Hospice in Hungary 2004 Dr. Katalin Hegedus VI. Hungarian Hospice-Palliative Congress, Miskolc, 23 April 2004

Transcription

1 1 Hospice in Hungary 2004 Dr. Katalin Hegedus VI. Hungarian Hospice-Palliative Congress, Miskolc, 23 April Number of population Number of death Cancer death Patients in palliative care in inpatient centres (77 beds) 15 hospice home care teams 2 day care centres 4 hospice teams in nursing homes (29 beds) 5 hospital teams 3. Number of hospice patients since 1991: (2203 patients in 2003) cancer patients in palliative care: 89% average of duration of hospice care: 29,4 days 4. Table 1. Hospice inpatient units Name: Date of Number of beds: establishment: Gyula, Pándy K. Hospital Hospice Department Budapest, St. László Hospital Hospice Department Miskolc, Semmelweis Hospital Erzsébet Hospice Debrecen, St. Erzsébet Hospice Pécs, Merciful Hospice Table 2. Name: Hospice teams in nursing homes Date of establishment: Number of hospice beds:

2 2 Sóstó, Nursing Home Pécs, Nursing Home Tatabánya, Nursing Home Hajdúböszörmény, Nursing Home Table 3 Name: Hospice home care Date of establishment: Hungarian Hospice Foundation (Budapest) 1991 Hospice Foundation of Szombathely 1992 Satisfaction Hospice Foundation (Budapest) 1993 Miskolc, Erzsébet Hospice Foundation 1994 Debrecen, Spital Hospice 1994 Kecskemét, Hospice Foundation 1995 Székesfehérvár, Help Bt 1995 Nagymaros, Pax Corporis Foundation 1995 Pécs, Social Net Association 1996 Óbuda-Békásmegyer Home Care Service 1998 Nyírtelek, Nursing Association 1998 Ruzsa, Bánfi Home Care Service 1999 Kaposvár, Nevitt Cindy Home Care Service 1999 Szeged, Hospice Foundation 2002 Pécs-Baranya Hospice Foundation Differences between home care and hospice home care Home care general home care nurse and physiotherapist Hospice home care care of dying patients multidisciplinary team hospice trainings contact with hospice services 8. Hospital teams 1. Jewish Charity Hospital, mobile team, Budapest (2001) 2. "Life for years" Foundation, Dombóvár (2001) 3. Satisfaction Hospice Foundation, mobile team (2001) 4. Hungarian Hospice Foundation, mobile team (2001) 5. Baranya county Hospital, mobile team, Pécs (2003)

3 3 9. Complex services Hungarian Hospice Foundation (hospice home care, hospital mobile team, day care centre, pain outpatient clinic, psycho-oncological outpatient clinic, telephone mental health service, bereavement service, education centre) Elisabeth Hospice, Miskolc (inpatient unit, hospice home care, day care centre, telephone mental health service, bereavement service, education centre) Come into being: Pécs (hospice home care, mobile team, hospice in nursing home, education centre) 10. Hospice staff in Hungary, 462 persons 33 physicians 184 nurses 27 physiotherapists 20 psychologists and mental health experts 121 volunteers 19 priests 15 social workers 9 dieticians 17 administrators, co-ordinators 6 occupational therapists 7 bereavement counsellor 1 Bach flower therapist 2 masseur 11. Successes 1. Legal background Hospice-palliative care in Health Care Act (99. ) (1997) Accredited post-graduated hospice education system (3000 people since 1994) Consensus conference in the Ministry of Health and National Guidelines (Standards) (2000, 2002) Media campaign with human rights and patients rights organisations in 2003 to initiate a parliamentary examination (2003)

4 4 Hospice minimum standards, ministerial decree (15/2004. (III.8.) 12. Successes 2. To form attitude media campaigns volunteer education educational forums, workshops, open days concerts, exhibitions 13. Meaning of 'hospice' volunteer, caritative organization part of health care system philosophy philosophy+ palliative practice movement character 14. Weaknesses - in general Not enough financial support from National Health Insurance Fund Insufficiency of under-graduated palliative education Non-acceptance of multidisciplinary team in the health care system, few volunteers Management Quality control Evaluation 15. Weaknesses 1. Financial difficulties Sources Financial aid of the National Health Insurance Fund (3-50%) Local governmental support 1% of tax Grants (Soros, Phare, ministries, Parliament, European Union etc.) Donations (Aim:70% finance of National Health Insurance Fund) 16. An example: Finance of the Hospice Foundation of Szombathely, Soros grants

5 local government from 1997-től National Health Insurance Fund (50%) 1 % of tax (one part of the nurse visits, mental health expert) local government (coordinator's salary) pharmaceutical support (for educations) donations (medicines, therapeutic aids) (Reference: Nóra Tóthné Nagy) 17. Weaknesses 2.Quality control, evaluation Basis: Guidelines, standards (2000,2002) + quality control documents, March 2004 (theoretical background) Lacking quality control in practice measuring of quality of life improvement need assessment by international and Hungarian samples (see Higginson) 18. Quality standards and realization in Hungary standards indicators realization holistic care multidisciplinary team yes special education how many % of the team yes possess improvement of quality how many time, how there is not measuring of life many patients (%)? access to care by needs how many patients need and receive palliative care (%) there is not measuring 19. Information system Website: Hospice News ( 4 in a year) s (occasional (see the computer misery of hospitals) Personal contacts 20. Initiative of a parliamentary examination, March 2003

6 6 Four questions were addressed officially to the Parliament to examine: 1. Are there enough available modern treatments, medicines and trained specialists in the institutions caring for dying patients? 2. Is there enough psychical care and information for terminal patients? 3. Are there enough palliative care services? 4. Is there a good-quality care in the chronic departments and institutions? 21. Results 1. Minimum standards (March 2004) 2. Two years financing model of hospice/palliative services (National Health Care Insurance Fund) ( April 2004) 3. National Palliative Plan (from 2004 to 2008)