A psychiatric nurse can prescribe medication
1. The most important things in a nutshell
Nursing at home can be prescribed by contract or clinic doctors if, for example, patients still need medical / nursing care or household support after a hospital stay. Health insurance is usually the payer.
Home care should not be confused with home care from long-term care insurance.
Psychiatric nursing for people with severe mental illness is a special form.
Under certain conditions, those with statutory health insurance are entitled to home nursing care. As a rule, the health insurance is the cost bearer, in the event of an accident at work / commuting or an occupational disease, the accident insurance is responsible. In individual cases, the sickness benefit of the social welfare agency covers the costs.
Home nursing can be prescribed if:
- hospital treatment is avoided or necessary but cannot be carried out, e.g. because the patient refuses to consent to hospitalization for understandable reasons or because the patient is unable to travel (Hospital avoidance care)
shortening hospital treatment (Hospital shortening care)
a serious illness or an acute worsening of the illness is present, e.g. after a hospital stay or an outpatient operation (Support care)
it is necessary to secure the medical treatment goal, e.g. in the form of wound care or injections (Backup maintenance)
- no person living in the household can care for the patient to the extent required.
2.1. Exceptionally, costs will be covered on request
People with statutory health insurance can inquire with their health insurance company whether they will voluntarily take on home care beyond the requirements mentioned (Section 11 (6) SGB V).
3. Place of care
Home nursing is provided in suitable locations where the patient regularly stays, e.g .:
Homeless people can also receive nursing at home if they are temporarily admitted to an institution or other suitable accommodation, e.g. in a homeless shelter or a women's shelter.
3.1. Integration assistance institutions
According to a ruling by the Federal Social Court (file number B 3 KR 11/14 R), integration assistance facilities must carry out simple nursing measures, e.g. measuring blood pressure or administering medication, themselves. Treatment care (see below) is only granted if constant monitoring and care by a qualified nurse is necessary.
The Hospital avoidance care is possible up to 4 weeks per case of illness. In medically justified cases (examination by the medical service) also longer. Outpatient palliative care falls under these exceptional cases and can therefore be prescribed for longer than 4 weeks.
The Fuse maintenance can be prescribed for as long as it is medically necessary.
Scope of hospital avoidance care:
- Treatment care
- Basic care
- Domestic supply
Scope of backup maintenance:
- Treatment care
- Basic care (duration is regulated in the statutes of the health insurance company for security care)
- Domestic care (duration is regulated in the health insurance statutes for security care)
Scope of support care:
- Basic care
- Domestic supply
- Treatment care are:
- medical assistance
e.g. administering medication, applying bandages, injections, measuring blood pressure or body temperature, douching and rubbing
- Performance-related illness-specific care measures
E.g. putting on and taking off compression stockings from class 2, sucking off secretions, help with bladder or bowel evacuation (enema, enema, disposable catheter) or changing of speaking and permanent cannula.
These measures can also be prescribed if they have already been taken into account in the need for help in determining the need for care in the long-term care insurance.
- medical assistance
- Basic care are nursing services of a non-medical nature, e.g. personal hygiene, nutrition, mobility.
- Domestic supply are household help, e.g. shopping, cooking, cleaning, washing up, washing, heating.
5.1. Practical tips
- The prerequisite for the assumption of costs for home nursing by the health insurance company is that the doctor has prescribed treatment care. Basic care and household care without the need for treatment care is not covered.
- If home nursing is insufficient and the patient does not need care according to Section 14 of the Social Code Book XI, short-term care can be applied for if there is no need for care.
Home nursing is usually prescribed by a contract doctor, e.g. the family doctor. The first prescription is possible for a maximum of 14 days, the subsequent prescription can also be issued for a longer period of time.
Hospital doctors can also prescribe home nursing care for a maximum of 7 days as part of discharge management. The hospital doctor should inform the contract doctor treating further treatment in good time so that further care is seamlessly guaranteed.
Insured persons who have reached the age of 18 pay 10% of the costs per day for a maximum of 28 days in a calendar year, as well as 10 € per prescription (§ 61 SGB V). There is no additional payment obligation in the case of pregnancy and childbirth.
8. Service providers
As a rule, home nursing is carried out by Care serviceswho have concluded contracts with the health insurance companies. The nursing service then bills the patient's health insurance directly.
The cost of a self-procured caregiver can be taken over in an appropriate amount (i.e. based on the tariff or customary remuneration of a nurse) if:
- the health insurance company cannot provide staff for home nursing, e.g. if the capacity of the care services with which the health insurance company has concluded contracts is exhausted.
- the self-procured caregiver causes lower costs.
- the person to be cared for, for understandable reasons, only accepts a certain self-selected carer. This caregiver must be able to provide nursing services, which does not necessarily require a completed training.
The Federal Joint Committee has for home nursing of the Health insurances a policy created. This can be downloaded from www.g-ba.de/informationen/linien/11.
The "Common Guidelines of the Associations of the Accident insurance carrier about home health care "can be found at the German Social Accident Insurance at www.dguv.de/de/reha_leistungs/linien-uvt/index.jsp.
10. Who can help?
Health and accident insurance companies.
11. Related links
Outpatient child nursing
Child care sick pay
Home care long-term care insurance
Short-term care when there is no need for care
Outpatient palliative services
Sources of law: § 37 SGB V - § 32 SGB VII
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