Dealing with death and the process of dying is undergoing a slow rethinking in German society through hospice work. The debate about parting from life is difficult for many people; the thought of the end is pushed far away. Because the topic of dying is filled with fear and fear, and the idea of dying in a hospital bed surrounded by gadgets and tubes is terrible to most people.
A common request: to die at home
Many people want to die at home, in their familiar environment. In the meantime, this wish has been taken into account with outpatient hospice work, although only about 5 percent of the approximately 200,000 terminally ill patients. If caring for and care for the dying in your own home is no longer possible, inpatient hospices are an alternative. Here dying people are cared for and accompanied on their last journey.
The history of the hospices
The beginnings are old and can be dated back to the beginning of Christianity in the Roman Empire. Travelers, the sick, the needy and the dying were received and cared for. In the Middle Ages, this task was transferred to the Christian orders, who also founded their own hospices. In the 19th century, the idea was resumed, especially in France and England.
In contrast, the hospice movement in the Federal Republic is still very young. It was not until 1986 that the first hospice in Germany officially started work. The development of inpatient hospices was accompanied by the establishment of so-called palliative wards in hospitals nationwide. At these wards, patients with advanced, incurable diseases are treated.
There are now about 300 palliative wards nationwide. In addition to pain therapy, the preservation of the maximum possible quality of life is in the foreground. The first Chair of Palliative Medicine was established in 1999 at the University Hospital Bonn: Since then, this medical specialty has also been established as a research area.
What is hospice work?
In the foreground of the hospice work are dying people and their relatives with all their needs, wishes and rights. The hospice work - whether outpatient or inpatient - is based on the following priorities:
- the spiritual accompaniment that benefits both the dying person and his loved ones and helps to grasp the experience of death.
- Psychosocial support with the emotional support of those involved. In the face of the approaching death, there are often still unresolved conflicts - to solve these conflicts or to accept that they can no longer be dealt with costs a lot of emotional power.
- palliative care as well as palliative medicine treat the pain and concomitant effects of the dying patient's illness and strive to improve the quality of life on the threshold of death.
In Germany, there are now 1,500 outpatient hospice services and 235 inpatient hospices.
Who bears the costs?
The financing of outpatient and inpatient hospice work has only been established since 2002 by health insurance companies and long-term care insurance. Initially, however, only the outpatient hospice service was free for the patient. Since 2009, patients in the inpatient hospice have been exempted from all costs.
About 90 percent of the subsistence costs are borne by the health insurance and nursing care insurance, and the remainder is provided by the hospice. Therefore, the hospices depend on donations and subsidies.
Dying at home
The care of dying people at home is no easy task for the relatives. The emotional stress comes from physical exertion and the complete change of the usual everyday life. With some preparation and the support of an outpatient hospice service, this task can be handled more easily:
- Anyone who cares for a dying person at home does not need a special room for it. A familiar room or a room with a cozy atmosphere is sufficient.
- Helpful is a suitable care bed, which may be borrowed from the health insurance. There should also be asked for a so-called bedsore mattress, which prevents bedsores.
- Dressing, care and consumables should be as readily available and available as pillows for storage and suitable blankets.
- The establishment of a washing facility or a wheelchair must be adapted to the spatial conditions.
Caring for relatives or friends at home takes on a great responsibility - ultimately also for oneself. One's own emotional and physical well-being must be taken seriously to do justice to this task. Often, friends and acquaintances withdraw, the social isolation - also due to the temporal and spatial connection to the dying - can be very large.
It helps to organize visits beforehand, to reconsider the purchase and the supply of the everyday life and to find for themselves also a contact and companion.
Preparing for the hard time
If a dying person is released from the hospital, contact the hospital social service and the family doctor first.
In a joint discussion, all upcoming tasks should be discussed and especially the pain therapy should be clarified. The family doctor must understand and accept that the dying person does not want life-prolonging measures. In the search for an outpatient hospice service help the social service of the hospital, the welfare institutions of the churches and the health insurance.
The staff of the outpatient hospice services usually work on a voluntary basis and have been prepared for their tasks through special courses. Their focus is primarily on the emotional well-being of the dying person and the people around him. They bring fears with their closeness and empathy and accompany the mourning and loss work.
Inpatient hospices are small, family-owned institutions that care for the palliative care of the dying. This means 24/7 qualified nursing, supported by volunteers. The hospice is involved in on-site medical care. The medical care usually takes over the family doctor. Social workers, psychologists and geriatric nurses care for the dying and his relatives.
The children's hospice
A special institution are children's hospices. Not only the little patients but also their parents and siblings are looked after here. The care required here is particularly large: There must be space and living space for the families, the emotional and psychosocial care of the entire family must be guaranteed as well as the palliative care of the small patient.
Recreational activities and school commitments of accompanying siblings must be taken into account. But also games, fun and laughter should not be neglected despite all the grief. The children's hospice work is a so-called "relief care", a short-term care as a "vacation" for children and parents.
In some children's hospices, stays are possible several times a year. For example, in the children's hospice Balthasar in Olpe: It is the first children's hospice in Germany, which also allows four-week stays several times a year under the guideline "A second home for the whole family". There are currently 14 in-patient children's hospices and more than 100 outpatient children's hospice services in Germany.