Intensive home care
The Domestic intensive care is Home Care , which is up to 24 hours a day guaranteed. People who require constant monitoring or intensive care care for medical reasons can return to their home environment with the help of home intensive care or stay there, for example long-term ventilator patients. The home environment refers to the person's apartment, which can also be in the nursing home , with his or her family, in an assisted living facility or in an intensive care group. The basis of all care is the health insurance policy “outpatient before inpatient”.
There is no uniform terminology for intensive care in the home. It is also offered as ventilation care , 1-to-1 care , outpatient intensive care or 24-hour care . The medical service of the National Association of Health Insurance Funds uses the term extra-clinical intensive care (AKI).
Services
The services of home intensive care include, on the one hand, treatment care of the patient according to SGB V and basic care according to SGB XI as well as the organization of aids, arrangement of doctor's appointments and examinations, cooperation with therapists of all disciplines, maintenance of social contacts, etc. Under certain circumstances, domestic activities, like preparing small meals. Relatives can be instructed according to their possibilities and integrated into the care. Cooperation with competitors or other outpatient services is possible to care for the patient. For example, taking on night shifts in combination with outpatient care by other service providers (e.g. Diakonie, Caritas or private providers) can be combined. In some cases, it is also possible that family members take on a certain amount of care each day and, for example, the specialist care service only covers 16 or 18 hours a day.
Forms of care
Different forms of care have become established in home intensive care:
- the domestic individual or 1: 1 supply
- care in specialized care facilities or care facilities for the elderly
- care in shared nursing homes with care in 24-hour shifts by an intensive care service
A legally competent client can also select his assistant staff according to purely personal criteria regardless of their professional qualifications (employer or assistant model). The family doctor is responsible for medical care .
Costs and cost units
The costs for this special type of outpatient care are usually fully covered by the health insurance companies, the long-term care insurance funds and the allowance as well as the social welfare providers . In contrast to basic care, the providers do not bill their services as modules or service complexes, but in hourly rates according to service group IV. The services of the individual companies can vary greatly depending on the service catalog of the respective provider. Most of the services negotiate with the payers. A fixed period of time for the care of the person concerned is generally not provided, a certain level of care is not required. If the person concerned has to be treated in hospital during the care, the supply contract is suspended.
requirements
The prerequisite for intensive care at home results from an increased maintenance effort and / or a vital threat to the patient, e.g. B. a severe disturbance of vital functions such as life-threatening cardiac arrhythmias , ventilation , respiratory insufficiency , unconsciousness , coma , disorders of the fluid, electrolyte , acid and / or base balance . The costs for old-age diseases such as pure dementia care are not borne in this context. However, if the symptoms of old age occur together with the above-mentioned clinical pictures, this does not rule out a prescription of benefits.
Service provider
Service providers are mobile care services who offer intensive care at home in addition to other services or who specialize in this alone.
Nursing staff
Nursing staff of different qualifications are used in home intensive care. Depending on the area of application, a completed vocational training as a geriatric nurse , health and nurse , nurse , health and child nurse or child nurse is required. Exceptions are residential groups that also employ nursing assistants. Further training to become a specialist nurse for intensive care and anesthesia or respiratory therapist is recommended by the Federal Association of Private Providers of Social Services (bpa) for the management of an out-of-hospital intensive care service.
Web links
- S2 - Guideline - Non-invasive and invasive ventilation as a therapy for chronic respiratory failure ( Memento of May 16, 2011 in the Internet Archive ) (PDF; 1.14 MB)
- Intensive care at home: Federal Social Court relieves those in need of care and obliges health insurance companies - Berlin, October 19, 2010 (No. 40/2010) ( Memento of August 12, 2011 in the Internet Archive ) (PDF; 16 kB)
- Overview of care services in Germany with AOK care services navigator
Individual evidence
- ↑ Quality testing guideline for home nursing (QPR-HKP) adopted. MDS report dated December 11, 2017 ; accessed on February 11, 2019
- ↑ Out-of-hospital intensive care: Current challenges in hygiene management. Epidemiological Bulletin of the Robert Koch Institute, No. 39 of September 28, 2015; accessed on February 11, 2019.
- ↑ Requirement profile for nursing services active in intensive care. Federal Association of Private Providers of Social Services e. V. (bpa), March 2009 ; accessed on February 11, 2019