Five involvement indicators were: main caregiver (yes [indicator met] or no by self-definition), expenditure of time (high [indicator met] = daily for 3 to 6 h or longer or low = once to multiple times a week for a minimum of an hour), level of care (serious level of care [indicator met] = level 3, 4, and 5 or minor level of care = level 1 and 2), dementia in care recipient (yes [indicator met]/no), professional help (day care facility and / or ambulatory care = yes [indicator met]/no). Subsequently, involvement indicators were added up to determine the mean number. The number of involvement indicators ranges from 0 to 5 with higher results indicating a higher involvement in care. In order to determine the level of care (i.e., the third care involvement indicator) on the basis of the German long-term care insurance guidelines according to the German Social Security Code XI, items in six modules contribute to the final score: 1) mobility = 10%; 2) either cognitive and communicative abilities; 3) behavior and psychiatric problem = 15%; 4) self-care = 40%; 5) dealing with requirements because of illness or therapy = 20%; and 6) organization of everyday life and social contacts = 15%), which are weighted differently. The score ranges from 0 to 100, with higher scores indicating worse condition. An applicant receives level of care 1 if the total score is > 12.5, indicating minor impairments of autonomy or of skills; level 2 means considerable impairments, level 3 means serious, level 4 means severe, and level 5 means most severe impairments of autonomy or of skills with 90 to 100 overall points [25].

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