Background In December 2015, §132g was introduced into Social Code Book V. It provides financial coverage of advance care planning (ACP) for residents in long-term care institutions and institutions for persons with disabilities. At the end of 2017, the sickness funds and care home providers defined the details of the implementation in a mutual agreement.
Methods Policy analysis with description and critical reflection of the relevant regulations and the current status of ACP implementation in Germany.
Results Since early 2018, German care homes can get reimbursement for ACP-facilitators (1/4 full time equivalent for 100 residents), who can be either employed by the care home, by its carrier or by a regional cooperating partner. The mutual agreement specifies the structure and content of the planning process and defines the qualification requirements for ACP-facilitators, but not for facilitator trainers. Furthermore, the agreement calls for intra- and inter-institutional coordination, but does not provide for adequate workforce. Since 2016, there have been courses qualifying some 270 ACP-facilitators and 35 trainers, and several institutional ACP implementations. To promote the quality of the ACP-implementations, a German ACP-association (the DiV-BVP e.V.) was founded in 2017 to further develop facilitator and trainer curricula using simulated patient supported role plays, the contents of ACP-conversations, and of their adequate documentation.
Conclusions While §132g Social Code Book V provides a historic opportunity to implement ACP in German care homes, there are still major challenges to overcome, especially regarding facilitator qualification and institutional and regional implementation of the ACP system.
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