Ambulant Palliative Care in a Rural Area

Introduction The extent to which it is possible to provide and finance qualified palliative medical care nationwide is currently a topic of intense debate. This paper aims to describe the home care provided by a palliative care team, and the associated costs in a fairly rural area in the north of Germany. Method The data was analysed from an SHIaccredited practice, which has been providing palliative home care with specialised nurses for 10 years. The place of death of the patients was identified over ten years. The number and duration of hospital stays were presented in a retrospective reviewof tumour patients in 2006. In order to establish a basis for the financial requirement of a palliative home care concept, the medical and nursing services provided in 2006 were broken down on a business management level and a case study was described to illustrate this. Results Of 176 tumour patients being treated at home by the centre since 1997, 96.0% died at home. The 35 patients in 2006 were cared for at home for an average of 54 days, and there was an average of 1.3 days per patient spent in hospital. In 30 patients (86%) no hospital treatment was required. In 2006, 20 of 21 patients died at home, and one patient in a hospice. It was not possible to cover the cost of this palliative home care concept under the guidelines of the applicable benefits catalogue EBM 2000 Plus. Conclusions While a palliative home care concept as presented in this study can offer effective palliative medical care, the costs are not covered under the terms of the benefits catalogue EBM 2000 Plus. If centres of specialised palliative homecare are to be developed nationwide in greater numbers, a proper and coherent reimbursement structure in the sense of standardized financing must be developed.