Social medical aftercare

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The social medical aftercare (SMN) is a service provided by the statutory health insurances that follows immediately after hospital treatment or inpatient rehabilitation . It thus fulfills an essential task of social medicine . With this follow-up care, chronically ill or seriously ill children who have reached the age of 14 and, in particularly serious cases, have not yet reached the age of 18, are provided with the necessary social medical follow-up measures. This applies if follow-up care is necessary due to the type, severity and duration of the illness in order to shorten the inpatient stay or to ensure the subsequent outpatient treatment.

Details

The social-medical aftercare according to Section 43 (2) SGB V developed significantly from the Bunter Kreis aftercare model . The aim of the measure is to shorten and avoid hospital stays, to ensure successful treatment and to integrate the sick child into their environment. The Social Medical follow-up is based on the concept of action case management . First and foremost, she coordinates and networks between the inpatient and outpatient sectors and involves everyone involved: from family members to treating doctors, therapists and employees in the service providers to self-help groups. In addition, it offers motivational, psychosocial, emotionally relieving and practical help. As a rule, 20 hours of aftercare are paid for by the health insurers, in exceptional cases it can be extended to 30 hours. The basic recommendations and agreements of the central associations of the health insurance funds form the basis for the SMN. The application for the SMN at the health insurances is done with the help of the International Classification of Functions and Disabilities of the WHO (ICF).

target group

At the SMN, premature and high-risk babies and children with cancer or chronic diseases are cared for together with their families. The indication for social medical aftercare results from a list of ICD-10 diagnoses and existing damage / problems that are defined by the ICF. This means that for the regulation of SMN

  • at least one relevant ICD-10 diagnosis must be available and
  • that the patient must also have at least two severe injuries (impairment of body structure and / or body function) requiring intervention and
  • that this damage leads to severe impairment of age-related activities and participation such as mobility, communication, interpersonal relationships and self-sufficiency and
  • that complex interventions such as extensive care, intensive care, technical sophisticated mobility aids or the initiation of comprehensive family counseling / therapy are necessary and
  • that negative context factors such as difficult provision and use of aids and technologies, difficult availability of specialists and a familial overburden with the care task must be present.

Children in the final stage of palliative care receive SMN without checking these requirements.

literature

  • vdak 2005a: Association of Salaried Health Insurance Funds eV (vdak) 2005. Framework agreement of the central associations according to Section 43 (2) SGB V.
  • vdak 2005b: Association of Salaried Health Insurance Funds eV (vdak) 2005. Recommendations of the central associations according to § 132c SGB V.
  • WHO ICF 2006: International Classification of Functioning, Disability and Health (ICF). www.dimdi.de/statc/deklassi/ICF/index.htm (January 5, 2006).

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