Nübling et al. BMC Public Health 2010, 10:428 http://www.biomedcentral.com/1471-2458/10/428 Background In the years and decades to come, industrial countries will have to face major challenges concerning geriatric care for their population [1]. In the geriatric care sector, the number of people requiring professional care will rise. In recent years, due to the decrease in informal care by family members and the demographic develop- ment, there has been a rise in professional care for elderly at home (home care, HC) or in long term care facilities like Geriatric Nursing Homes (GNH) [2]. Based on the statistics of the German Federal Statistical Office, 54% of the 2.25 million people in need of care require professional care in Germany (HC 502.232 and GNH 709.311) [3]. According to current forecasts, an increase of the group of people in need of care of nearly 7% is to be expected until 2010. Totally, the number of persons in need of care will increase to almost 3 million people in 2030 [2], which in turn will cause a rising need of employees in professional care, particularly within the geriatric care sector [4,5]. Simultaneously, a shortage of nursing staff is being expected, due to diminishing will- ingness to be trained as and to work as a nurse and the lack of financial resources in this health care sector [6]. In summary, for 600.000 trained and untrained nur- sing staff in HC or GNH [7] this means an increase in workload and work intensity. This especially mental or psychosocial workload - caused by the increase in care intensive clients (HC) and residents (GNH) as well as by the increasingly older nursing staff in the facilities - can lead in turn to growing psychosocial job stress for the nursing staff [8-11]. In the German Health Report 2003 for the long term care sector, nursing staff in GNH reported high time pressure due to high intensity of work [12]. They com- plained about not having enough time for the support of the residents and that frequently the work had to be interrupted. Further stressors reported were the aggres- siveness of some residents, or the handling with incur- able diseases and dying. This may have consequences for sickness absence, absenteeism, and for intention to leave the job and job turnover. According to data of a German health insurance company, the average rate of sickness absence of employees in the geriatric care sec- tor was 5.8% (21.3 days/year) compared to an overall rate of 4.9% (17.7 days/year) [13]. Hasselhorn et al. sum- marize from the results of the European NEXT-Study (Nurses Early Exit Study) that changes in job strain can affect fluctuations and nurses’ considerations of leaving their profession [14]. However, research results do not show high strain for the geriatric nursing staff for all aspects. In the German BELUGA-Study (BELUGA = Belastungsanalyse und gesundheitsforderliche Arbeitsgestaltung in der Page 2 of 12 Altenpflege; Analyis of stressors and possibilities for health-promoting work design in nursing homes for the elderly) with 1838 participants in 111 geriatric nursing homes and home care facilities the researchers reported for instance a moderate level of stressors in the nursing homes “ (e.g. low good cooperation between colleagues and supervisors, which the authors call “low social stres- sors”) and “predominantly positive” indicators of employees’ health (irritation, burnout, physical and men- tal health). Major problems reported were physical work load (lifting), high time-pressure and frequent interrup- tion of work [15]. Altogether for the geriatric care sector the current state of research on psychosocial workload is heteroge- neous. Additionally, no literature was found on the sys- tematic comparison between the workload and stress of nursing staff and other occupational groups, which would be necessary to evaluate the workload of the ger- iatric nursing staff in HC and GNH. The present study is intended to partly close this gap empirically with a survey on psychosocial workload and stress in geriatric care in the two groups: employees in home care and in geriatric nursing homes (long term care facilities, homes for the aged). Aims of the present study are to compare the psycho- social factors at work between these two study groups as well as with external reference data for nursing staff in general hospitals and with the general mean across all professions in the COPSOQ database (a database with profession specific reference values collected with the German COPSOQ). A second goal is the analysis of the impact of working schedule aspects (on-call duties, weekly hours worked) on psychosocial factors. Methods Instrument: the COPSOQ-questionnaire The well established German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work in geria- tric care. COPSOQ is a comprehensive tool for the assessment of psychosocial factors at work, originally developed in Denmark by Kristensen and Borg (Danish and English version). The goal of the authors was to develop a questionnaire that was “...theory-based but not attached to one specific theory”. The questions and scales are mostly derived from already existing instru- ments, the content was to be as broad as possible in order to take into account the indeterminateness of the issue of psychosocial factors at work [16,17]. A German standard version was formed in a validation study 2003-2005 with a detailed examination and assess- ment of the questionnaire’s psychometric properties and measuring qualities (e.g. objectivity, validity, reliability of