By Yvonne Dauer
In its session of 27 November 2015, the Federal Council approved the law passed by the Bundestag to improve hospice and palliative care in Germany. Its main contents can be summarised as follows.
The new law aims to achieve several goals: the expansion of palliative care in structurally weak and rural regions and support for the hospice movement; the networking of medical and nursing care services with hospice support and cooperation among the providers involved; the anchoring of palliative care as part of standard care in primary and specialist medical care, home nursing care and the nationwide spread of specialised outpatient palliative care (SAPV); the improvement of financial support for inpatient children’s and adult hospices and outpatient hospice services; the strengthening of palliative care and hospice culture in residential care facilities and hospitals; and targeted information for insured persons about existing hospice and palliative care services, as well as individual care planning for the last phase of life for nursing-home residents.
The main measures at a glance
- Improvement of outpatient palliative care and promotion of networking in standard care. This includes the introduction of additionally remunerated services in the contracted medical sector. These services will initially be financed by statutory health insurers outside the regular budget.
- Strengthening of palliative nursing care. The entitlement to home nursing services in relation to outpatient palliative care is clearly defined by law. In addition, the Federal Joint Committee is tasked with specifying the care requirements for palliative nursing care.
- Facilitation of specialised outpatient palliative care. To promote SAPV further, especially in rural areas, contractual implementation is made easier. A statutory arbitration procedure is intended to facilitate even controversial contract negotiations and offer solutions. It is also clarified that specialised and general outpatient palliative care may be regulated jointly in selective contracts.
- Strengthening of inpatient hospice care and outpatient hospice work. Inpatient hospices are to receive stronger support through increased funding. In future, health insurers will cover 95 percent of eligible costs, taking into account benefits from long-term care insurance; previously the figure was 90 percent. The daily minimum subsidy from health insurers for inpatient hospice care will be increased to nine percent of the monthly reference value under section 18 paragraph 1 of Book IV of the Social Code; previously it was seven percent. In outpatient hospice work, material costs as well as personnel costs will be considered in funding by health insurers. From the point at which outpatient hospice services provide end-of-life accompaniment, insurers should grant funding promptly. The ratio of full-time and voluntary staff should meet current care requirements, and outpatient teams should also be able to work in inpatient facilities.
- Introduction of an entitlement to advice and assistance. To ensure that affected persons are optimally informed, an explicit entitlement is created to individual advice and assistance from statutory health insurers in selecting and using palliative and hospice care services.
- Promotion of hospice culture in residential care facilities. Hospice culture and palliative care in residential care facilities will be improved further. It is clarified that nursing measures for end-of-life accompaniment are part of care according to the generally recognised state of medical and nursing knowledge in inpatient and outpatient care under Book XI of the Social Code.
- Improvement of medical care in fully residential care facilities. Medical care in fully residential care facilities is improved by encouraging these facilities to conclude cooperation agreements with contracted medical service providers. Participation by contracted physicians in such cooperation agreements is financially supported. Financing is initially provided by statutory health insurers outside the morbidity-based total remuneration.
- Incentives for individual, holistic counselling. Fully residential care facilities and facilities for the integration of people with disabilities should offer counselling to reduce residents’ fears about dying and strengthen their self-determination in the last phase of life. Financial incentives are set so that these facilities provide and organise individual, holistic counselling in cooperation with other care providers and service providers. Requirements and contents of the counselling are agreed uniformly in a framework agreement between the National Association of Statutory Health Insurance Funds and the relevant federal organisations representing the interests of these facilities. The counselling is financed by statutory health insurers.
- Support for palliative care units in hospitals. To support palliative care units, the option of negotiating hospital-specific fees instead of nationally calculated flat-rate fees is strengthened.
This text is based on the bill; its contents have been adopted in meaning and in some cases also verbatim.
