[Out-patient hospice services--their importance for palliative care in Germany]

Hospice services can be divided into three groups. Few institutions deliver the full scope of palliative home care, most of the others can provide considerably less. The third group of services are those that do not support patients but aim to establish a home care service or a hospice. In February, 1997 396 home care services were working in Germany. 48 of these services provided palliative home care, 69 services were hospice initiatives. The scope of services rendered is very broad and reaches from psychosocial support to complex medical tasks. In the last year, 13,700 patients have been supported at home by hospice services in Germany. Palliative care services usually have professional staff, but they would not be able to work without honorary help. Beside of support for patients and relatives tasks of the home care service are the coordination and exchange between in-patient units, general physicians and social care ward. By cooperation with all institutions for out-patient and home care as well as with general physicians, they contribute to avoid in-patient treatment for their patients. Another important function is to spread the hospice idea and work as multipliers for knowledges and attitudes in palliative care. The number of home care services available in Germany is not sufficient. Only 48 institutions can be ranked as palliative care services. The distribution of the hospice services in Germany is very irregular, and providers of home care services are even more scarce in the eastern part of Germany.