Home care

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This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

Medication administration in the home environment

Home health care (HKP) is a service provided by statutory health insurance in Germany . It is provided as a benefit in kind by the health insurance companies and is legally standardized in Section 37 of Book V of the Social Code. Out-of-hospital intensive care (AIK) is a specialization in home nursing.

Home nursing services should not be confused with home care , a long-term care insurance benefit .

Eligibility requirements

Statutory health insurance received in the household or in their family home care by appropriate agency (eg., Via an outpatient care service and a social station or similar equipment), if in addition to medical treatment is required to

  • avoid or shorten the duration of inpatient hospital treatment , or
  • hospital treatment is indicated but not feasible (Section 37 (1) SGB V) or
  • if it is necessary to ensure the goal of medical treatment (Section 37 (2) SGB V)
  • and if the necessary tasks cannot be carried out by the patient himself or by another person living in the household.

Home nursing must be prescribed by a doctor and approved in advance by the health insurance company. For the prescription, the doctor uses a special form that is presented to the health insurance company for approval. As a rule, home nursing is prescribed once, for treatment care alone (see below) the doctor usually issues a prescription every quarter. However, a prescription for a longer period is also possible. However, it may become necessary that additional activities are necessary and thus supplementary regulations become necessary, which has an impact on the amount of the co-payment (see below).

Nursing at home can only be used if it is provided in the household or family of the sick person or at other suitable locations where the insured person regularly visits; for example schools, kindergartens, assisted living arrangements or workplaces. When describing the insured person's whereabouts, the legislature was concerned with the delimitation of the provision of services in the inpatient area, e.g. B. in a nursing home . Residents of a facility for the disabled are therefore excluded from the benefit according to § 37 SGB V (BSG, judgment of September 1, 2005, B 3 KR 19/04 R). Insured persons in need of care in full or part-time inpatient care or short-term care who are entitled to benefits according to SGB ​​XI ( statutory long-term care insurance ), currently receive medical treatment care benefits in the inpatient area as part of the care benefits of the long-term care insurance (Section 41 (2) SGB XI, Section 42 para. 2 SGB XI, 43 para. 2 SGB XI).

Changes due to the GKV Competition Enhancement Act

Until 2007, home nursing services could only be prescribed and approved in the household of the insured person. However, the Federal Social Court has ruled that the health insurance company is obliged to provide benefits for a medically necessary insulin injection into a child while attending kindergarten or school (judgment of November 21, 2002, B 3 KR 13/02 R). The legislature specified the places, like the BSG before, where home nursing can take place, namely in addition to the household or the family of the person to be cared for at another suitable location, in particular in assisted living arrangements, schools, kindergartens and if there is a particularly high need for care in workshops for disabled people. For medical treatment care in inpatient facilities within the meaning of § 43 SGB XI (nursing homes), the insured person is exceptionally entitled to benefits in accordance with § 37 SGB V if there is a particularly high need for treatment care. The Federal Joint Committee also laid down the details of the type and content of the performance-related, disease-specific care measures in a guideline. These changes took effect on June 27, 2007.

Content of home nursing

Nursing at home includes the necessary treatment care (e.g. medication, injections or dressing changes), basic care (e.g. personal hygiene, exercise, help with nutrition) and housekeeping (e.g. cooking, tidying up the apartment or shopping) ). Which activities, to what extent and for what duration can be prescribed and approved, was agreed in the guideline of the Federal Joint Committee on the regulation of home nursing care between health insurers and doctors.

performance

Home nursing services are provided as benefits in kind, which means that the nursing services settle the costs incurred for the prescribed services directly with the health insurance company. Nursing services may only provide home care if they have a corresponding supply contract with the health insurers. The remuneration for the individual activities is also agreed in these contracts.

Home nursing as substitute hospital care

Home nursing care, i.e. basic and treatment care as well as domestic care, can be claimed for up to four weeks per illness (Section 37 (1) SGB V). In exceptional cases, an extension is possible if the medical service agrees to an extension due to medical necessity. The prerequisite is that inpatient hospital treatment is avoided or shortened by home nursing or, for certain reasons, is necessary but not feasible.

Out-of-hospital intensive care

Home nursing to ensure the goal of medical treatment

Treatment care can also be granted if it is necessary to ensure the goal of medical treatment (Section 37 (2) SGB V). In principle, this can be done for an unlimited period of time as long as treatment care is medically necessary from a medical point of view.

  • Example for Section 37 (2) SGB V - "to ensure outpatient medical treatment": A patient asks for early discharge from inpatient hospital treatment in order to be able to go about his business. The doctor agrees to the request, provided that the patient presents to the surgical outpatient department of the hospital once a week to check the wound. Nursing at home as treatment care (rinsing the wound, re-bandaging) is carried out once a day by a nursing service. Basic care is not required because the patient does not need any assistance with the activities of daily living.

In these cases, home nursing usually only includes treatment care. In deviation from this, however, the health insurance companies can stipulate in their statutes that, for a certain period of time and up to an extent specified in the statutes, basic care and household care can also be provided in addition to treatment care. This is legally only possible as long as no need for care has been determined, because then the long-term care insurance is responsible for providing basic care. Treatment care is also paid for by health insurance for those in need of care.

Home mental health care

Home nursing for the mentally ill (also known as outpatient psychiatric care (APP)) has been part of home nursing since July 2005. It was included with the revision of the guidelines for the regulation of home nursing according to § 92 SGB V and is a community-oriented care offer. It is intended to help mentally ill people lead a dignified, independent life in their usual context. Local care should involve the environment and ensure social integration. Outpatient psychiatric care can avoid recurring hospital stays, which are often perceived as stigmatizing by those affected and the social environment. The outpatient care is to prevent with their flexible, outreach services discontinuations. The details are regulated in the guideline of the Federal Joint Committee , G-BA :

  • It can only be prescribed for certain psychiatric diagnoses.
  • The diagnosis must be confirmed by a specialist.
  • The duration of the prescription is limited to up to 4 months.

Co-payments

An additional payment of 10 euros per medical prescription has to be paid for home nursing services; an additional 10 percent of the costs are due as an additional payment for the first 28 days of each calendar year. The co-payments are calculated and collected by the health insurance companies. There is an exception if home nursing is required due to pregnancy or childbirth, in these cases the women concerned do not have to pay any additional payments (§24 e and g SGB V).

Quality and billing control

Until 2017, quality and billing audits were only possible in care facilities with a supply contract at least in accordance with Section 72 of the Social Code Book XI. Service providers according to Section 132a SGB who only provided home health care and no long-term care insurance services could not be examined. This gap was closed with the entry into force of the Third Care Strengthening Act (PSG III); from January 2018, the review of these care services will be part of the remit of the medical services.

In other countries

  • In German-speaking Switzerland, home care and nursing is called Spitex ; in Austria there is the Home Care Act for people in need of care.

Individual evidence

  1. ↑ Home Nursing Guideline of the G-BA, § 1 (2)
  2. ↑ BSG B 3 KR 19/04 R
  3. ↑ BSG B 3 KR 13/02 R
  4. ↑ BGBl 2007 Part 1 No. 11 Art. 1 No. 22
  5. ↑ Guidelines of the Federal Committee of Doctors and Health Insurance Funds on the regulation of “home nursing” according to Section 92, Paragraph 1, Sentence 2, No. 6 and Paragraph 7 of the Social Code Book V. Accessed on February 8, 2019.
  6. ^ Guideline of the Federal Joint Committee on the regulation of home nursing. Retrieved February 8, 2019
  7. ↑ § 36 SGB XI care in kind
  8. ↑ § 72 SGB XI approval for care by supply contract.
  9. ^ Guideline of the Federal Joint Committee on the regulation of home nursing. P. 5 ; accessed on February 8, 2019
  10. ^ Guideline of the Federal Joint Committee on the regulation of home nursing. Pp. 7-9, 34f. Retrieved February 8, 2019
  11. ↑ Quality testing guideline for home nursing of the National Association of Statutory Health Insurance Funds 2017

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