Palliative care at home — what it takes to make it work

Three pillars of palliative care at home — plus a fourth

Pillar 1: AAPV (general outpatient palliative care):

The GP plus a home care service with palliative experience. The standard arrangement. It works where symptoms are moderate.

Pillar 2: SAPV (specialised outpatient palliative care):

A palliative team of palliative physicians and nurses comes to the home, is reachable 24/7 and takes on complex symptom control. It requires a prescription from a hospital or a specialist. The health insurer covers the cost.

Pillar 3: hospice companionship:

Volunteer hospice services come to the home, support relatives and are simply there, without being medical. Free of charge.

Pillar 4: private-pay 1:1 companionship (what we provide):

Where the family cannot be there continuously, where volunteer bedside companions are not enough, where an additional dependable presence is needed — we step in.

Who leads all of this?

Responsibility for palliative care rests in principle with the GP. Where SAPV is involved, the SAPV team coordinates. In practice a great deal is organised by relatives — and we often help out here, because families are stretched beyond their limits at this stage.

What families should know

Letting someone die is not a failure:

When a stage of life is coming to an end, not every medical option has to be exhausted. An advance healthcare directive (Patientenverfügung) protects against treatment being continued that nobody wants any more.

Freedom from pain is possible:

Good palliative pain management brings suffering under control in almost every case. If you have the feeling that it is not under control: get another doctor, bring in SAPV.

The last breaths can take a long time:

During active dying, breathing often becomes irregular, sometimes over hours or days. It alarms relatives — but for the dying person it is usually not suffering. An experienced companion can do a great deal to calm this.

There is nothing that has to be said:

In the final hours nobody needs a great conversation. Being there is enough. Holding a hand is enough.

What we can contribute in practice

• Night companionship, so that the family can sleep.
• Weekend cover, so that relatives get a chance to breathe.
• 24-hour care over the last 2-5 days, once the dying process has begun.
• Companionship after death — until the undertaker and the doctor have arrived.

Frequently asked questions

• Who decides whether SAPV is prescribed?

  The prescription comes from the GP, a hospital or a specialist. It requires a complex palliative care situation.
• Is palliative care at home possible without SAPV?

  Yes, with AAPV (GP plus home care service) and hospice services alongside. We are often brought in where that is not enough.
• How quickly can end-of-life companionship be arranged?

  Reliably with 24 hours’ notice, and in emergencies often the same day.
• Will an insurer cover our companionship?

  As a rule, no. Some private health insurers reimburse part of it — we are happy to provide an invoice suitable for submission.