Home | CONTACT US

Dr. Thomas Moeltgen, head of the department of matters of principles and parish relations at Caritas, the Catholic social services agency in Cologne, Germany, visited Sagamore Institute on February 28, 2007. Along with the Indianapolis-Cologne Sister City Committee, Foundation for Lutheran Child and Family Services and the Max Kade Center at IUPUI, Sagamore hosted a luncheon discussion featuring the following keynote address from Dr. Moeltgen.

When Sven Schumacher asked me whether I would be interested to speak about the faith aspect of our church welfare work at Caritas, the catholic charities organization of Cologne, here at Sagamore, I accepted the invitation with joy for two reasons:

First of all and with great gratitude, I remember the 2003 Heartland Symposium on Faith Based Organizations, organized by Jay Hein, then of Hudson Institute, which took place under the patronage of the former Ambassador of the United States to Germany, the Honorable Daniel Coats. Mr. Hein later founded Sagamore, and Ambassador Coats now serves as Sagamore’s co-chairman of the board. That excellent symposium gave us a good view over the vivid social work in the USA, carried out by the Christian faith, especially in Indianapolis, the sister city of Cologne.

Therefore it is an honor for me to be here again. And I am honored to see how much institutions are supporting this event today. So Ms. Daniels thank you very much indeed for giving me the opportunity to give a little contribution to a continuing transatlantic dialogue.

The second reason is that that I’m pleased to give you, ladies and gentleman, an idea on how the welfare service of Caritas Cologne works. Further, I shall try to explain the organization of the social work in Germany to clarify how the dimension of faith on both sides of the Atlantic, in different ways, is an important basis of the work. Ambassador Coats, at the aforementioned symposium, had already outlined the substantial difference between our health systems. “Contrary to popular opinion, there is far less separation of church and state in Germany and most parts of Europe than in the United States. Both the Catholic and the Protestant churches in Germany have quasi-official roles in policy matters, ranging from public broadcasting to the delivery of social welfare services. Yet many Europeans instinctively reject the possibility that expressions of religious passion, religious commitment, or life-changing ministries have any place at all in dealing with the problems of the political and social world. ” (Daniel Coats, Indianapolis 9/2003).

So let us take a view of a small part of the German health system, the ambulatory nursing for the sick. All of the 16 Caritas Associations in our Diocese (which covers 2400 square miles with 2.2 million Catholics out of 5.1 million citizens) together run about 50 ambulatory nursing units with about 10 to 20 nurses each.

Some other figures on Caritas in the Archdiocese of Cologne:

-57 Hospitals with 15,000 Beds

-160 Nursing Homes for 15,000 people

-43 Houses for disabled persons

-3 Hospices and 3 palliative care units

-More than100 ambulatory nursing units who daily serves about 16,500 people

-15 counseling and treatment facilities for drug and alcohol dependent persons

-13 Hospitals for drug dependent for 1,800 People

-21 counseling units against abortion

-32 Family supporting units

-836 catholic kindergartens for about 56,000 children in 2,500 Groups

-6 Hotels for family holidays

-4 Homes for women

-1 Home for mother-child cure

-16 parent counseling services

-12 counseling units for people with marriage, family or other problems

-36 counseling units for immigrants

-2 homes for young immigrants

-8 counseling units and center for jobless people

-8 counseling units for disabled people

-14 counseling units for debtors

In the Federal Republic of Germany there are two kinds of health insurances: The legal health insurance (GKV) and the private health insurance (PKV). The legal health insurance secures approximately 90% of the population against the risks of illness. It has the task to receive the health of the insured ones, to restore or to better it. The insured ones and their relatives enjoy insurance protection after the social legal code XI.

Insured are, for example: workers and employees, university students, home workers, people who are running an own business, teachers, unemployed person, farmers, retired persons, artists and journalists.

The health insurance covers:

-Medical check-ups

-Measures for preventing of diseases for example:

Protective inoculations, dental prophylaxis)

-Medical and dental treatment

Artificial dentures, pharmaceutical supply, cure treatment, orthopedic supply

-Rehabilitation measures; costs for transport; nursing at Hospital

-Medical home care and nursing support

-Support and treatment during the pregnancy and after giving birth

-Sickness benefit (after legal 6 weeks continuation of wage payments by the employer)

-Sickness benefit because of care of a child under 12 years

-Maternity benefit with subsidy by the employer.

For the purpose of cost-cutting, additional payment regulations exist. The insured ones must pay a fee for physicianattendance (practice fee) one time in a quarter of a year (10 €), for drug supply, surgical dressing, cure, aid, stationary precautions and rehabilitation measures, hospitalization, artificial dentures, medically necessary travels. For certain groups of needy persons there is a whole or partial release from the additional payments. The expenditure delimitation in the legal health insurance is a central task, in order to keep the health system efficient and payable.

We are now just looking on the range of change in the ambulatory nursing for the sick. The Caritas Associations in the 1970s took over the ambulatory nurses from the parishes where they had been employed. In the Church’s concept in caring of the ill and old people in our diocese of Cologne, they found it necessary to improve and standardize the supply. In the meantime independent Caritas associations have been established on a regional level. And with them Caritas care stations were also established. 

At these the former nurses of the district were united. The Caritas associations have to operate the station economically. From the very beginning one knows that in fact not all of the nurses’ services of that time were accountable at the health insurance companies, because they went beyond the range of the medical care. The church decided to take over these costs and balanced the deficits of the Caritas association. It was a really comfortable situation for the managing directors to deal with. These non-accountable services were to be assigned the church origin service with a religious range. Independent of these measurements the deficit rose ever more, whereby an improvement of the Church’s intended service was not to be observed.

The year 1996 brought a dramatic economic acceleration to the care stations. The services starting from this year on were not longer paid in accordance to a used service time but to a defined service complex. So it would not matter in which condition the patient was and how much time the nurse actually needed for the service.

I’ll give you some examples of the remuneration agreement. The following services are bound in service complexes and describe performance-referred and not time-dependent activities for people in need of care in the German State of North Rhine Westphalia, where Cologne is locate.

I will give you four examples of the 30 defined service complexes:

Each service has a point value and each point is worth of approximately $0.06, or €0.04. 

Service complex: Complete Washing

service contents:

1. Washing, showering, bathing

2. Mouth, teeth and lip care

3. Shaving

4. Skin care

5. Hair care (if necessary washing)

6. Nail care

7. Dressing and undressing inclusive placing of prosthesis

8. Preparing and cleaning of the work area

Points 460 = $27.60

Service complex: Accompanying Persons to Authorities and Physicians

service contents:

1.Accompanying persons in need of care

360 Points = $21.60

Service complex: Assistance in Food Intake

service contents:

1. Preparing of food (warming up food, also delivered food)

2. Preparing of the person in need

3. Disposing of the necessary materials

4. Cleaning the work area

5. Knowledge transfer for correct nutrition (e.g. Diabetics)

100 Points = $6.00

Service complex: Small Assistance

service contents:

1. Change of the bed linen

2. Arrange the bed

80 Points = $4.80

As you see, no longer is time alone money, but you have to pack more service in the same time.

The services are of very different kind and costs, so that some achievements can be conducted also by persons who are not a nurses with a diploma. On the other hand, certain persons (e.g. people suffering with AIDS or Alzheimer disease) need more time to get an appropriate care, which is not recompensed within these sums.

Additionally, the competition has been intensified. One result of this competition is that some of these health care companies are only looking for low or good risks. They reject caring those who are not able to be served at the government-set fee. So most of the very ill patients are being cared for by churches’ welfare organizations at higher costs, which are not to be remunerated.

Lets hear once again from Ambassador Coats. “The discussion of faith, and the use of faith as a healing tool for many of our social ills, is something that is becoming much more widely accepted. ” Within the Catholic social services, our employees live their private faith. In Germany people are very shy to express their personal faith or to confess it. But because of the mission statement of Caritas there is a necessity to connect faith to work and vice versa.

There are three forces, which are to be considered to play a role for faith integration into our social work in Germany: 

-The strong economic pressure on the quasi-official institutions

-The increasing separation of the Caritas services from their original basis, the churches in the neighborhood

-The barely existing operational integration of faith and social work.

So how do we meet these three measured variables in our work?

First, if the service tenderer stands in the market competition, then the CEOs must be convinced that a faith-based service for the user has an increased value. Since these could not be furnished by the paid personnel, a new co-operation with the local churches had to be developed.

The care units are making contracts with the churches of the district. A goal of these agreements is it to fix a supporting service to the nurses’ job. The churches are looking for volunteers and ask them which service they would like to do. The list of these voluntary services becomes a part of the care units’ services. The volunteers are being supported by local chaplains and members of the staff of the care unit.

The local church now is further interested in supporting the nurses in their difficult job. On-the-job nurses offer the additional services to the persons in need of care. In case of a need they generate an inquiry, which is passed on to the volunteer coordinator of the church. This person then contacts the appropriate volunteer and brings her or him in contact with the ill person. If the person in need accepts the volunteer, the service can then take place.

From the perspective of the people in need of care there is one comprehensive service which is able to satisfy his or her needs. For the care station this is an important competitive advantage.

The volunteers are recruited either in a direct face to face contact for the work, which is most successful way, or by a special Internet homepage, where we are getting more and more interested volunteers.

Our hope is that these non-Church volunteers, like Saint Augustine once said, are moving from serving to praying while the believers more closely connected to the Church move from praying to serving.

Second, with the concrete inclusion of the volunteers of the parish into the Caritas service, the responsibility of the church for the patients is again established.

The task of the parish and its clergy is it to give the people in action spiritual assistance. The co-workers of the special services are supporting this effort. Primarily, we don’t speak of training for the job but of a qualified assistance for the volunteers. It’s not our way to generate quasi-professional coworkers.

Beyond that, the volunteers obtain a different picture of social reality inside the parish.

Under the outlined condition of the private faith, a model was developed at Caritas, in which the employees in a narrative procedure are invited to speak about their motives and concerning social work in a faith context. This material is offered to the wider community of coworkers to discuss the faith issue and to reflect the design of their own Caritas services.

Now in Germany there is a renaissance of the discussion about faith questions. The process has been accelerated by the outstanding Encyclical Letter DEUS CARITAS EST of Pope Benedict XVI. “Church agencies, with their transparent operation and their faithfulness to the duty of witnessing to love, are able to give a Christian quality to the civil agencies too, favoring a mutual coordination that can only redound to the effectiveness of charitable service. Numerous organizations for charitable or philanthropic purposes have also been established and these are committed to achieving adequate humanitarian solutions to the social and political problems of the day. Significantly, our time has also seen the growth and spread of different kinds of volunteer work, which assume responsibility for providing a variety of services...For young people, this widespread involvement constitutes a school of life which offers them a formation in solidarity and in readiness to offer others not simply material aid but their very selves. The anti-culture of death, which finds expression for example in drug use, is thus countered by an unselfish love which shows itself to be a culture of life by the very willingness to ‘lose itself’ (cf. Lk 17:33 et passim) for others.

“In the Catholic Church, and also in the other Churches and Ecclesial Communities, new forms of charitable activity have arisen, while other, older ones have taken on new life and energy. In these new forms, it is often possible to establish a fruitful link between evangelization and works of charity.”

 Thank you very much for your attention.