Paediatric palliative care in Germany.: Structures and initiatives

Structures. At the present there exists no paediatric palliative care ward in Germany. Especially trained paediatricians working in such a ward could advise their primary care colleagues, as might their nurse colleagues advise out-patient nurses in care for the dying child. Paediatric hospices offering respite care lorth the aim to support families and to enable them to care for the dying child die at home. There is no shortage of German paediatric hospice beds, but out-patient services offering emotional and practical support for families are missing. There exists no German out-patient paediatric palliative service except for a few model projects. Education. The Institute for Paediatric Pain Therapy and Paediatric Palliative Care (IKP) at the Vest' Childrens Hospital in Datteln has developed an appropriate curriculum. The institute started teaching paediatric palliative care to physicians, nurses, and psychosocial workers in April 2005. Reimbursement. The German reimbursement regulations are inadequate for the complex structuresInstitut fur Kinderschmerztherapie und Padiatrische Palliativmedizin (IKP), Vestische Kinder- und Jugendklinik Datteln in paediatric palliative care. While as a rule 10 days of final care per case are reimbursed for nurse based home care, the reimbursement is far below the expenses. The peculiarities of in-patient paediatric hospice care have been neglected. Reimbursement regulations for ambulatory paediatric palliative care are missing.