To die at home – desire, but rarely a reality
Where do you want to die once? Mainly elderly and sick people have frequently been with this in mind apart: according to surveys, most people do not want to die here in a hospital. However, the reality is usually different – almost every second person dies either in the hospital or in a nursing home.
But let him avoid, says Jana Jünger, Director of the state audits of Doctors competent Institute for medical and pharmaceutical examination questions (IMPP). Through a better training of Physicians: “If there would be better communication, we could improve this Situation within five years.”
Younger advocates, to practicing Doctors, as it is possible to discuss with patients the best of their wishes and aspirations in view of the near approach of death. “That must be implemented in the education and training,” says Younger. “These issues we need to bring in the state examinations for Doctors.”
The 55-year-old Thomas M. remembers the death of his father five years ago. With inflammation in the abdominal cavity of the 74-Year-old had been in a Ludwigsburg hospital, he says. In spite of the surgery had not improved his condition. He was lost in the twilight, a hospital germ came to be. The old man had wanted to go home, told M. But the head physician have arranged a further surgery. “Why is that?” I asked M., “my father is dying right now.” The Professor was left to him in response. Home the father no longer came.
Unnecessary procedures, surgeries, costly suffering times
A typical scenario, says Doctor Younger. “The patient is getting worse, because he dies, but the remains often unbesprochen between the doctor and the Patient or relatives.” The result: unnecessary procedures, surgeries, costly suffering periods in intensive care during the last days of life.
According to a study by the Max-Planck-Institute from the last year, the proportion of those who die in the hospital was long in decline. It amounts to Figures from the year 2016 but is still 46 percent, and stagnating since then. “That’s not too much, since it corresponds to the Wishes of the patient,” says Younger.
The supply of sick people die outside of hospitals, for example, in Baden-Württemberg to be well regulated, says a spokesman for the country’s Ministry of social Affairs. “Ambulatory care has improved significantly in recent years and is now on a good path.” In addition to outpatient hospice services, the so-called team of the specialized outpatient palliative care (SAPV) took care of dying adults and children: “The cover with SAPV Teams in the state of Baden-Württemberg is over 90 percent,” says the spokesman.
Therapy instead of dismissal
Why die so many patients still in the hospital? One reason is that, for instance, people with incurable cancers receive in the last weeks of her life, a therapy, rather than being discharged home. The Barmer Ersatzkasse on the basis of accounting data between 2012 and 2015, about 15 percent of these cancer patients in the last 30 days of your life is still a chemotherapy – usually this is done in the hospital.
Another reason could be Angela Carollo from the Max-Planck-Institute in Potsdam, according to that old people are often delivers with respiratory diseases to hospital, and there, within a few days of death. Or there is no living will: members are unsure of what to do, want to make no mistake, the desire of the patient will go unheard.
“Disease and truth communication at the bedside, which is always a process,” says Benno Bolze, Executive Director of the German hospice – and palliative Association (dhpv). For patients, it is not always easy to use, whether a therapy is useful or not. To criticize “Übertherapie” lump is from the point of view of the Barmer but not fair. Also in the hospital for a dignified death was possible.
“The number of older people is rising – we are in need of a high level of hospice and palliative care,” says Bolze. It is important that networks are established and functioning well: community care services, specialised Teams, palliative care, hospices – all of them would have to work together. Especially old people’s homes are in need of a close connection to the palliative networks, so Bolze: “As for the residents of the home there and there he will die.”
