Germany – the overview

Caretaker job market analysis

Nursing staff are in demand throughout Europe. According to figures from the Employment Agency (for Germany), the unemployment rate among nursing staff is below 2% and continues to decline. Due to the demographic development, the shortage of personnel in the nursing sector will continue to increase. The training of hearing impaired people can be a countermeasure to the increasing shortage of personnel and an example of functioning employee mobility and inclusion in the EU.

The unemployment rate in Germany in the last years: 

Statistics on employment of people with disabilities in Germany:

Represented in all sectors of the economy:

1. Manufacturing – 265,000
2. Public service sector – 215,000
3. Services – ??
4. Healthcare – 76,000
5. Nursing & social services – 73,000

Statistics on the deaf and hard of hearing in Germany:

About 80,000 deaf people       (German Association of Deaf)

16 million hearing impaired      (German Association of hearing disabled)

140,000 with degree of disability of more than 70%, these people need the sign interpreters

The rate of unemployment of deaf people is much higher than the unemployment rate of people without hearing impairments. The exact numbers are unknown.        (German Association of deaf people)

The number of people who depend on care services is growing. Correspondingly, the demand for nursing specialists will increase from 1.9 million people in 2015 to around 2.3 million people in 2035. In the same period, the supply of qualified specialists will increase from 1.46 million just to 1.56 million people because of the stagnating number of trainees in the health professions in recent years. Nursing is currently lacking 30,000 specialists, and the trend is rising.

84% of nursing and caretaking  jobs require VET, 16% are auxiliary jobs. Almost every person wishing to work in nursing have to visit a professional training of 3 years and pass exams successfully. Auxiliary jobs need no special qualifications, but are paid badly.

Qualifictaion requirements for caretaking professions

The requirements for training or retraining as a nursing/caretaking specialist in Germany are:

• Personal and health suitability 
• Secondary school certificate or another school qualification recognized as equivalent of 10-year school education OR
• Secondary school certificate plus a completed at least 2-year vocational training or at least 1 year of training as a nursing assistant or geriatric care helper

Existing VET learning programs for caretakers

The VET as a nursing specialist is divided into a theoretical and a practical part. In the theoretical part of the nursing training, which comprises a total of 2,100 hours. Nursing-relevant knowledge is imparted in the following areas: Health and nursing, Nursing and health sciences, Science and medicine, Social sciences and humanities, Economy, law and politics.

The practical part comprises 2,500 practical hours in inpatient and outpatient  facilities in various fields: Internal Medicine, geriatrics, neurology, pediatrics, psychiatry, Maternity and infant ward, gynecology, surgery, orthopedics.

The 3-year VET as a nursing specialist ends with a Chamber of Commerce and Industry exam consisting of a written, oral and practical part. The written and oral parts are based on the specialization in nursing, pediatric nursing or elderly care

New generalized nursing/caretaking professions law came into force on 01/01/20. Accordingly to this law one become professional qualification as a nursing specialist without age grading (like “child nursing” or “elderly care” etc.), this qualification is automatically recognized across the EU. Further bachelor level in nursing possible.

(BUT there are NO bachelor programs in nursing for people with hearing impairment!)

There are three qualification levels of VET in nursing in Germany:

• Level 1: state-recognized full level “Nursing specialist”, “Elderly caretaker” (medical and hygienical care, patient monitoring, documentation)
• Level 2: state-recognized “Nursing assistant”, “Elderly caretaker assistant” (Functions: personal body care, support, everyday help, medication)
• Level 3: “Qualified practitioner in care”, “Qualified practitioner in personal service” (school certificate is not needed. Functions: classical housekeeping, personal support and help of elder or sick persons in their everyday life.

VET learning programs in caretaking for deaf

The choice of possible career opportunities for people with hearing disabilities has not notably grown in the last years throughout Europe and the number of available qualifications is way below the wishes of the deaf and Hard-of-Hearing.

The VET opportunities for deaf and hearing impaired in the area of caretaking in Germany is possible, but often limited to ”caretaking assistant assistance” formally considered to be a starting qualification in the caretaking field.

There are different kinds of educational centres in Germany, which provide VET trainings for people with disabilities:

• Vocational Training Rehabilitation Centres (BBW) : 51 nationwide

    Training options: vocational training and post-secondary vocational courses for young people, residential care, medical supervision and psychological support; usually specialise in certain types of disability.

• Vocational Reintegration Training Centres (BFW): 31 nationwide

    Training options: education and training /re-education of people with work experience, boarding school, medical supervision and psychological support; partially specialize in certain types of disability.

• Similar educational institutions

     Training options: see above (as in BBW and BFW)

• Sheltered Workshops for people with disabilities: 682 nationwide

      Opportunities: Pre-assessment/training/working experience for people who, due to disability (mental retardation, high degree of physical disability, severe mental illness) (so far) are unable to find employment in the general labour market.

• Other local educational institutions

    Possibilities: If people with disabilities do not need the special services of the BFW/BBW Rehabilitation Centres, training or retraining can be provided at the local educational institution

• On-the-job training/re-qualification in the employer’s company

Though any person has a right to take part on VET couse of choice, people with hearing impairments are usually not able to learn nursing at a conventional VET-facility together with other students without hearing disabilities. Mostly there need special learning and exam plans, and adopted environment needed.

Special VET- schools for deaf and hard of hearings:

Currently there are just two professional schools throughout Germany, where deaf young people can learn nursing at the state-recognized full level (level 1). Some other professional schools for people with disabilities offer only educational programs for “-helper” or “-assistance” in care (level 2) or even housekeeping (level 3), which is not so good qualified and paid but still hardworking. (equial rights, equial chance)

Nursing specialist (state-recognized full level), elderly caretaker (IBAF-Deaf College)

During the training time besides the subject-specific content, communicative skills in dealing with own hearing impairment will be developed and role behavior will be practiced. The teaching content is adapted to the learning forms and abilities of the deaf trainees. In the area of ​​communication special classes are offered to promote written language skills. 

Elderly caretaker (state-recognized full level), elderly caretaker   (Paulinenpflege, Wurttemberg)

Visualization is used to simplify learning for prospective geriatric nurses. Hearing impaired people rely heavily on vision, so they learn in rooms with good natural light. Sound-optimizing measures are also beneficial for this. Small classes are divided according to learning level and two teachers teach so that everyone can understand at their own pace. 

 Special VET- schools for deaf and hard of hearings:

Nursing assistant (Regional education centre for hearing impaired of the Federal State Lower Saxony, Osnabruck) 

• Closed VET-programs in elderly care for people with hearing impairments (Berlin, Leipzig etc.)
• NEW: “Qualified practitioner in personal service” (different special VET-centers/schools for people with disabilities) – 3 years

 Medical or caretaking organisations:

The Hospital zum Heiligen Geist in Hamburg trains and retrain in two professions:

– Elderly caretaker

– Nursing assistant

The nursing school of the Hospital has already trained some hearing impaired people. The teachers know the special situation of the hearing impaired. The school offers tutoring and support. Of course, the lessons take place in German sign language (or Manually coded languages) with interpreters.

 Pilot projects in similar areas

1. JSB_Association, Federal State of Bavaria: Deaf people as hospice helper for the deaf people, course in German sign language. During seven weekends, 10 participants were trained in topics such as psychosocial aspects of dying, work in the hospice service, grief, etc. by experienced experts from various fields, such as the deaf neurologist Dr. Inge Richter or the palliative care physician Dr. Roland Martin Hanke. The training ended in February 2017 with the “Certified Hospice Helper” certificate. The helpers can assist deaf people in German sign language both on an outpatient basis and in hospice facilities. 

2. GIA Competence Center Essen. Dementia attendant training for deaf and hearing people. Deaf people with dementia who live at home need accompaniment, entertainment, employment, some activites. The best of it they can become from deaf people who want to work with people and want to qualify themselves. The qualification measure is accompanied by sign language interpreters and the GIA Competence Center Essen.   

Challenges:

Pedagogical and methodological difficulties in the learning process:  

The teaching in schools for children with hearing impairment is mainly done in sign language and leads to serious linguistic or written deficiencies.

A spoken and simultaneous practical presentation of learning material – completely normal for hearing people – is not possible for people with hearing impairments. In contrast to hearing people, the individual training contents must therefore be conveyed verbally and/or visually step by step in advance, only then can practical instruction and implementation take place.

People with hearing impairments have the same period to complete VET as non-disabled persons. For the hearing impaired, the training content must therefore be conveyed in an extremely condensed form from the first day of training, because it must be transported via intermediate steps, such as translation into sign language. In the process, the young adults are constantly required to perform at their best in terms of concentration.

Teachers in vocational schools usually teach in spoken language with sign language support. Practical lessons are held in small classes, if possible, and the teaching material is prepared and offered by the teachers specifically for the hearing impaired or deaf, supported by illustrative material and visualization tools. Additional assistance could be provided by a lexicon of technical terms developed especially for the industry.

Problems and difficulties in the learning process:

• Written examination tasks as a hurdle
• Deafness is usually accompanied by a strong reduction in vocabulary, reduced grammar and syntax. 
• Especially written tasks are the biggest challenge for the trainees. Although the trainees are prepared very intensively for the written tasks in advance, examination tasks are often very difficult to solve from the point of view of the trainers and the trainees.
• Therefore, the concise formulation of the examination tasks, combined with a multitude of foreign and technical terms, is often incomprehensible for the hearing impaired trainees. In the past, grammatically difficult sentences sometimes led to hearing impaired trainees only partially completing exams despite existing knowledge because they either did not understand the exam tasks at all or interpreted them incorrectly. 
• The time for understanding and completing the examination tasks is sometimes too short. Foreign words and technical terms make understanding even more difficult. Thus, reading and understanding the written examination tasks takes a lot of time, which is missing for answering the tasks. Many of the trainees would prefer more multiple-choice tasks, as they are easier to understand and can therefore be solved in less time. As a result of the new examination structures for the extended final examinations, the teaching of training content has become more difficult in some cases, since certain training content is already examined and assessed in Part 1 of the extended final examination – and thus earlier than before. On the other hand, the step-by-step approach to training has been retained after the implementation of the extended final examination.

Organizational and technical problems in the learning process

• structural barriers (e.g. regional labour market; requirements for employment positions; availability of suitable jobs), 
• procedural barriers (e.g. in counselling and employment services, in providing assistance and information) 
• mental barriers (e.g. prejudices, lack of knowledge, thoughtlessness, indifference) 
• barriers which are in people themselves (e.g. stress limits, qualifications, application behavior, lack of information)