Minister Gröhe: "Terminally ill people should not be left alone"
On 17th June 2015, the German Bundestag came together for the first reading of the Act to improve Hospice and Palliative Care in Germany.
The Bill envisages reforms in the statutory health insurance, the social long-term care insurance and the hospital system. It contains regulations on out-patient palliative and hospice care for insured persons in their home, as well as provisions on in-patient care in long-term care facili-ties, hospices and hospitals.
“ Severely ill persons should be able to live in the certainty that, in the last phase of their life, they are not alone and will be supported and cared for in every respect. With the Bill that was adopted today, we will be able to achieve definite improvements in providing care and support for terminally ill persons. Our aim is to establish a finely-meshed network of palliative and hospice benefits and services throughout Germany. We are strengthening palliative care and the hospice culture in places where people spend the last phase of their lives – whether in their own home, at a nursing home or a hospital. In addition, we are creating individual counselling and care opportunities for affected persons. We believe that every terminally ill person should receive the assistance and support they wish and need to have in the last phase of their life.
The provisions of the hospice and palliative care law in detail:
- Palliative care will become an explicit component of standard care in the statutory health insurance. With respect to panel doctors, the self-administration partners from the medi-cal profession and the health insurance funds will agree on additional benefits that will be reimbursed separately. These additional benefits will be aimed at improving the qual-ity of palliative care, providing additional qualification for physicians as well as promoting networking with the other professional groups and the long-term-care facilities involved in the provision of care.
- The Federal Joint Committee will be entrusted with the task of giving concrete form to the individual palliative care benefits in its Guideline on Prescribing Home Nursing Services.
- In order to speed up the further expansion of so-called specialised, out-patient palliative care (SAPV), particularly in the rural areas, an arbitration procedure will be introduced for the corresponding service provider agreements to be concluded between the health insurance funds and the teams providing the specialised out-patient palliative care bene-fits.
- The financial basis for in-patient child and adult hospices will be improved. One of the ways in which this will be achieved is by raising the minimum grant paid by the health insurance funds. By this means, hospices that are currently still underfunded will receive a higher per diem rate for each insured patient in their care (an increase of 25% from the current 198 euros to approximately 255 euros). The other measure is to have the health insurance funds bear 95%, instead of the current 90%, of the eligible costs in the future. Maintaining the co-payment of five percentage points is in keeping with the explicit wish on the part of the hospice organisations, as this ensures the maintenance of the charac-teristic feature of the hospice movement – that it is supported by the voluntary commitment of citizens.
- With respect to the grants for out-patient hospice services, non-personnel costs (such as transport costs for voluntary helpers) will also be taken into account, alongside personnel costs, in the future. Moreover, an appropriate ratio between voluntary helpers and full-time staff will be ensured. Furthermore, financial assistance will be rendered more contemporaneously – from the very first case of terminal care. The effort and expenditure that goes into hospice work in nursing homes is to be taken into greater account and, in future, hospitals will be entitled to commission hospice service providers with the provision of terminal care in their facilities as well.
- Terminal care will become an explicit component of the social long-term care insurance's mandate to provide care. Co-operation contracts, between the nursing homes and family doctors and specialists, regulating the provision of medical care for residents, are now no longer only voluntary, but must be entered into by the contractual partners. Doctors who participate will receive additional remuneration.
- In addition, the statutory basis will be created to allow nursing homes to organise and offer their residents a service provision plan for individual and comprehensive medical, nursing, psychosocial and pastoral support in the last phase of life. This special offer will also be financed by the health insurance funds.
- In a move to strengthen the hospice culture and palliative care in hospitals, it is envis-aged that, for palliative care wards, hospital-specific fees are to be agreed with the third-party payers, if the hospital so wishes.
- Hospitals are to be obliged to give insured patients individual counselling and assistance in selecting and making use of the various benefits and opportunities offered in the context of palliative and hospice care.