To die in the hospice or at home?
Larissa Melville completed her traineeship in the editorial team of . After studying biology at Ludwig Maximilians University and the Technical University of Munich, she first got to know digital media online at Focus and then decided to learn medical journalism from scratch.
More about the experts All content is checked by medical journalists.Dying people are in good hands in a hospice. Many, however, wish to die in the familiar home. What speaks for one thing, what for the other?
Where does an old or terminally ill person want to die? Depending on the private and medical situation, different locations are possible: at home, in the hospice, in the nursing home or in the hospital. Every place has its own characteristics in terms of the people around you, the rules - and of course the costs.The atmosphere, the possibility of involving relatives and, last but not least, how we deal with the dying person themselves differ.
The stationary hospice
First of all: what is a hospice? An inpatient hospice is an independent facility, both structurally, organizationally and economically. Each hospice has its own trained staff and its own concept. However, the aim is always to provide psychological, (palliative) nursing and (palliative) medical care and support to people at the end of their life in a harmonious environment.
However, due to the uneven regional distribution, a palliative care unit is hardly available for some people. There are over 60 hospices for adults in North Rhine-Westphalia, but only 16 in all of Bavaria and only seven in Mecklenburg-Western Pomerania. These gaps should be closed as soon as possible. The parliamentarians voted for this with a large majority at the beginning of November 2015 when they passed the bill to strengthen hospice and palliative care in Germany. The statutory health insurances should spend up to 300 million euros more on palliative care - money that should also benefit the seriously ill who are waiting to die at home.
The focus of the hospice is the seriously ill and dying patient with his wishes and needs. The aim is to fulfill these and to enable the dying person to say goodbye as pleasantly as possible in a harmonious environment and without fear. A hospice not only looks after the patients, but also their relatives. You will be advised, included in the care of the patient and can stay with him around the clock. In addition, it can be a great relief for the relatives to know that the sick person is in constant professional care.
A hospice is managed by a nurse trained in palliative care. The holistic care and supply is carried out by trained full-time and voluntary employees who are open to the subject of death. Social workers, psychologists or pastors take care of the psychological and pastoral care. Medical care is provided by doctors experienced in palliative medicine. The entire team in a hospice usually cares for 8 to 16 patients.
Hospices for adults as well as children’s hospices try to meet everyone's desire for accompaniment and care. However, due to the limited number of seats, there may be waiting times. The offer is primarily aimed at seriously ill and dying people for whom home care cannot be guaranteed, symptoms are present that severely impair the dying person and for whom hospital treatment is no longer useful or no longer desired.
Dying at home - outpatient hospice service
But many people want to die in the familiar surroundings at home. Outpatient hospice services have set themselves the goal of making this issue possible for as many old and sick people as possible and accompanying them in the last phase of life.
In 2014 there were over 1,500 such services in Germany - with a focus on the old federal states. In some regions the supply density is still low. However, more and more efforts are being made to expand across the board.
A central feature of the hospice services are the volunteers who primarily provide psychosocial care for several hours a week. These forces are specially trained and receive continuous supervision. They are guided and supported by full-time coordinators who are also responsible for the organization of the supply network.
The term outpatient hospice services includes various forms of organization: outpatient hospice groups, initiatives and services, outpatient hospice and palliative counseling services, and outpatient palliative care services.
A purely outpatient hospice service does not usually take on any nursing or medical tasks itself. However, he takes care of a holistic care of the dying with palliative medical, palliative care, psychosocial and spiritual offers. The outpatient hospice service cooperates not only with relatives, but also with often specialized nursing services and general practitioners. In addition, hospice services often offer grief counseling and groups and organize general counseling and information events on the subject of death, dying and grief.
Dying in the nursing home
A direct comparison of the competencies and the quality of their hospice suitability is difficult among the nursing homes. Because every nursing home has a different concept, a different philosophy and also different personnel and spatial capacities.
In most of the 11,500 inpatient nursing homes (as of 2014), the personnel ratio is very low. Often, caregivers simply have too little time to meet the demands of the dying person. Needs for privacy or closeness may not be adequately met. The involvement and support of relatives is usually less than in a hospice, through an outpatient hospice service or in the palliative care unit.
On request, outpatient hospice services, visiting services from the hospices or voluntary dying attendants can also accompany the patients in the last phase of life.
The German Society for Palliative Medicine (DGP) and the German Hospice and Palliative Association (DHPV) call for the integration of a hospice culture and palliative competence into the philosophy of the homes.
And there is actually a movement in this direction: In recent years, the interest of nursing and old people's homes in the hospice culture and the palliative concept has increased. More and more homes are incorporating elements of this into their own concept and trying to meet the needs of the dying in this regard.
Palliative care unit in the hospital
Nowadays there are palliative care units in many acute hospitals. In 2014 there were around 250 such mostly homely designed stations in Germany - mostly in the old federal states.
The ward team consists of doctors and nursing staff trained in palliative medicine as well as social workers, psychologists, pastors and volunteer helpers. Particularly terminally ill people with very severe complaints can be optimally treated in a palliative care unit. Knowing that they can be adequately cared for at any time relieves many people of the fear of pain or shortness of breath and makes the last time more bearable for them. And the relatives also benefit from round-the-clock care. You can give up responsibility and withdraw once in a while to draw new strength.
Regardless of this, the hospital remains a hospital: the environment is strange, the staff changes frequently, a certain routine is established among doctors and nurses, and adequate privacy is difficult to ensure.
Whenever possible, the doctors in the palliative care unit try to stabilize the patient's state of health and release him home or to a hospice. If it is no longer possible to discharge, the dying person has a room that is as comfortable as possible, in addition to the terminal care.
Specialized outpatient palliative care
People with particularly severe or complex illnesses for whom general outpatient palliative care is no longer sufficient can take advantage of the specialized outpatient palliative care (SAPV). The multi-professional palliative care team fulfills similar advisory and coordinating tasks as the hospice services. In addition, it offers specialized palliative medical and nursing advice and / or (partial) care as well as advice from outpatient specialist services and general practitioners.
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