Transitional care in the hospital – Independent patient advice welcomes new legal entitlement for insured persons
25.11.2021 16:44
Since July 20, 2021, those with statutory health insurance have been entitled to transitional care in hospital if they were treated there and the services required following discharge, such as home care, cannot be provided or can only be provided with considerable effort. The Independent Patient Advice Germany (UPD) welcomes the decision to enshrine the right to transitional care in law. “In recent years, people seeking advice have repeatedly reported to us that they have significant problems finding a care service for themselves or their relatives when they are discharged from the hospital,” says Thorben Krumwiede, managing director of the UPD. “The new regulation will take a huge burden off their shoulders.”
The right to transitional care in hospitals was enshrined in law with the Health Care Development Act (GVWG). If the requirements are met, the hospital will provide full care for the legally insured person for up to ten days. This includes, among other things, accommodation and food, the administration of medicines, basic and treatment care as well as the medical treatment required in individual cases. Entitlement to transitional care: Documentation of the requirements necessary The necessary requirements for the entitlement to transitional care must be verifiably documented by the hospital for each individual case. The umbrella association of the Federation of Health Insurance Funds (GKV), the Association of Private Health Insurance eV (PKV) and the German Hospital Association (DKG) agreed on the documentation requirements on October 31, 2021.
The documentation must specify the individually required follow-up care, for example medical rehabilitation, home nursing care or short-term care. The level of care that has already been determined or the application to determine the need for care serves as proof. In addition, in order to claim, it must be demonstrated that a short-term care place is either not available or is only available at a great distance, or that home care cannot be guaranteed: Those affected would then incur a so-called “significant effort” when looking for nursing care .
“The legal regulation in the GVWG alone has not yet made it clear when there is a ‘significant effort’ and therefore the requirements for the claim are met,” says Heike Morris, legal director of the UPD. “The documentation agreement creates clarity for those with statutory health insurance as well as for hospitals and statutory health insurance companies. From the patient's perspective, we are very pleased about this." Insured persons should point out their right to discharge management. All legally insured persons are entitled to discharge management in the hospital: The hospital must ensure that patients receive continuous, needs-based care outside of the hospital after treatment. This includes, in particular, that the hospital prescribes the necessary medication, aids and home nursing care and can determine incapacity for work for a period of up to seven days - currently for a maximum of 14 days due to the epidemic situation.
“It is important that the hospital informs patients about their entitlement to transitional care if follow-up care is not yet sufficiently ensured,” says Thorben Krumwiede, referring to the UPD’s advisory experience. Accordingly, those seeking advice repeatedly report that hospitals want to discharge them even though their continued care is not guaranteed. “We advise those with statutory health insurance to point out their legal right to discharge management and, if necessary, transitional care if the hospitals want to discharge them prematurely,” emphasizes the UPD managing director, and adds: “Of course, we are happy to advise and inform those affected about their situation in our consultation Rights and options when discharged from hospital.”