Care of critically ill people is steadily improving
On Friday, the Federal Council is expected to pave the way for a law that allows dried cannabis and cannabis extracts on prescription as a cash benefit in the future. For Minister of Health Gröhe (CDU), the law represents a further step in the improvement of palliative care. In this area, many measures have recently been adopted to strengthen the care of seriously ill patients. At the end of 2015, the Act to Improve Hospice and Palliative Care (HPG) came into force. But has the supply really improved?
finanzen.de talked to Benno Bolze, the managing director of the German Hospice and Palliative Association (DHPV), about cannabis on prescription and about the HPG and followed up in which areas the palliative care in Germany would have to be improved .
In future, cannabis will be paid as a medicine by the health insurance companies. Federal Minister of Health Gröhe sees the law strengthening palliative care in Germany. How does the DHPV assess the innovation planned for March 2017?
Benno Bolze: It’s a good step in the right direction. Even before the regulation was changed, it was possible that cannabis was used as medicine. However, this was associated with hurdles. First, a prescription of the doctor was necessary. In addition, the patient needed a state permit and had to pay the remedy himself. With the amendment of the law, the requirements are significantly simplified , so that cannabis as a medicine is an accessible and therefore free option for the care of seriously ill patients.
For more than a year, the law has been working to improve hospice and palliative care, which aims to strengthen the care of critically ill people wherever they spend their final stages of life. In your opinion, has the law made a significant contribution to better people being accompanied?
Benno Bolze: The DHPV has made a major contribution to getting these legislative changes underway. They lead to a significant improvement in the care and support of seriously ill and dying people in Germany. The law provides the basis for the improvements. Further details are given by additional agreements. For example, we have already achieved very good results in the framework of the revision of the framework agreement for outpatient hospice services. There are already significant improvements in funding . These mean better structures for the outpatient services and thus an improvement in the care of those affected .
We are experiencing similar developments in the area of inpatient hospice care, where we are still in talks. There, too, we are on a very good way.
Will the higher minimum subsidy for inpatient hospices, as agreed by law, be enough for the sick in care?
Benno Bolze: The higher minimum grant is part of the solution . However, we need precise regulations on the question of quality and performance in inpatient hospices , so that we have uniform standards nationwide in inpatient hospice care. So far, this has sometimes been implemented very differently in the individual federal states. At present, we still have individual countries where financing is not yet designed to ensure supply and support with a correspondingly high level of quality. However, improvements are also being made here through the HPG.
What is the minimum grant?
The health insurance companies pay a minimum amount per inpatient hospice and day to inpatient hospices. In the course of the HPG, this was raised from seven to nine percent of the so-called reference value in social insurance, so that the minimum subsidy in 2017 is 267.55 euros.
How can patients know how good a hospice is? Is there similar to the nursing home care notes?
Benno Bolze: Quality is a very important issue. For the people who come to us and are cared for in the inpatient hospices need a high degree of care, support and care at the end of their lives.
Years ago, there was the idea of transferring the nursing fees given to nursing homes to the hospices. However, it quickly became apparent that these standards of quality measurement for inpatient hospices are only very limited, for example because there are other priorities in care. That’s why we are working on a new catalog for testing quality in inpatient hospices in the course of the HPG.
Irrespective of this, it remains the decision of the person who is admitted to inform himself in advance about the work in the inpatient hospice . What forms of support are there? How are the relatives cared for and accompanied? Anyone living in the hospice should always seek the interview with the hospice management if something did not go optimally. In addition, there is a hospice advocate to whom residents can turn.
In Germany there are more than 2,000 outpatient hospice services, inpatient hospices and palliative wards in hospitals. In your opinion, is this sufficient for the trustworthy accompaniment of seriously ill and dying people?
Benno Bolze: In Germany, we now have a dense supply network , for example through the teams of specialized outpatient palliative care and thus improved care at home. In view of that, it would be a mistake to say that we need a certain number of beds nationwide. Instead, one has to look at the situation on the ground to decide if and which form of care in the region will be further developed. For example, if there has been a stationary hospice on site for many years, a complementary team of specialized outpatient palliative care could be useful.
Cost of inpatient palliative care
95 percent of the costs for the care of seriously ill in inpatient hospices takes over the statutory health and long-term care fund. The remaining five percent raise hospices, among other things, from donations.
What steps still need to be taken to further improve palliative care in Germany?
Benno Bolze: We see room for improvement, especially for inpatient care facilities. Here an expansion of the supply is necessary . Nursing homes are always places where people have lived many years and sometimes want to be cared for and accompanied at the end of life. Here we also want to ensure that patients at the end of life do not have to be transferred from the nursing home to a hospital, but can stay in their usual environment, because the care in the home is accordingly well organized.
Thank you for the interview, Mr Bolze.