Pending German Legislation on ACP

The German Federal Government has issued a draft law that is planned to pass parliament in November 2015: http://www.bmg.bund.de/fileadmin/dateien/Downloads/Gesetze_und_Verordnungen/GuV/H/Kabinettvorlage_HPG_18-15032.pdf

Below is a non-authorised, significantly abbreviated and simplified free translation (by Jürgen in der Schmitten) of the section Nr. 10 of the law that refers to Advance Care Planning in German care homes.

 

Draft Law by the Federal Government

Draft for a law to improve hospice and palliative care in Germany (28.04.2015)

 

Nr. 10: Inclusion of a new § 132g SGB V

Advance Care Planning for the last period of life 

(1)   Care homes […] can offer their residents advance care planning for the last period of their life. Residents are to be counselled with regard to medical and nursing care in the last period of their life, and they are to be informed about options and support available when they are dying. In the frame of a case conference, individual preferences of the residents are to be explored, potential emergiencies to be discussed, and eligible single measures of palliative nursing and medical care, and psychosocial care, to be depicted. This case conference can be held repeatedly when there is a relevant change in care needs.

(2)   The resident’s family physician (or other physicians) and his family are to be invited to the case conferences if this what the resident wishes. Potential emergencies should be planned for, and the necessary transfer should be prepared. Also other regional care options should be involved in order to warrant a comprehensive advance care planning with consideration of potential medical, nursing, hospice and spiritual needs. […]

(3)   The roof organisations of sickness funds and care homes negotiate the details of the contents and demands for an advance care planning according to (1) and (2). […]

(4)   The health insurance (sickness fund) of the resident carries the necessary costs for the provision of ACP as characterised in (1), (2) and (3). […]

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Rationale

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re. Nr. 10 (§ 132g)

ad (1). An individual, holistic counselling offer with regard to support and options for the medical, nursing, psychosocial and spiritual care in the last period of life can alleviate the fear of serverely ill patients or residents of dying and suffering. At the same time, a good case management, involving cooperation of all health care professionals potentially participating in the individual’s care, can contribute to the concerned individuals‘ demand for self determination, and avoidance of unwanted treatments.

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Residential care homes can, therefore, provide an advance care planning service for the last period of life that residents may voluntarily use in order to be comprehensively informed and, supported by professional facilitation, be able to make autonomous treatment decisions.

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If a residential care home provides such an advance care planning service, the consultation is not to be confined on a mere information about the claims and services an insured person is entitled to. This information is to be provided by the sickness funds anyway, as regulated in the new §39. Rather, the service of an „advance care planning for the last period of life“ is to enable the residents, based on individual consultation and case conferences, to develop a conception of medical trajectories, of the extent, intensity, and limits of medical interventions, and of palliative care treatments. These includes in particular the consultation about the possibilities and consequences of decisions to forgo treatments. Family and other close persons are to be involved in the consultation process if that is the wish of the resident concerned.

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ad (2). […] It must be provided, together with all other regional care services, that the resident experiences a comprehensive medical, nursing, and hospice care that is in congruence with his or her wishes and conceptions, as explored in the advance care planning process. Therefore, all regional health care providers are to be involved in this advance care planning process, for example also emergency services, hospitals, communal and spiritual institutions.

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