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DAK Nursing Report Most people do not die at home
Two out of three Germans do not spend the last hours of their lives in the place they want. According to a recent DAK health study, only six percent of Germans want to die in hospital or nursing home. In reality, however, three quarters of all people die in such institutions. This clear difference between desire and reality shows the health insurance in their care report 2016.
Hardly anyone dies where he wants. Image: Photographee.eu - fotolia For the report, the AGP Institute for Social Research at the Freiburg Protestant University has for the first time investigated the desires, ideas and experiences people have when it comes to dying. The analysis includes a representative population survey on the subject, analyzes of DAK statistics and qualitative interviews with people who have accompanied dying relatives. According to Pflegereport every fifth patient dies alone in the hospital. In addition, therefore, numerous hospital stays are almost avoidable shortly before death. This causes unnecessary costs and is contrary to the wishes of those affected.
60 percent want to die at home
According to the DAK Nursing Report, 60 percent of respondents say they want to die at home. 16 percent are undecided. Only four percent call the hospital, two percent the nursing home. The trend is even clearer for people who already have nursing experience. Caregivers say 76 percent say they want to die at home. Among the reasons most say that the habitual environment makes dying more bearable (73 percent) and that it brings more dignity (58 percent). "These results indicate a pronounced skepticism towards palliative care in clinics and homes," says Professor Herbert Rebscher, CEO of DAK Health.
Dying in institutions is increasing
Nevertheless, well over 75 percent of all people in Germany die in the hospital or nursing home. If you compare this number with your wishes, 69 percent will not be there where they want. In addition, there is a tendency towards further institutionalization of dying, which results from the descriptions of the dying process of relatives or friends: more than 20 years ago, 55 percent died at home and 6 percent in the nursing home. In the last five years, however, 32 percent died at home and 22 percent in the home. The proportion of those who died in the hospital remained about the same at just under 40 percent.
In the hospital, one in five dies alone
About one in five would have liked relatives or friends to die in another place. Above all, the home was specified as desired (total 14.5 percent). The explanation given is usually the experience in the hospital: Dying people are connected to machines there and alone at the time of death. In fact, every fifth person died in the hospital and even every third person in the nursing home alone. At home there were only seven percent who had no one at the time of death.
Many would take care to last
More than one in three would dare to care for somebody until his death. Especially women state that (41 percent). However, the answer depends on employment: Of the women working full-time, one in three dares to do the job, and one in two is still working for part-time women. Many respondents cite support from relatives, volunteers and professionals as a condition. The nursing expert Thomas Klie, who has scientifically designed, conducted and evaluated the report, says: "The DAK nursing report shows a great willingness to take care of even the death. But that requires reliable local structures. "
Cost driver hospital
Not only does hospital dying contradict the wishes of most people. It also burdens the solidarity system. For the DAK care report data of more than 60,000 deceased insured were evaluated, who were in need of care before their death. 64 percent of these people were hospitalized in the last quarter before their deaths. Especially hospital stays are expensive: their share of the total costs in the last three months of life is 83 percent. Such a stay costs on average just under 9000 euros. "The large number of premortal hospital admissions contradicts the principle of" outpatient inpatient care ". One can assume that many of them are avoidable, "says Herbert Rebscher. "These preventable hospital stays not only burden the community of solidarity. They are also in clear contradiction to what most people want when they have to die. Here it is up to us as a health insurance company to intervene in a controlling manner, and here we are happy to go forward. "
Hospice and palliative legislation must be implemented
Qualitative interviews with people who cared for and cared for the dying show that hospital stays are often the result of inadequate care at home. "Constellations in which the number of participants was limited provoked stressful situations," says Thomas Klie. "The dismantling of hospital admissions is only possible with an expansion and the re-organization of outpatient care." It should also be systematically established, also with a view to the better compatibility of care and work, counseling and relief options. Herbert Rebscher says: "The results of the DAK Nursing Report 2016 make clear that the Hospice and Palliative Act is not only necessary. It also urgently needs to be implemented. "The law was passed at the end of 2015 and aims to improve palliative care, especially at home.