Fit for home again

Brain City Berlin

Can elderly people regain independence through targeted exercise and perhaps even return home from a care facility? This question was examined by Brain City Ambassador Prof. Dr. Uwe Bettig and his team at Alice Salomon University of Applied Sciences Berlin (ASH Berlin) in the CarePerform project—with surprising results. The regional domino-coaching Foundation is the partner of this project, which is funded by the BMFTR.

An elderly man falls in his apartment and breaks his thigh bone. After hospitalization and rehabilitation, he ends up directly in a nursing home because he can no longer care for himself. This is now an everyday situation. The number of people in need of care in Germany is steadily increasing. According to the Barmer Care Report 2025, 5.7 million people required care in 2023, almost twice as many as in 2015. And according to the Federal Statistical Office, about one-fifth of those in need of care currently live in care facilities. This poses enormous challenges for the German healthcare system. Spaces are becoming scarce and increasingly expensive, and care staff - especially for physically and mentally demanding long-term care - are hard to find. A promising approach, therefore, is to mobilize nursing home residents and enable them to return to their own homes. This is precisely what the domino-coaching Foundation, headquartered in Birkenwerder, Brandenburg, offers residents of its facilities at no additional cost. The domino-coaching™ concept: Eldery people are literally put back on their feet through an individualized training program. They become fitter, healthier, more independent, and mentally more balanced. This, in turn, relieves caregivers - and, for those who return home, the care system as a whole.

But how effective is the domino-coaching™ concept really? The foundation wanted a scientific evaluation and approached the HTW Berlin Berlin University of Applied Sciences (HTW Berlin) in early 2024. This led to the project “CareMore”, funded by the Federal Ministry of Research, Technology and Space (BFTR) with two subprojects: In the “CareLaw” project, HTW Berlin, under the direction of legal expert Prof. Dr. Martin Heckelmann, examined the legal framework. Brain City Ambassador Prof. Dr. Uwe Bettig, Professor of Management and Business Administration at ASH Berlin, took over the scientific leadership of the “CarePerform” project. From June 2024 to the end of November 2025, he and his team evaluated the foundation’s coaching approach in several phases. “I was initially a bit skeptical,” recalls Uwe Bettig. “Returning home from a nursing facility is rather unusual for people in need of care. But our results show that the coaching approach really works - because it improves basic mobility and reduces older people’s fear of falling.”

Coaching in this case means: Specially trained staff support elderly people in need of care over an extended period and carry out an individualized exercise program with them. At the beginning, both parties jointly define a treatment goal, which is regularly reviewed and adjusted as needed during the process. The programme is particularly intensive for so-called lighthouse patients, who are generally still quite fit and therefore have a greater chance of becoming more autonomous. Their training programme can last up to four hours a day. “Our study showed that independence improved significantly for all participants through training,” says Uwe Bettig. “About two-thirds of the lighthouse patients were actually able to return to their homes.”

In total, 67 people with an average age of 83.7 years were surveyed by the ASH Berlin team over a six-month period. All respondents had just been admitted to the domino coaching Foundation facilities in Tegel, Oranienburg, and Treptow at the start of the study. “First, we collected demographic data such as age, gender, education level, and living situation before moving into the facility. Exclusion criteria were severe cognitive impairments such as dementia and severe depression,” explains Uwe Bettig. Thirty-four study participants were categorized as “lighthouses” (Leuchttürme).

At three measurement points, all study participants were scientifically monitored for several months and surveyed using standardized instruments. The first phase began upon admission to the facility, the second three months later, and the third another three months after that. The interviews themselves lasted a maximum of 60 minutes to avoid overburdening the seniors. “We asked participants about their mobility, assessed symptoms of depression, determined their level of independence at each measurement point, inquired about fear of falling, and asked questions about health-related quality of life,” says Bettig. “We also assessed whether and to what extent individual development and therapy goals were achieved through coaching.” A core goal of domino-coaching is to improve the quality of life of those in need of care.

The study results confirmed that physical training can be effective even at an advanced age. “General health perception among all respondents improved significantly over the study period thanks to coaching, and physical pain decreased,” says Bettig. Perceived autonomy increased especially among the generally fitter lighthouse patients. Ultimately, both the residents surveyed, and the participating coaches were satisfied with the therapy goals achieved. Even small successes are motivating, as a parallel survey of staff conducted by ASH Berlin researchers showed. Bettig: “Caregivers’ satisfaction increases when they see measurable results of their work when people in need of care learn to walk again through coaching, stop falling, and perhaps even return home. As a result, there is hardly any staff turnover in the facilities we surveyed.”

And what happens after CarePerform funding ends? Ideally, according to Uwe Bettig, participants should be surveyed regularly over the long term to check whether the study results persist and whether participants remain fit and mobile. Berlin offers excellent conditions for projects like CarePerform. “Among the many outstanding research institutions here, it’s easy to find project partners,” says the Brain City Ambassador. The practical facilities in Berlin are also very open to science. “In our case, the domino-coaching Foundation approached us with a specific question, and from that emerged a great project that also benefited our students through theses and student assistant positions. That’s fantastic and typical Berlin!”

Author: Ernestine von der Osten-Sacken