Those who are critically ill, in need of care, or dying with no medical prospect of recovery may seek palliative care from physicians and nurse practitioners.
Statutorily insured patients are entitled to health care planning for the last phase of life (§132g SGB V). Statutorily insured persons can make use of this offer via fully inpatient care facilities and facilities for integration assistance. For persons with private health insurance, the nationwide compass private pflegeberatung offers a comparable range of fully comprehensive and free nursing care consulting services. If you are privately insured and would like to use palliative care services, you should clarify the question of costs with your insurance company in advance.
What does palliative care provide??
Palliative care services are intended to help alleviate the symptoms of the disease on the one hand and, on the other hand, to maintain the quality of life and enable a dignified death as far as possible. The legal regulations are defined in § 39a SGB V. There is also a distinction between outpatient and inpatient palliative care.
Most people wish to spend the end of their lives at home in the company of their relatives. Outpatient services can at best fulfill this wish, as long as palliative medical care and nursing can be provided locally. In addition to nursing services, specialized outpatient palliative care (SAPV) also includes monitoring of necessary pain therapy, psychosocial support for patients and their relatives, and medical activities such as dressing changes and port care.
Funding and reimbursement
The reimbursement of costs in the statutory health insurance is in accordance with the established reimbursement agreements. For persons with private health insurance, reimbursement depends on the agreed scope of the private health insurance tariff. It is therefore advisable for the service provider to contact the private health insurance company on your behalf in order to clarify the scope of reimbursement for the measures before the service is provided. Individual medical or nursing services provided as part of SAPV may also be reimbursable as individual services. This requires differentiated invoicing.
Otherwise, only inpatient hospices or palliative care units in hospitals can be considered. By the way: According to the Federal Statistical Office (2018) and the German Medical Journal (2021), one in two people in Germany dies in a hospital. In addition to the general care services provided by outpatient and inpatient providers, there are now also a growing number of additional offers and relief service options, e.g.B. Day hospices.
Day hospice and inpatient hospice
Day hospices offer terminally ill people palliative therapy and the opportunity to participate in social life despite a serious illness. For relatives, they mean daily opportunities for relief in the care situation. In the compulsory social insurance (SPV), funding for inpatient and outpatient hospice services is provided through § 39a SGB V (German Social Code). In the private compulsory long-term care insurance (PPV), reimbursement is made via day care – if the facility is approved for day-care – or via preventive care less 5% own contribution, if the prerequisites for preventive care, in particular a reason for prevention, are met. In addition, you can also use the relief amount if necessary.
Inpatient hospices offer palliative, nursing, social, psychological and spiritual care. Hospices accompany relatives beyond the patient's death. Patients do not have to pay anything extra, regardless of their insurance status. The costs are borne by claims from the health and long-term care insurance system. Nevertheless, it is best to clarify with the private health insurance company the possible reimbursement of costs before making use of this option.
Appraisal and level of care
If you have not yet been classified as needing long-term care, in the case of outpatient palliative care or. If staying in a hospice or similar facility, on-site assessment by an assessor essential. It should be done without delay, but at the latest within one week of receipt of the application by the relevant long-term care insurance fund or. Care insurance companies, be carried out.
If you have any further questions about benefits or financing palliative care, or if you have any questions about the assessment, we recommend that you contact an independent care advisory service. They will assist you in finding the right supplies for your situation.