A hospital is not enough: the need for integrated care

In the developed world, long-term care is moving outside hospitals, because they cannot fulfill the social or spiritual dimension that frail and chronically ill people need. The speaker emphasized that social services facilities must also provide adequate healthcare—the prevention of pressure ulcers or complications is just as important as support and accompaniment. Families are often surprised at how limited the availability of nursing is in practice, even though strategies exist on paper. Without real resources and responsibilities, however, they remain only partially fulfilled.

What has been achieved and what needs to change

After years of effort, new money has been directed straight to social services facilities, earmarked exclusively for nursing by nurses in line with approved standards and legislation. Many providers praise this step and consider it an important shift; the pandemic also showed that nurses in these facilities are indispensable. A brake, however, remains the capacity ceiling (e.g., a limit on the number of beds), which prevents additional facilities from entering the system. Expanding capacity and stable rules are therefore crucial so that help reaches everyone who knows how and wants to provide it.

The next step is to contract also with those social services providers who today do not have a contract with health insurers, and to allocate resources from public health insurance for that purpose. The foundation should be "coordinated care": in each facility at least one nurse–coordinator, who monitors health status, collaborates with physicians and the mobile hospice, and trains caregivers. There is also a need for more services from home nursing care agencies (ADOS) directly in the facilities, focused on prevention and comprehensive health management, with appropriate remuneration. Only then will the most vulnerable people stop suffering because of the gaps in the system and be able to live with dignity until the end.