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An Occupation with Too Little Appeal

Professional nursing assistants for the elderly and infirm remain active in the occupation for an average of only 8.4 years. Tobias Hackmann, an expert in public finance at the University of Freiburg, argues that this must change if Germany is to avoid a chronic shortage of trained healthcare workers in this sector in the future.


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Nursing Assistants leave the profession too early: This must change if Germany is to avoid a chronic shortage of trained healthcare workers in this sector in the future. (Foto: © gilles lougassi -


Germany’s population is aging—and needs more care. But the market for nursing assistants can’t keep up with this development. Tobias Hackmann, an expert in public finance for the chair of Prof. Dr. Bernd Raffelhüschen at the University of Freiburg, has calculated in his study Developments in Professional Healthcare in the Face of Demographic Change that the amount of persons dependent on full-time care will nearly double between the years of 2007 and 2050: from circa 2.3 million cases to around 4.4 million. In the same time period the amount of full-time nursing assistants is expected to increase by only 30 percent, from 316,000 to 420,000.

Nursing Assistants Leave the Profession Early

According to Hackmann, the main reason for this lies in the fact that most nursing assistants engaged in care for the elderly and infirm only remain active in the field for a short time—for an average of only 8.4 years. The typically better trained geriatric nurses, on the other hand, remain active for around 13.7 years on average. Young nursing assistants in particular tend to change their field of employment quickly: While assistants of the age of 36 work in the sector for an average of 11.2 years, those aged 19 remain in the occupation for only 2.8 years. When all ages are taken into account, geriatric nursing assistants only remain employed in the sector for an average of 8.4 years. As Hackmann explains in his study, the high dropout rates among young assistants may be put down to the fact that they receive an impression of the occupation during training that often does not correspond to reality. In addition, it is easier to change occupations while one is still young and does not yet have a family to support. The economist believes that a part of the increased future demand for geriatric nursing assistants could be covered if young assistants were motivated to remain longer in the occupation: If it were possible to increase the average career length to around 13.7 years by 2050—a length similar to that of registered nurses—the amount of full-time geriatric nursing assistants could rise from 260,000 to 680,000. Then it would be possible to meet the expected demand by attracting an additional 48 percent to the occupation—on top of the projected 30 percent increase.

The Occupation Must Become More Attractive

On the basis of his analysis, Hackmann concludes that employers, training institutions, politicians, and scientists will need to weigh various measures for increasing the length of careers in geriatric care carefully in the future. The length of training and the nature of the occupation also appear to have an impact on career length, because the better qualified assistants for general nursing remain in their occupation longer than those in the area of geriatric care. Since young assistants at the beginning of their career are likely to leave the occupation early, future changes should cater expressly to their needs. Not only would this lower the dropout rate, it would also make the occupation more attractive, thus leading to an increase in the amount of trainees. Moreover, Hackmann argues that the industry should offer incentives to win back those who have already left the occupation. In the end, the right combination of measures would make it possible to prevent the impending crisis in geriatric care.

(Tobias Hackmann’s study was published in: Nienhaus, Albert (Ed.): Gefährdungsprofile. Unfälle und arbeitsbedingte Erkrankungen in Gesundheitsdienst und Wohlfahrtspflege. Landsberg/Lech, 2010.)

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Dipl.-Vw. Tobias Hackmann

Tobias Hackmann serves as research assistant at the Chair for Public Finance I, headed by Prof. Dr. Bernd Raffelhüschen, and works at the Inter-Generational Contracts Research Center of the University of Freiburg. He studied economics in Freiburg and Lund, Sweden, until 2007 and is currently completing his doctoral thesis. At the Inter-Generational Contracts Research Center he researches and publishes on topics like the healthcare employment market, health economics, and demographic change. He also serves as project leader in several expert advising projects on healthcare for public and private institutions. In April 2011 Hackmann received the prize for the best contribution at the yearly conference of the German Society for Health Economics, held at the University of Bayreuth, for his talk on “Career Length in Healthcare in Light of Increased Life Expectancy.”


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Active time of female nursing assistants after their period of education (Statistic: Hackmann)    Personnel requirements of full-time professional nursing in the year 2007 - 2050 (Statistic: Hackmann und Moog und Statistisches Bundesamt)
   Supply and demand of full-time professional nursing in the year 2007 - 2050 (Statistic: Hackmann)
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Comparison of active time of nurses and nursing assistants (Statistic: Hackmann)   Personell progress with different active time (Source: IABS 1975-2004)    


















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