Development and state of the in-patient palliative care institutions in Germany

In April 1999 altogether 114 inpatient units providing palliative care (50 palliative care units, 64 inpatient-hospices) offered a total of 989 beds. Compared to 1993 this has been an increase of 256%, compared to 1997 of 60% . The number of available beds, compared to 1997, increased markedly (58%), with a availability of 12 beds per one million residents. However, there a re still major deficits: the distribution of the units is very irregular an d the number of available beds is still to low, compared to the estimated n eed of 50 inpatient beds per one million residents. The quality of palliative care shows significant deficits (e.g. the availab ility of nursing staff, cooperation with pain clinics, standardised documen tation, education), Differences between palliative care wards and hospices were huge. According to the definition of the German Society for Palliative Care, a palliative care ward should provide a ratio of at least 1.4 nursin g staff per bed, however, only 18% of the palliative care units fulfil this definition. Only few hospices and half of the palliative care units worked in close cooperation with pain clinics. Despite a significant increase in units and inpatient beds providing pallia tive care, there still is a major deficit in the overall number of beds and the quality of palliative care.