age individuals in Germany.

Methods

Data were gathered from a population-based survey of the German population aged 65 and above in 2015 (n = 1006).

Results

It was important for individuals in old age that long-term caregivers were ‘empathetic, kind’ (99.3%), ‘punctual, reliable’ (98.2%), have an ‘orderly appearance’ (96.4%), work in a ‘small team’ (92.5%) and have ‘enough time’ (91.5%). Moreover, while most of the individuals (76.5%) reported high preferences for ‘German language’, the preferences were lower for ‘same cultural background’ (54.2%) and ‘same gender’ (35.7%). In multiple logistic regressions, preferences for ‘same gender’ were positively associated with being female [OR 8.3 (5.6–12.1)], living with partner or spouse [OR 1.4 (1.0–1.9)], and being born abroad [OR 1.8 (1.1–3.1)]. Preferences for ‘German language’ were positively associated with being female [OR: 1.5 (1.1–2.1)]. Preferences for ‘same cultural background’ were positively associated with age [OR 1.0 (1.0–1.1)], living with partner or spouse [OR 1.4 (1.0–1.9)], and East Germany [OR 1.9 (1.3–2.7)]. Preferences for ‘orderly appearance’, ‘empathetic, kind’, ‘punctual, reliable’ and ‘small nursing team’ were all not significantly associated with included independent variables, whereas preferences for ‘enough time’ were positively associated with being female [OR 1.9 (1.1–3.5)], living with partner or spouse [OR 1.9 (1.1–3.4)], education [Apprenticeship, full-time vocational school, OR 3.1 (1.3–7.6)], not providing care for family/friends [OR 1.9 (1.1–3.3)], and involvement in the issue of need for care [OR 1.3 (1.1–1.6)].

Conclusions

Our data suggest that it is important to almost every individual aged 65 and above in Germany that professional long-term caregivers are (i) empathetic, kind, and understanding, (ii) punctual and reliable, (iii) have enough time (e.g., for conversation), (iv) and have an orderly appearance. Furthermore, several factors such as gender or region were found to be associated with preferences for characteristics of caregivers. By knowing these factors, nursing services can tailor their activities to the needs of care-recipients.

Keywords

Need for care Preferences Long-term care Old age Nursing home care Germany

Background

It is most likely that the number as well as the proportion of old age individuals will considerably increase in the upcoming decades [1]. Since age is strongly associated with the need for care [2, 3], it is also most likely that the number of individuals in need for care will markedly increase, posing great challenges.

While it is well known that individuals prefer to be cared for by family members at home as long as possible [4]—which is often explained by factors such as social relations or familiar environments—preferences shift towards professional care and nursing home facilities when the need for care grows [58]. However, only a few studies have examined preferences for characteristics of professional long-term caregivers [911].

Hence, we aimed at examining which factors are associated with preferences for characteristics of professional long-term caregivers among individuals in old age (65 years and above). Previous studies found that, besides professional caring skills, soft skills such as empathy or sensitivity are important caregiver characteristics for care-recipients [911]. With increasing care needs, the specific tasks become more complex and time-consuming [12]. Consequently, when care needs grows, professional caring skills might be most important for care-recipients. Moreover, it has been demonstrated that care-recipients would like to build a relationship with the individual providing care [4]. Furthermore, a calm nature of the caregiver is important for care-recipients. Please see the ‘Previous research’ section for further details.

This knowledge is important for caregivers as well as nursing services. Knowing the factors which are important for care-recipients might help to reduce the gap between care-recipients’ expectations and reality in professional caregiving at home or nursing home facilities. Our study focused on individuals aged 65 and above as these individuals are at risk of needing long-term care in the near future. Moreover, it was demonstrated that these individuals are well-informed about different aspects of long-term care [13].

Methods

Sample

Trained staff interviewed 1006 individuals aged 65 years and over living in private households with conventional telephone connection by phone (Computer Assisted Telephone Interview, approximate duration 25 min) in 2015 [14, 15]. Fieldwork was conducted by Berlin based USUMA—a market research company. By using the Guidelines for Telephone Surveys from the ADM (Arbeitskreis Deutscher Markt- und Sozialforschungsinstitute e.V.), individuals were randomly selected from the community-dwelling older population. Moreover, computer-generated numbers were used in order to allow for ex-directory households as well. Furthermore, repeat calls were made on different days of the week until an answer was obtained. From the gross sample (n = 2346), 1006 interviews were realized (42.9%). Lack of time/lack of interest (12.1%) and refusal to take part in telephone surveys (26.5%) were main reasons for refusal.

When the respondents agreed to complete the interview, oral informed consent was given. Oral consent is common in survey research in Germany. The ethical guidelines of the International Code of Marketing and Social Research Practise by the International Chamber of Commerce and the European Society for Opinion and Marketing Research were followed. Drawing on expert interviews [4] as well as a systematic review of the literature (which is currently under review), a questionnaire was designed to measure long-term care preferences including characteristics of professional caregivers (Additional file 1). Thereby, items were not taken directly from previously published instruments. Instead, items were developed based on existing items because most of the existing items did not fit the structure of a Likert scale. Therefore, items were reformulated. Moreover, the items were adapted to the target group of old age individuals. Thus, the purpose was to create understandable, short and succinct items. According to recent guidelines [16], Likert scales are easy to answer and produce a high response rate among old age individuals.

In order to improve the questionnaire different pretests were done including evaluation conversations and a pilot study. First, evaluation conversations were carried out with experts, guided interviews and telephone interviews with participants not included in the current study. Subsequently, a pretest was done under real life conditions (n = 31) with the target-population. Furthermore, the trained staff from USUMA received a glossary where the items and the underlying intentions were explained in detail.

Dependent variables

The preferences for characteristics of professional caregivers were quantified as follows: Regarding the characteristics of professional caregivers irrespective of care provided at home or in a nursing home, it is important to me that … (from 1 = “totally agree” to 4 = “totally disagree”):
  • … they have the same gender (short (notation used in Table 1 and Table 2): same gender).
    Table 1

    Bivariate associations between independent variables and preferences for nursing home care

     

    Same gender

    German language

    Same cultural background

    Orderly appearance

    Empathetic, kind

    Punctual, reliable

    Enough time

    Small team

    Low preferences (n = 638; 64.3%)

    High preferences (n = 354; 35.7%)

    Low preferences (n = 236; 23.5%)

    High preferences (n = 767; 76.5%)

    Low preferences (n = 452; 45.8%)

    High preferences (n = 534; 54.2%)

    Low preferences (n = 36; 3.6%)

    High preferences (n = 965; 96.4%)

    Low preferences (n = 7; 0.7%)

    High preferences (n = 998; 99.3%)

    Low preferences (n = 18; 1.8%)

    High preferences (n = 986; 98.2%)

    Low preferences (n = 84; 8.5%)

    High preferences (n = 902; 91.5%)

    Low preferences (n = 74; 7.5%)

    High preferences (n = 911; 92.5%)

    Age: Mean (SD)

    75.3 (6.4)*

    76.2 (7.0)

    75.0 (6.4)+

    75.9 (6.6)

    74.8 (6.4) ***

    76.3 (6.7)

    77.1 (6.4)+

    75.6 (6.6)

    73.7 (7.2)

    75.7 (6.6)

    75.9 (6.0)

    75.7 (6.6)

    77.0 (6.6)*

    75.5 (6.6)

    76.8 (6.7)

    75.5 (6.6)

    Sex

     Women

    263***

    299

    121**

    314

    256

    302

    17

    550

    3

    566

    12

    556

    42

    521

    35+

    524

     Men

    375

    55

    115

    453

    196

    232

    19

    415

    4

    432

    6

    430

    42

    381

    39

    387

    Living situation

     Living with partner or spouse

    280***

    106

    94

    297

    165

    220

    11

    380

    1

    391

    5

    387

    25+

    360

    41

    556

     Others

    358

    248

    142

    470

    287

    314

    25

    585

    6

    607

    13

    599

    59

    542

    33

    355

    Region

     West Germany

    484

    256

    183

    565

    367***

    370

    26

    720

    7

    742

    17+

    731

    67

    669

    57

    677

     East Germany

    154

    98

    53

    202

    85

    164

    10

    245

    0

    256

    1

    255

    17

    233

    17

    234

    Education

     Without a vocational degree

    33***

    39

    12***

    62

    36*

    36

    4

    71

    1

    74

    2

    73

    10*

    63

    7**

    64

     Apprenticeship, full-time vocational school

    202

    170

    67

    313

    148

    223

    15

    362

    3

    377

    5

    374

    20

    350

    17

    355

     Professional school or trade and technical school for vocational education

    156

    86

    58

    185

    110

    129

    5

    238

    2

    241

    8

    235

    24

    216

    16

    224

     University, school of engineering

    242

    58

    98

    202

    156

    142

    12

    288

    1

    300

    3

    298

    30

    267

    34

    262

    Place of birth

     Born in Germany

    594

    322

    216

    709

    410

    498

    33

    890

    7

    920

    17

    909

    79

    830

    67

    842

     Born abroad

    42

    31

    20

    55

    41

    34

    3

    72

    0

    75

    1

    74

    5

    69

    7

    66

    Having children

     Yes

    526

    301

    187*

    650

    364*

    459

    31

    805

    5

    834

    15

    823

    64+

    760

    57

    764

     No

    111

    53

    49

    116

    87

    75

    5

    159

    2

    163

    3

    162

    20

    141

    17

    146

    Status of health insurance

     Statutory health insurance

    518***

    326

    188**

    666

    377

    463

    32

    821

    7

    849

    18+

    837

    68

    773

    58+

    781

     Private health insurance

    116

    28

    47

    98

    73

    69

    4

    140

    0

    145

    0

    145

    16

    125

    16

    126

    Provided care for family/friends

     Yes

    320+

    157

    108

    373

    251*

    259

    14

    504

    2

    519

    11

    510

    35

    437

    42

    470

     No

    317

    197

    128

    393

    200

    275

    22

    460

    5

    478

    7

    475

    49

    464

    32

    440

    Level of care

     Yes

    29**

    31

    10

    50

    21

    37

    3

    57

    0

    60

    0

    60

    5

    55

    6

    53

     No

    607

    322

    224

    716

    429

    496

    31

    907

    6

    936

    17

    924

    78

    845

    67

    856

     Self-rated health (from ‘very bad’ to ‘very good’): Mean (SD)

    3.7 (0.9)*

    3.5 (0.9)

    3.8 (0.9)**

    3.6 (0.9)

    3.7 (0.9)**

    3.5 (0.9)

    3.4 (1.2)

    3.6 (0.9)

    4.0 (1.4)

    3.6 (0.9)

    3.7 (1.0)

    3.6 (0.9)

    3.6 (1.0)

    3.6 (0.9)

    3.6 (0.9)

    3.6 (0.9)

    Involvement in the issue of need for care, from ‘very little’ to ‘very much’): Mean (SD)

    2.9 (1.4)

    3.0 (1.4)

    2.8 (1.5)

    2.9 (1.4)

    3.0 (1.5)*

    2.8 (1.4)

    3.1 (1.6)

    2.9 (1.4)

    3.1 (1.7)

    2.9 (1.4)

    3.0 (1.7)

    2.9 (1.4)

    2.6 (1.4)*

    2.9 (1.4)

    2.8 (1.6)

    2.9 (1.4)

    Comparisons between the two groups were done using t test and Chi square procedures. +.10, *.05, **.01, ***.001

    Table 2

    Predictors of preferences for nursing home care. Results of logistic regressions (for each outcome measure: 0 = low preferences; 1 = high preferences)

    Independent variables

    (1)

    (2)

    (3)

    (4)

    (5)

    (6)

    (7)

    (8)

    Same gender

    German language

    Same cultural background

    Orderly appearance

    Empathetic, kind

    Punctual, reliable

    Enough time

    Small team

    Age

    1.000

    1.006

    1.032**

    0.972

    1.115

    1.007

    0.969

    0.976

    (0.977–1.023)

    (0.982–1.030)

    (1.011–1.054)

    (0.921–1.027)

    (0.955–1.301)

    (0.935–1.084)

    (0.933–1.007)

    (0.939–1.013)

    Sex (Ref.: male)

    8.270***

    1.511*

    0.985

    2.193+

    5.374+

    1.232

    1.931*

    1.547

    (5.640–12.13)

    (1.062–2.150)

    (0.724–1.340)

    (0.921–5.222)

    (0.810–35.63)

    (0.399–3.801)

    (1.068–3.491)

    (0.870–2.751)

    Living situation (Ref.: Living with partner or spouse)

    0.716*

    0.753

    0.712*

    0.524

    0.276

    0.615

    0.527*

    0.920

    (0.514–0.997)

    (0.534–1.062)

    (0.530–0.955)

    (0.230–1.192)

    (0.0334–2.281)

    (0.202–1.874)

    (0.296–0.941)

    (0.529–1.600)

    West and East Germany (Ref.: East Germany)

    0.957

    0.896

    0.524***

    1.236

     

    0.209

    0.899

    0.791

    (0.648–1.412)

    (0.591–1.358)

    (0.364–0.754)

    (0.491–3.114)

     

    (0.0277–1.574)

    (0.450–1.797)

    (0.394–1.587)

    Apprenticeship, full-time vocational school (Ref.: Without a vocational degree)

    1.188

    0.955

    1.304

    1.583

    4.939

    2.332

    3.141*

    2.094

    (0.683–2.066)

    (0.478–1.909)

    (0.767–2.216)

    (0.492–5.096)

    (0.406–60.12)

    (0.414–13.14)

    (1.306–7.556)

    (0.809–5.422)

    Professional school or trade and technical school for vocational education

    0.862

    0.714

    0.979

    3.893+

    5.611

    0.881

    1.832

    1.660

    (0.477–1.556)

    (0.350–1.457)

    (0.558–1.715)

    (0.830–18.26)

    (0.353–89.29)

    (0.167–4.635)

    (0.757–4.435)

    (0.614–4.486)

    University, Fachhochschule, school of engineering

    0.609

    0.514+

    0.750

    1.319

    17.87

    1.301

    2.101

    0.810

    (0.327–1.135)

    (0.251–1.053)

    (0.423–1.331)

    (0.349–4.993)

    (0.476–670.3)

    (0.202–8.378)

    (0.831–5.312)

    (0.313–2.094)

    German-born (Ref.: no)

    0.555*

    1.115

    1.481

    1.325

     

    0.396

    0.497

    1.987+

    (0.323–0.953)

    (0.643–1.933)

    (0.918–2.388)

    (0.423–4.153)

     

    (0.0429–3.657)

    (0.165–1.501)

    (0.963–4.099)

    Children (Ref.: No children)

    1.024

    1.208

    1.183

    0.854

    1.911

    0.868

    1.610

    1.432

    (0.672–1.559)

    (0.800–1.824)

    (0.818–1.709)

    (0.303–2.403)

    (0.260–14.06)

    (0.232–3.247)

    (0.869–2.982)

    (0.765–2.681)

    Status of health insurance (Ref.: statutory health insurance)

    0.625+

    0.772

    0.938

    1.162

      

    0.738

    0.874

    (0.382–1.023)

    (0.513–1.161)

    (0.641–1.372)

    (0.372–3.625)

      

    (0.371–1.471)

    (0.462–1.655)

    Provided care for family/friends (Ref.: no)

    0.840

    0.737+

    0.845

    1.637

    1.843

    0.390+

    0.520*

    0.670

    (0.609–1.160)

    (0.531–1.024)

    (0.638–1.120)

    (0.754–3.552)

    (0.274–12.41)

    (0.131–1.161)

    (0.304–0.891)

    (0.398–1.128)

    Level of care (Ref.: no)

    0.622

    1.026

    0.787

    0.734

      

    1.005

    1.737

    (0.328–1.182)

    (0.494–2.132)

    (0.430–1.437)

    (0.182–2.954)

      

    (0.321–3.146)

    (0.645–4.677)

    Self-rated health (from ‘very bad’ to ‘very good’)

    0.882

    0.877

    0.863+

    1.409+

    0.696

    1.050

    1.089

    1.009

    (0.740–1.053)

    (0.734–1.047)

    (0.741–1.005)

    (0.953–2.084)

    (0.264–1.832)

    (0.591–1.868)

    (0.816–1.454)

    (0.762–1.337)

    Involvement in the issue need for care (from ‘very little’ to ‘very much’)

    0.953

    1.064

    0.908+

    0.827

    1.065

    1.110

    1.344**

    1.167+

    (0.851–1.066)

    (0.949–1.192)

    (0.823–1.003)

    (0.634–1.079)

    (0.558–2.033)

    (0.780–1.581)

    (1.109–1.630)

    (0.971–1.401)

    Constant

    0.350

    3.240

    0.544

    32.37

    0.00193

    204.3

    31.01

    5.131

    (0.0231–5.299)

    (0.188–55.86)

    (0.0481–6.146)

    (0.0809–12,946)

    (3.40e−09–1095)

    (0.142–294,745)

    (0.358–2685)

    (0.0745–353.6)

    Observations

    974

    983

    967

    982

    521

    788

    967

    967

    Pseudo R2

    0.178

    0.036

    0.046

    0.067

    0.145

    0.061

    0.073

    0.056

    Odd ratios were reported. 95% confidence intervals in parentheses

    Region was dropped (253 observations not used) since it predicts success perfectly. Place of birth was dropped (58 observations not used) since it predicts success perfectly. Status of health insurance was dropped (121 observations not used) since it predicts success perfectly. Level of care was dropped (32 observations not used) since it predicts success perfectly. Status of health insurance was dropped (141 observations not used) since it predicts success perfectly. Level of care was dropped (55 observations not used) since it predicts success perfectly. Observations with missing values were dropped (listwise deletion). *** p < 0.001, ** p < 0.01, * p < 0.05, + p < 0.10

  • … they have very good German language skills (short: German language).

  • … they share the same cultural background (short: same cultural background).

  • … they show an orderly appearance (short: orderly appearance).

  • … they are empathetic, kind, understanding (short: empathetic, kind).

  • … they are punctual and reliable (short: punctual, reliable).

  • … they have enough time (going beyond physical care, e.g., for conversation) (short: enough time).

  • … the nursing team is small (short: small team).

The dependent variables were dichotomized (0 “totally disagree” and “rather disagree”; 1 “totally agree” and “rather agree”) to reflect high preferences versus low preferences. For the sake of readability, the terms “importance” and “preferences” have been used interchangeably in our study because we assume that these factors are highly correlated.

Independent variables

Socioeconomic variables were used as follows: age, sex, whether they have children or not (Ref.: no children), whether they were born in Germany or not (Ref.: not born in Germany), West and East Germany (Ref.: East Germany), living situation (Ref.: living with partner or spouse; others (living alone; living with other family members; living with other individuals)), status of health insurance (Ref.: statutory health insurance; private health insurance), and education (Ref.: without a vocational degree; others (apprenticeship, full-time vocational school; professional school or trade and technical school for vocational education; University, school of engineering)).

Moreover, individuals were asked whether they have ever provided informal care for family or friends (Ref.: no). As for health status, self-rated health (from 1 “very bad” to 5 “very good”) and level of care (Ref.: no) were included as independent variables. Recipients are classified into three levels of care (depending on the care required) based on an assessment by a nurse or a physician of the medical service of the German statutory health insurance system. The need of care was dichotomized (with 0 no level of care; 1 level 1 to 3). Furthermore, the involvement in the issue of need for care (“How much have you thought about the issue of ‘need for care’”) was assessed, ranging from 1 (“very little”) to 5 (“very much”).

Statistical analysis

Bivariate associations between preferences (high preferences; low preferences) and independent variables were analyzed using t-tests, Chi square and Fisher’s exact tests, as appropriate. Logistic regressions were used to investigate the relationship between our numerous independent variables and the preference outcomes. Eight logistic regressions models were computed. Outcome variables were (preferences for…): (i) Same gender, (ii) German language, (iii) Same cultural background, (iv) Orderly appearance, (v) Empathetic, kind, (vi) Punctual, reliable, (vii) Enough time, (viii) Small team. In each model, independent variables were age, sex, living situation, region, education, place of birth, having children, status of health insurance, provided care for family/friends, level of care, self-rated health, and involvement in the issue of need for care.

In additional analysis, we used penalized maximum likelihood logistic regression [17, 18]. It can be used when some of the cells formed by the outcome and categorical predictor variable have no observations [19, 20]. The statistical significance was defined as p value of 0.05 or smaller. All statistical analyses were performed using Stata 14.0 (StataCorp, College Station, Texas). Given that our sample size was sufficiently large (n = 1006 individuals), at least medium effects can be detected.

Results

Bivariate associations

Table 1 displays sample characteristics by preferences (low preferences vs. high preferences). The preferences were highest for ‘empathetic, kind’ (99.3%), ‘punctual, reliable’ (98.2%), ‘orderly appearance’ (96.4%), ‘small team’ (92.5%) and ‘enough time’ (91.5%) (Please see also Fig. 1). Moreover, most of the individuals (76.5%) reported high preferences for ‘German language’, whereas the preferences were markedly lower for ‘same cultural background’ (54.2%) and ‘same gender’ (35.7%).
Fig. 1

Preferences for nursing home care

Preferences for ‘same gender’ were significantly associated with age, gender, living situation, education, status of health insurance, need of care, and self-rated health. Preferences for ‘German language’ were significantly associated with gender, education, having children, status of health insurance, and self-rated health. Preferences for ‘same cultural background’ were significantly associated with age, region, having children, provided care for family/friends, self-rated health, and involvement in the issue of need for care. Neither preferences for ‘orderly appearance’, nor preferences for ‘empathetic, kind’, nor preferences for ‘punctual, reliable’ were significantly associated with included predictors. Preferences for ‘enough time’ were significantly associated with age, education, and involvement in the issue of need for care. Preferences for ‘small team’ were significantly associated with education.

Regression analysis

Results of multiple logistic regressions are depicted in Table 2.

Preferences for ‘same gender’ were positively associated with being female [OR 8.3 (5.6–12.1)], living with partner or spouse [OR 1.4 (1.0–1.9)], and being born abroad [OR 1.8 (1.1–3.1)]. Preferences for ‘German language’ were positively associated with being female [OR 1.5 (1.1–2.1)]. Preferences for ‘same cultural background’ were positively associated with age [OR 1.0 (1.0–1.1)], living with partner or spouse [OR 1.4 (1.0–1.9)], and East Germany [OR 1.9 (1.3–2.7)]. While preferences for ‘orderly appearance’, ‘empathetic, kind’, ‘punctual, reliable’ as well as ‘small nursing team’ were all not significantly associated with included independent variables, preferences for ‘enough time’ were positively associated with being female [OR 1.9 (1.1–3.5)], living with partner or spouse [OR 1.9 (1.1–3.4)], education [Apprenticeship, full-time vocational school, OR 3.1 (1.3–7.6)], not providing care for family/friends [OR 1.9 (1.1–3.3)], and involvement in the issue of need for care [OR 1.3 (1.1–1.6)].

Since some of the cells formed by the outcome and categorical predictor variable have no observations, we repeated our estimates with penalized maximum likelihood logistic regressions (instead of logistic regressions) in additional analysis. In terms of effect sizes and significance, our findings were comparable to those from the main logistic regressions (results not shown but available upon request).

Discussion

Main findings

By using a large, population-based survey in individuals aged 65 and above in Germany, we aimed at investigating which factors are associated with characteristics of professional long-term caregivers among individuals in old age. More specifically, the predictors of preferences for characteristics of caregivers were examined.

The preferences were highest for ‘empathetic, kind’ (99.3%), ‘punctual, reliable’ (98.2%), ‘orderly appearance’ (96.4%), ‘small team’ (92.5%) and ‘enough time’ (91.5%). Moreover, most of the individuals (76.5%) reported high preferences for ‘German language’, whereas the preferences were markedly lower for ‘same cultural background’ (54.2%) and ‘same gender’ (35.7%).

In multiple logistic regressions, preferences for ‘same gender’ were positively associated with being female, living with partner or spouse, and being born abroad. Preferences for ‘German language’ were positively associated with being female. Preferences for ‘same cultural background’ were positively associated with age, living with partner or spouse, and East Germany. Preferences for ‘orderly appearance’, ‘empathetic, kind’, ‘punctual, reliable’ and ‘small nursing team’ were all not significantly associated with included independent variables, whereas preferences for ‘enough time’ were positively associated with being female, living with partner or spouse, education, not providing care for family/friends, and involvement in the issue of need for care.

Previous research

As already found in the literature [9, 10], soft skills of caregivers such as empathy, kindness, punctuality or reliability are most important for care-recipients. This is also in line with a recent study [4] showing that individuals in need for care wish to build a relationship with the caregiver. Moreover, the caregiver should do their tasks and activities with calm and in a leisurely way [4]. Besides, the high preferences for a small nursing team might be explained by the perception of individuals that small teams are associated with deep personal relationships as well as soft skills such as trust or feelings of emotional attachment which are highly important for individuals in need for care [4]. Compared with soft skills, we found that other factors such as ‘same cultural background’ and ‘same gender’ are far less important. This might be mainly explained by the fact that these preferences, unlike soft skills, do not reflect basic caregiving needs. This corresponds to the findings of van Haitsma and colleagues [21].

Being female was positively associated with preferences for ‘same gender’ and preferences for ‘German language’. This is also in line with previous studies reporting that women prefer a general practitioner of the same gender [2225]. Moreover, this is also in accordance with a previous qualitative study among 60 older lesbian, gay, bisexual and queer (LGB) individuals in which Westwood [26] found that older LGB women might be more likely to prefer gender-specific care. Our findings might be explained by the fact that women experience increased levels of stress when getting intimate care by men [27]. In addition, women might fear that quality of care and conversations suffer when caregivers have poor skills in the German language. This might explain why preferences for ‘German language’ were positively associated with being female.

Living with partner was positively associated with preferences for ‘same gender’ and preferences for ‘same cultural background’. Consequently, individuals living with partner might be more afraid of care provided by the opposite gender. This might be explained by the fact that individuals in old age living with partner could not imagine that other individuals apart from their wife or husband provide assistance with basic activities of daily living such as toileting or bathing.

In addition, preferences for ‘same cultural background’ were positively associated with age and East Germany. These associations might reflect differences in cultural values [2830]. Different preferences for ‘same racial/ethnic group’ regarding health care providers were also reported among different ethnic groups (Asian-Americans compared to non-Latino Whites) [31].

The non-significant associations between ‘orderly appearance’, ‘empathetic, kind’, ‘punctual, reliable’ as well as ‘small nursing team’ and included predictors might be mainly explained by the fact that nearly every individual wishes to have them in the future. Thus, these preferences for characteristics of professional caregivers might be generally seen as basic (human) needs.

The positive association between preferences for ‘enough time’ (going beyond physical care, e.g., for conversation) and being female, higher education as well as living with partner or spouse might be explained by the greater need for social interactions in these groups [32, 33].

Furthermore, while the positive association between involvement in the issue of need for care and preferences for ‘enough time’ might be explained by the fact that a high involvement in this issue is associated with a higher preference for soft skills of caregivers, the positive association between not providing care and the preferences for ‘enough time’ was quite unexpected and might be explained by unobserved factors associated with providing informal care (for example, personality traits [3436]). In addition, this association might be explained by the fact that individuals who already provided informal care have a more realistic perspective on life in a long-term care setting. Consequently, these individuals might be more aware of the organizational and time constraints faced by caregiver and that “enough time” (not closely related to caregiving aspects, e.g. time for conversations) will likely place additional burden on caregivers. However, further research is required to clarify this relationship.

Strengths and limitations

It should be highlighted that our data were derived from a large, population-based sample among individuals in old age. Moreover, numerous important independent and dependent variables were captured. For example, adjusting for numerous potential confounders, we provide novel evidence that region (West and East Germany) is differentially associated with preferences for ‘same cultural background’. However, our study also has some limitations. This is a cross-sectional study. Therefore, temporal relationships cannot be determined. Future studies aimed at examining the long-term impact of predictors on long-term care preferences are needed. In addition, upcoming studies should validate the instruments used in our study. In addition, the self-reported data might suffer some degree of inaccuracy.

Conclusions

Our data suggest that it is important to almost every individual aged 65 and above in Germany that professional long-term caregivers are (i) empathetic, kind, and understanding, (ii) punctual and reliable, (iii) have enough time (e.g., for conversation), (iv) and have an orderly appearance. Furthermore, high preferences for skills in German language were reported. Moreover, it is important to them to be cared for in a small team. Characteristics such as having the same cultural background or having the same gender are less important. Furthermore, several factors such as gender or region were found to be associated with characteristics of caregivers in nursing home facilities. By knowing these factors, nursing services can tailor their activities to the needs of care-recipients. Reducing the gap between caregivers’ needs and reality might in turn help to increase the satisfaction of care-recipients in nursing home facilities.

Abbreviations

ADM: 

Arbeitskreis Deutscher Markt- und Sozialforschungsinstitute

CATI: 

Computer Assisted Telephone Interview

OR: 

odds ratio

USUMA: 

Unabhängige Serviceeinrichtung für Umfragen, Methoden und Analysen

Declarations

Authors’ contributions

The conception and design of the study, or acquisition of data, or analysis and interpretation of data: AH, TL, AW, SRH, HHK. Drafting the article or revising it critically for important intellectual content: AH, TL, AW, SRH, HHK. Final approval of the version to be submitted: AH, TL, AW, SRH, HHK. All authors read and approved the final manuscript.

Acknowledgements

We want to thank all participants for taking the time and effort to participate in the interviews.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The datasets used and analysed during the current study are available from the corresponding author on reasonable request for all interested researchers. Interested parties may contact the Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf (contact information: Dr. André Hajek, a.hajek@uke.de, +49 (0)40 7410-52877).

Consent to participate

Participants provided their oral informed consent prior to assessment, under the premise that participation for this scientific survey was voluntary and analyses would be conducted anonymously. Oral consent is common in survey research in Germany in order to prevent a significant increase of selective distortion thru non-response (participation refusal) in representative approaches.

Consent for publication

Not applicable.

Ethics approval

The study was reviewed and approved by the Ethics Committee of the General Medical Council Hamburg, Germany (Approval No. PV4781). The ethical guidelines of the International Code of Marketing and Social Research Practise by the International Chamber of Commerce and the European Society for Opinion and Marketing Research were followed.

Funding

This publication was funded by the German Federal Ministry of Education and Research (BMBF) (Grant: 01EH1101B IIIB). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf
(2)
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig

References

  1. Bundesamt S. Bevölkerung Deutschlands bis 2060-Ergebnisse der 12. koordinierten Bevölkerungsvorausberechnung. Wiesbaden. 2009.Google Scholar
  2. Hajek A, Brettschneider C, Ernst A, Posselt T, Mamone S, Wiese B, Weyerer S, Werle J, Pentzek M, Fuchs A. Einflussfaktoren auf die Pflegebedürftigkeit im Längsschnitt. Gesundheitswesen. 2017;79(02):73–9.PubMedGoogle Scholar
  3. Hajek A, Brettschneider C, Posselt T, Lange C, Mamone S, Wiese B, Weyerer S, Werle J, Fuchs A, Pentzek M, Stein J, Luck T, Bickel H, Mösch E, Heser K, Jessen F, Maier W, Scherer M, Riedel-Heller SG, König HH. Predictors of frailty in old age—results of a longitudinal study. J Nutr Health Aging. 2016;20(9):952–7. doi:https://doi.org/10.1007/s12603-015-0634-5.View ArticlePubMedGoogle Scholar
  4. Heuchert M, König H-H, Lehnert T. Die Rolle von Präferenzen für Langzeitpflege in der sozialen Pflegeversicherung–Ergebnisse von Experteninterviews. Gesundheitswesen. 2016. doi:https://doi.org/10.1055/s-0041-111839.
  5. McCormick WC, Ohata CY, Uomoto J, Young HM, Graves AB, Kukull W, Teri L, Vitaliano P, Mortimer JA, McCurry SM. Similarities and differences in attitudes toward long-term care between Japanese Americans and Caucasian Americans. J Am Geriatr Soc. 2002;50(6):1149–55.View ArticlePubMedGoogle Scholar
  6. Min JW. Preference for long-term care arrangement and its correlates for older Korean Americans. J Aging Health. 2005;17(3):363–95.View ArticlePubMedGoogle Scholar
  7. Pinquart M, Sörensen S. Older adults’ preferences for informal, formal, and mixed support for future care needs: a comparison of Germany and the United States. Int J Aging Hum Dev. 2002;54(4):291–314.View ArticlePubMedGoogle Scholar
  8. Pinquart M, Sörensen S, Davey A. National and regional differences in preparation for future care needs: a comparison of the United States and Germany. J Cross Cult Gerontol. 2003;18(1):53–78.View ArticlePubMedGoogle Scholar
  9. Denson LA, Winefield HR, Beilby JJ. Discharge-planning for long-term care needs: the values and priorities of older people, their younger relatives and health professionals. Scand J Caring Sci. 2013;27(1):3–12.View ArticlePubMedGoogle Scholar
  10. Harrefors C, Sävenstedt S, Axelsson K. Elderly people’s perceptions of how they want to be cared for: an interview study with healthy elderly couples in Northern Sweden. Scand J Caring Sci. 2009;23(2):353–60.View ArticlePubMedGoogle Scholar
  11. Pope ND, Riley JE. “Keep dignity intact”: exploring desires for quality long-term care among midlife women. J Gerontol Soc Work. 2013;56(8):693–708.View ArticlePubMedGoogle Scholar
  12. Hajek A, Brettschneider C, Ernst A, Posselt T, Wiese B, Prokein J, Weyerer S, Werle J, Fuchs A, Pentzek M, Stein J, Riedel-Heller SG, Bickel H, Mösch E, Heser K, Jessen F, Maier W, Scherer M, König HH. Longitudinal predictors of informal and formal caregiving time in community-dwelling dementia patients. Soc Psychiatry Psychiatr Epidemiol. 2016;51(4):607–16. doi:https://doi.org/10.1007/s00127-015-1138-7.View ArticlePubMedGoogle Scholar
  13. Kuhlmey A, Suhr R, Blüher S, Dräger D. Das Risiko der Pflegebedürftigkeit: Pflegeerfahrungen und Vorsorgeverhalten bei Frauen und Männern zwischen 18 und 79 Jahren. Gesundheitsmonitor. 2013;5:2013.Google Scholar
  14. Hajek A, Lehnert T, Wegener A, Riedel-Heller SG, König H-H. Informelles Pflegepotenzial bei Älteren in Deutschland. Z Gerontol Geriatr. 2017:1–7. doi:https://doi.org/10.1007/s00391-017-1181-y.
  15. Hajek A, Lehnert T, Wegener A, Riedel-Heller SG, König H-H. Langzeitpflegepräferenzen der Älteren in Deutschland—Ergebnisse einer bevölkerungsrepräsentativen Umfrage. Gesundheitswesen. 2017:1–8. doi:https://doi.org/10.1055/s-0042-124663.
  16. Jacob R, Heinz A, Décieux JP. Umfrage: Einführung in die Methoden der Umfrageforschung. Oldenbourg: Walter de Gruyter; 2013.Google Scholar
  17. Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80(1):27–38.View ArticleGoogle Scholar
  18. Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Stat Med. 2002;21(16):2409–19.View ArticlePubMedGoogle Scholar
  19. Cox DR, Snell EJ. Analysis of binary data. Boca Raton: Chapman and Hall; 1989.Google Scholar
  20. Hirji KF. Exact analysis of discrete data. Boca Raton: Chapman and Hall; 2005.View ArticleGoogle Scholar
  21. Van Haitsma K, Abbott KM, Heid AR, Carpenter B, Curyto K, Kleban M, Eshraghi K, Duntzee CI, Spector A. The consistency of self-reported preferences for everyday living: implications for person-centered care delivery. J Gerontol Nurs. 2014;40(10):34–46.View ArticlePubMedPubMed CentralGoogle Scholar
  22. Delgado A, Martinez-Canavate T, Garcia V, Frias J, Rueda T, Morata J. Patient preference and stereotype about the gender of the family physician. Aten Primaria. 1999;23(5):268–74.PubMedGoogle Scholar
  23. Fennema K, Meyer DL, Owen N. Sex of physician: patient’s preferences and stereotypes. J Fam Pract. 1990;30(4):441–7.PubMedGoogle Scholar
  24. Graffy J. Patient choice in a practice with men and women general practitioners. Br J Gen Pract. 1990;40(330):13–5.PubMedPubMed CentralGoogle Scholar
  25. Jung HP, Baerveldt C, Olesen F, Grol R, Wensing M. Patient characteristics as predictors of primary health care preferences: a systematic literature analysis. Health Expect. 2003;6(2):160–81.View ArticlePubMedPubMed CentralGoogle Scholar
  26. Westwood S. ‘We see it as being heterosexualised, being put into a care home’: gender, sexuality and housing/care preferences among older LGB individuals in the UK. Health Soc Care Community. 2015;. doi:https://doi.org/10.1111/hsc.12265.PubMedGoogle Scholar
  27. Inoue M, Chapman R, Wynaden D. Male nurses’ experiences of providing intimate care for women clients. J Adv Nurs. 2006;55(5):559–67.View ArticlePubMedGoogle Scholar
  28. Boehnke K, Hagan J, Hefler G. On the development of xenophobia in Germany: the adolescent years. J Soc Issues. 1998;54(3):585–602.View ArticleGoogle Scholar
  29. Van Hoorn A, Maseland R. Cultural differences between East and West Germany after 1991: communist values versus economic performance? J Econ Behav. 2010;76(3):791–804.View ArticleGoogle Scholar
  30. Wagner U, Van Dick R, Pettigrew TF, Christ O. Ethnic prejudice in East and West Germany: the explanatory power of intergroup contact. Group Process Intergr Relat. 2003;6(1):22–36.View ArticleGoogle Scholar
  31. Jimenez DE, Bartels SJ, Cardenas V, Dhaliwal SS, Alegría M. Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care. Am J Geriatr Psychiatry. 2012;20(6):533–42.View ArticlePubMedPubMed CentralGoogle Scholar
  32. Keith PM, Braito R, Breci M. Rethinking isolation among the married and the unmarried. Am J Orthopsychiatr. 1990;60(2):289.View ArticleGoogle Scholar
  33. Seccombe K, Ishii-Kuntz M. Gender and social relationships among the never-married. Sex Roles. 1994;30(7–8):585–603.View ArticleGoogle Scholar
  34. Gold DP, Reis MF, Markiewicz D, Andres D. When home caregiving ends: a longitudinal study of outcomes for caregivers of relatives with dementia. J Am Geriatr Soc. 1995;43(1):10–6.View ArticlePubMedGoogle Scholar
  35. Hayslip B Jr, Han G, Anderson CL. Predictors of Alzheimer’s disease caregiver depression and burden: What noncaregiving adults can learn from active caregivers. Educ Gerontol. 2008;34(11):945–69.View ArticleGoogle Scholar
  36. Rossi Ferrario S, Zotti A, Massara G, Nuvolone G. A comparative assessment of psychological and psychosocial characteristics of cancer patients and their caregivers. Psychooncology. 2003;12(1):1–7.View ArticlePubMedGoogle Scholar

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© The Author(s) 2017

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