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					The Austrian Experience


   Dr. Johann BAUMGARTNER, MD
   Coordination Palliative Care Styria
     johann.baumgartner@kages.at
              Styria, Graz




  Palliative Care Policy Development
    Hotel Rege, Budapest, Hungary
            October 16, 2003
Hospice and Palliative Care in Austria
    Hospice and Palliative Care in Austria




Content
•        Facts
•        Some Steps
•        Highlights
•        The way forward
  Hospice and Palliative Care in Austria




Facts about Austria
• 84.000 square kilometers
• 9 provinces
• 8,1 million inhabitants
• social demographic
  development:
   – increase of elderly
   – decrease of births
  Hospice and Palliative Care in Austria




Responsibilities in the health care system
• Ministries of federal goverment:
  - social insurance law
  - basic principles in health care
  - education for medical professionals
• Provinces and communities:
  - implementation and execution of laws
  - providing hospital care
• Social security institutions
  Hospice and Palliative Care in Austria




Characteristics of the healthcare system
• compulsory health insurance (> 99% coverage)
• 34.593 physicians 1:231 inhabitants (2000)
• 70.261 beds in 321 hospitals
                     1:115 inhabitants (2000)
• 68.033 places in 761 nursing homes
                     1:119 inhabitants (2001)
• ambulatory specialist outpatient care
                 from “Public Health”, Ministry for social Security and Generations, Vienna 2001
 Hospice and Palliative Care in Austria




Number and places of death
       deaths 2001                  Austria
       total                        74.767
       • hospital                    55,3 %
       • long term care              11,6 %
       • home                        27,0 %
       • other                            6,1 %
  Hospice and Palliative Care in Austria




Wishes of patients in Austria
• 81 % want to die at home
• 75 % want to die “suddenly and quickly“
• 83 % want to die without pain
• 92 % want to know the „truth“
                                           Zulehner, 2001
  Hospice and Palliative Care in Austria




History
• influences from Great
  Britain and Germany
• Book: “On Death and
  Dying”
• Film: “Still 16 days!”
• individual activities
• rise of volunteers and
  community programs
  Hospice and Palliative Care in Austria




„Hospice steps“
Hospice teams (volunteers)
• 1989:        Vienna
• 1993:        Innsbruck, Graz, Baden, Mödling
• 1994/95: Linz, Vorarlberg, Salzburg
• 1996/97: St.Pölten, Carinthia
           Burgenland
 Hospice and Palliative Care in Austria




„Palliative Care Steps“
• 1989: 1st home support team (Vienna)
• 1992: 1st palliative care unit (Vienna)
• 1998: 1st interdisciplinary palliative care course
            (Vienna)
• 1999: 1st hospital support team (Linz)
• 2000: 1st day hospice (Salzburg)
• 2000: 1st home support team for children
            (Vienna)
  Hospice and Palliative Care in Austria




NATIONAL ORGANIZATIONS
• Hospice Austria
  www.hospiz.at
  umbrella organisation of hospice and
  palliative care services (1993)
   - public relations, lobbying
   - interdisciplinary courses
   - directory of services
   - standards
  Hospice and Palliative Care in Austria




NATIONAL ORGANIZATIONS
• Austrian Palliative Care Association
  OPG (2000)
  www.palliativ.at
  Scientific oriented, lobbying
  - Courses for physicians and nurses
  Hospice and Palliative Care in Austria




Highlight 1992
• Enquete in the Austrian parliament:
  „Dying in Austria“
  first official awareness of the problem
  Hospice and Palliative Care in Austria




Highlight 1997
• Education of nurses:
  Integration of palliative care into the
  undergraduate education of registered nurses:
   – 60 hours during 3 years              (GUKKG 1997 )
  Hospice and Palliative Care in Austria




Highlight 2000
• Adoption of palliative care into the
  national plan for acute care hospitals              ÖBIG
                                           (ÖKAP/GGT 2000)

  – plan until 2005:
    30 palliative care units (274 beds)
  – financial regulation (LKF-system)
  – quality criteria for staffing and equipment
   Hospice and Palliative Care in Austria




Highlight 2001
• Declaration of all 4 political parties in the
  Austrian Parliament
  2001 May
           against Euthanasia
  2001 Dec.
           for Palliative Care
  Hospice and Palliative Care in Austria




Highlight 2002
• Family Hospice Leave (Familienhospizkarenz)

  legal claim for reduction/exemption from work
  for the care for their dying family members

   – 1 week - 6 months
   – social assurance is paid
   – no salary
 Hospice and Palliative Care in Austria




Highlight 2003                                       Universitäre
                                          Palliativmedizinische Einrichtung
• Palliative Care Programme                      LKH-Univ. Klinikum Graz


  Medical University Graz
  University hospital
  – inpatient unit: 12 beds
  – hospital support team
  – home support team
  – education
  – research
                                           Lebens-Station
  Hospice and Palliative Care in Austria




Levels of Palliative Care


               Inpatient
                                       Inpatient Unit
                Hospice

      Home Support Team               Hospital Support Team

                           Volunteers

at home
                                                hospital
nursing homes                 1
                            At home
 Hospice and Palliative Care in Austria




Inpatient Palliative Care

Austria 2003          number beds patients
Palliative care units    13   109  2.500
 Inpatient hospices       7    44     500
                total    20   153  3.000
  Hospice and Palliative Care in Austria




Inpatient Palliative Care Units
Inpatient Hospices
                              Austria 2003
 Hospice and Palliative Care in Austria




Support Teams and Day Hospices

Austria 2003                              number patients
             Day hospices                     2       90
      Home support teams                     12    1220
   Hospital support teams                     7     370
Hospice teams - Volunteers                   70    2097
                      total                  91    3777
  Hospice and Palliative Care in Austria




Hospital Support teams
Home Support Teams
Day Hospices        Austria 2003
  Hospice and Palliative Care in Austria




Funding sources
• acute care setting - PCU: hospital funds
• Specialist palliative care services in all other
  services -mixed funding:
   – patients and familymembers
   – social assurance
   – Provinces
   – charity

  Urgent need for further regulations!
 Hospice and Palliative Care in Austria




Education - undergraduate
              Preparation through undergraduate education for Palliative
                                Care (n=536, Missings=10)

             100                             4,4
                                 20,1                  21,5
                       29,5
                                             33,3



                                 42,9                  40,3           very poor
           % 50        40,5                                           poor
                                             44,4
                                                                      good

                                                       28,4
                                                                      excellent
                       19,8      30,6

                                             17,8
                       10,1       6,4                  9,9
               0
                   physicians    nurses     nurse      total
                     (n=227)    (n=219)   assistants
                                            (n=90)


        Baumgartner J., A. Gigl; Mobile Palliativbetreuung, ULIG, Graz (2001)
    Hospice and Palliative Care in Austria




Education – postgraduate
Diploma „Palliative Medicine“
Austrian Medical Association 2002
•      18 interdisciplinary courses since 1998
          participants: 610
•       5 courses for physicians since 1999
          participants : 145
•       5 courses for registered nurses since 2000
          participants :     90
    Hospice and Palliative Care in Austria



                             Advisory Board
                         Lead: Faculty of Medicine
High level:      MASTER Palliative Care
Education – postgraduate
                 Interdisciplinary Course - 170 units + 80 u. practice


Medium level:EXPERT Palliative Care
                 Interdisciplinary Course - 140 u.                   Interdisci-
                                                                       plinary
                                                                      Course
                 Profession specific courses–140 u.+40 u.pr.          „Expert“
                                             Psycho-social-            315 u.
    Medicine              Nursing
                                                spiritual

Basic level:     DIPLOMA Palliative Care
                 Interdisciplinary Course Palliative Care - 140 u.+ 40 u. pr.
                               Upper                        Lower
  Vienna       Salzburg                   Vorarlberg                     others
                               Austria                     Austria
  Hospice and Palliative Care in Austria




DECLARATION Government 2003 - 2006

„The human quality of our society can be
measured, how we care for people in the last time
of their lives.
There should be sufficient facilities for hospice
care, for all those who need it.“
                           Chancellor Dr. W. SCHÜSSEL, 6th March 2003, p. 25
                              http://www.austria.gv.at/regierungserklaerung.pdf
  Hospice and Palliative Care in Austria




Recommendations National Accounting Office
• The implementation of Hospital and Home
  Support Teams should have priority
• Ensure access and networking in the field of
  Palliative Care
• The development of Palliative Care needs
  coordination and administration
                           Rechnungshof Zl 001.506/111-E1/03, Vienna, April 2003
                                                  http://www.rechnungshof.gv.at/
  Hospice and Palliative Care in Austria




Future needs
• ensure access on all levels of care
• integration of the specialist services into the
  health care system
• resource allocation – national and federal
• national strategy and federal plans
• education, training and research
• bereavement services
• public awareness                    Hospice Austria
Hospice and Palliative Care in Austria
Hospice and Palliative Care in Austria
Hospice and Palliative Care in Austria

				
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