[Requirements and provision of services for severely handicapped patients according to SGBV regulations 1991-1993].

Benefits for non-institutionalised severely disabled persons by the German statutory health insurance system were introduced in 1989 and extended in 1991. They were provided depending upon a standardised medical examination. We analysed 4185 examinations carried out in the city and the region of Augsburg in Southern Germany during 1991-1993 with regard to social and medical conditions of applicants. A total of 2706 persons examined (64.7%) were considered to meet the criteria of permanent dependence on nursing. The majority of applicants were more than 75 years of age (56.9%) even though all age groups were represented. The leading cause for dependence on nursing were diseases of the circulatory system (29.4%), followed by diseases of the nervous system (20.5%) and musculoskeletal disorders (14.6%). The main burden of nursing care was borne by the relatives; professional institutions played only a minor role. The degree of dependence with regard to basic activities of daily living, especially "turning in bed", "dressing" and "using toilet" showed the strongest association with the overall assessment of nursing dependence. With the introduction of a new nursing care insurance system in Germany ("Pflegeversicherung") in January 1995, benefits for disabled persons have been extended further. To improve prevention of nursing-care dependence and to ensure the best possible care of patients in need of such care, further investigations are required which should focus on risk factors for both nursing-care dependence and long-term nursing home and hospital admission of disabled persons.