Studie: Pflege-Personal wird zunehmend knapp

Demografie und Politik in DNEWS24

Studie: Pflege-Personal wird zunehmend knapp

Die wirtschaftliche Lage deutscher Pflegeheime hat sich seit dem Jahr 2019 leicht verbessert. 9 Prozent lagen 2021 im „roten Bereich“ mit erhöhter Insolvenzgefahr, 55 Prozent im „grünen Bereich“. Ab 2022 dürfte sich die wirtschaftliche Lage jedoch durch steigende Sach- und Personalkosten wieder verschlechtern. Die Trends zur Ambulantisierung und Privatisierung hielten an, die Personalknappheit nimmt zu. Durch die Alterung der Gesellschaft ist bis 2030 in Deutschland mit 5,7 Millionen Pflegebedürftigen zu rechnen, das entspricht einer Steigerung von 14 Prozent gegenüber dem Jahr 2021. Damit verbunden steigt der Bedarf an Pflegepersonal und Kapital.

Im Pflegebereich herrscht weiterhin Personalknappheit. In der ambulanten und stationären Pflege waren im Jahr 2021 insgesamt 1.257.000 Vollkräfte beschäftigt, davon 341.000 Pflegefachkräfte. Zwar sind zwischen 1999 und 2021 427.000 zusätzliche Vollzeitkräfte hinzugekommen. Es werden jedoch weitere Arbeitskräfte benötigt. Da dieser Bedarf derzeit am Arbeitsmarkt nicht vollständig gedeckt werden kann, besteht ein zunehmender Mangel an Pflegefachkräften.

Die wirtschaftliche Lage deutscher Pflegeheime hat sich seit dem Jahr 2019 leicht verbessert. Im Jahr 2021 befanden sich 9 Prozent der Heime im „roten Bereich“ mit erhöhter Insolvenzgefahr, 55 Prozent im „grünen Bereich“ mit geringer Insolvenzgefahr und 36 Prozent dazwischen im „gelben Bereich“. Im Jahr 2019 waren noch ca. 20 Prozent im „roten Bereich“ und 38 Prozent im „grünen Bereich“. Auch ihre durchschnittliche Insolvenzwahrscheinlichkeit sank zwischen 2019 und 2021 von 2 auf 1,2 Prozent. In den Jahren 2022 und 2023 dürfte sich die wirtschaftliche Lage der Pflegeheime jedoch wieder verschlechtern, insbesondere durch steigende Sach- und Personalkosten.

Das Marktvolumen der ambulanten und stationären Pflegedienste betrug im Jahr 2021 rund 72 Milliarden Euro. Der Anteil des Pflegemarkts am gesamten Gesundheitsmarkt ist zwischen 1997 und 2021 von 9,8 Prozent auf 15,2 Prozent gestiegen. Damit liegt die Pflege in ihrer Bedeutung aktuell an zweiter Stelle hinter den Krankenhäusern.

Die wirtschaftliche Situation der Heime war in Sachsen-Anhalt/Thüringen, Hessen, Berlin/Brandenburg/Mecklenburg-Vorpommern und Sachsen am besten, in Schleswig-Holstein/Hamburg, Baden-Württemberg und Niedersachsen/Bremen am schlechtesten.

Erneut wurden mehr Pflegebedürftige ambulant versorgt. Ihr Anteil lag im Jahr 2021 bei 24,4 Prozent. Gleichzeitig nahm die Anzahl stationär gepflegter Menschen 2021 erstmalig leicht ab.

Auch der Trend zur Privatisierung hat sich fortgesetzt. Wurden im Jahr 1999 noch 25,4 Prozent der Pflegebedürftigen in einer privaten Einrichtung versorgt, waren es im Jahr 2021 bereits 39,8 Prozent. In ambulanten Diensten stieg der Anteil zwischen 1999 und 2021 von 35,6 auf 54,4 Prozent. Die Zahl der Plätze in privater Trägerschaft stieg seit 1999 um 143 Prozent. Allerdings ist die Auslastung privater Heime 2021 mit 86,2 Prozent unter das Niveau von 1999 mit 87,3 Prozent gesunken.

Heime in privater Trägerschaft arbeiten insbesondere in Westdeutschland kostengünstiger als öffentlich-rechtliche oder freigemeinnützige Heime. Inklusive des Investitionskostenanteils lagen ihre Preise 6,7 Prozent unter dem westdeutschen Durchschnitt.

Hauptgrund für das Wachstum des Pflegemarkts bleibt die Alterung der Gesellschaft. Bei konstanten Pflegequoten wird es voraussichtlich bis zum Jahr 2030 in Deutschland 5,7 Millionen Pflegebedürftige geben, bis 2040 dürften es 6,4 Millionen sein. Das wäre gegenüber 2021 ein Anstieg um 14 bzw. 28 Prozent. Dieser hätte bei Fortschreibung des Status quo einen zusätzlichen Bedarf von 322.000 stationären Pflegeplätzen bis zum Jahr 2040 zur Folge. Die erforderlichen Neu- und Re-Investitionen beliefen sich entsprechend auf 81 bis 125 Milliarden Euro.

Um die steigende Zahl an Pflegebedürftigen zu versorgen, ist mehr Personal nötig. Bis 2040 ist mit insgesamt 163.000 bis 380.000 zusätzlichen Vollzeitkräften in der stationären und mit 97.000 bis 183.000 in der ambulanten Pflege zu rechnen. Auf Pflegefachkräfte entfällt davon bis 2040 ein zusätzlicher Bedarf zwischen 124.000 und 210.000 in der stationären und ambulanten Pflege.

Damit der große Bedarf an Pflegefachkräften gedeckt werden kann, muss der Pflegeberuf attraktiver werden. Das könnte zum einen durch höhere Löhne geschehen. Zum anderen spielen auch weiche Faktoren eine wesentliche Rolle, z.B. eine gute Führungskultur, gesellschaftliches Ansehen des Berufs, eine gute Vereinbarkeit von Familie und Beruf, möglichst wenig Bürokratie, Karrieremöglichkeiten sowie die Übernahme von Verantwortung. Zudem steht die Altenpflege vermehrt im Wettbewerb mit Krankenhäusern, ein leichter Sogeffekt lässt sich bereits feststellen.

Darüber hinaus könnte die Zuwanderung qualifizierter Pflegefachkräfte den Fachkräftemangel lindern, zudem sollte auch in der Pflege verstärkt über arbeitssparenden Technikeinsatz nachgedacht werden. Eine Möglichkeit ist die Nutzung innovativer Technik im Bereich Ambient Assisted Living (AAL). Hier könnte moderne Technologie die Pflegekräfte unterstützen und ihnen mehr Zeit für zwischenmenschliche Beziehungen zu den Pflegebedürftigen geben.

Neben Personal wird überdies mehr Kapital benötigt, insbesondere privates Kapital. Dieses wird jedoch nur eingesetzt, wenn es risikogerecht verzinst wird. Die Politik sollte daher die Regulierungsdichte reduzieren und die unternehmerische Handlungsfreiheit ausweiten. So sind zum Beispiel Vorgaben zur Heimgröße oder zum Anteil der Ein-Bett-Zimmer überflüssig. Wichtig ist vielmehr, dass es ein ausreichend großes Angebot an Einrichtungen gibt, die miteinander in einem Preis- und Qualitätswettbewerb stehen. Dazu muss die Pflegequalität leicht verständlich dargestellt werden. Dann können sich die Pflegebedürftigen und ihre Angehörigen das Heim aussuchen, das ihren Präferenzen am besten entspricht und das für sie noch bezahlbar ist. Wenn die Politik indessen restriktive Vorgaben macht, läuft sie Gefahr, dass sie entweder nicht die Präferenzen aller Pflegebedürftigen trifft oder nur zu teure Angebote zulässt.

„Die Gesellschaft wird weiter altern. Um die damit verbundene steigende Zahl der Pflegebedürftigen adäquat versorgen zu können, braucht die deutsche Pflegebranche in den nächsten Jahren zusätzliches Personal und Kapital“, sagt RWI-Pflegeexpertin Dörte Heger. „Es gilt, Pflegeberufe attraktiver zu machen und so die Personalknappheit zu überwinden“, so Heger.

Bild: Clay Banks unsplash

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