Outpatient geriatric rehabilitation centre Schönebeck

Warum wurde diese Initiative implementiert?

The pilot project was started in order to improve the long-term effect of therapies and health maintenance of older people right after an acute hospital stay. The pilot project addresses two gaps between health and long-term care provision:

• As a consequence of the German system of hospital financing through Diagnosis Related Groups, hospitals have an incentive to discharge patients as soon as possible. Patients have thus to pass their period of convalescence outside the hospital. Patients need outpatient care and, particularly in the case of older people, rehabilitation. Rehabilitation is often the only chance for them to regain their ability to cope with activities of daily living at home.
• Geriatric rehabilitation usually takes place in clinics that are often far away from the home of the older person.

The innovative initiative of the centre was therefore to provide rehabilitation while patients are living at home. They are picked up by a shuttle service in the morning, spend about five hours in the centre and return back home in the afternoon. The advantages of this are that older people can quickly apply re-acquired skills in their familiar surroundings and that carers get some relief from the burden of caring.

Beschreibung

The outpatient geriatric rehabilitation centre Schönebeck was founded by four GPs in 1999. It provides integrated care and aims to maintain older peoples’ autonomy and prevent or reduce care needs.

The target group are people living in the district within a maximum of 30 km. The centre works using an interdisciplinary network that comprises gerontologists, physiotherapists, occupational therapists, speech therapists, social workers, nurses and a supply store for equipment. In order to prepare for the new challenges to start-up this centre, the four GPs attended a specific course (‘ambulant geriatric rehabilitation’, duration: 160 hours). They all run the centre in addition to their own surgeries.

The geriatric rehabilitation usually takes 20 days with two or three rehabilitation sessions per day.

With most of the health insurance funds a case-based lump sum has been arranged (approx. €110 per patient per diem). There is also an equity contribution (€10) and a contribution for catering (€5), both to be paid by the older person. The centre cares for about 15 older patients on average at a time. With an average occupation of about 13 patients the centre pays for itself.

Welche Effekte wurden erzielt?

The Schönebeck outpatient geriatric rehabilitation centre has been in operation for more than 10 years. There are at least five important aspects in relation to its impact:

• The rehabilitation provided by the centre taps the rehabilitation potential of its patients.
• It is highly accepted by the patients, with only a few drop-outs.
• The centre is widely accepted by the health insurance funds. It succeeds in obtaining supply contracts with almost every German health insurance fund.
• The centre is economically viable and self-sufficient.
• The pilot project was positive evaluated by the Institut für Sozialmedizin at the Otto von Guericke University. The crucial result: The centre meets the quality standards which allow German health insurance funds to refund costs incurred.

The centre is an excellent example of multi-professional working and it successfully bridges a gap within the German health care system between hospital and home. The centre helps patients leaving hospital to regain their ‘former’ daily living skills, which may prevent nursing home admission.

The centre is definitely sustainable as it is mostly operated at full capacity and is economically viable. 

Worin bestehen die Stärken und Schwächen der Initiative?

Strengths

• The centre uses group dynamics - the older people form a self-help group which helps its members to work hard on regaining their ‘former’ daily living skills
• it supplies the whole portfolio of experts required
• it gives a framework for therapists to always be able to coordinate practice
• it saves valuable working time (there is almost no need for home visits)
• it allows the older patients to be better monitored
• it contributes to the social integration of its users

Weaknesses

• The centre provides an artificial setting (it does not provide training at home)
• it works with noticeable fixed expenses
• older patients have to be transported to the centre

Impressum

Externe Links und Literatur

• http://www.agrsbk.de/
• http://www.agrsbk.de/presseartikel/Wirtschaft.gif
• http://www.agrsbk.de/presseartikel/Berliner_Aerzte_07_2007.pdf
• http://www.kbv.de/media/pdf/100330_Forum_indikationsuebergreifende_Versorgung_John.pdf

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