After criticism of the reform plans of Federal Health Minister Jens Spahn regarding the planned law on intensive care and rehabilitation for artificially ventilated patients – in 2018 19,000 outpatients and 3,400 inpatients were treated – Spahn is now changing his reform plans. Originally, out-of-hospital intensive care for these patients was only to be possible as an exception within their own four walls, because Spahn criticised weaning problems and too lax quality requirements for patients to be cared for at home. For this reason, he proposed in his draft that in future artificially ventilated patients should be accommodated in inpatient care facilities or in special residential units. Fierce resistance from affected persons and their relatives as well as from the federal and state commissioners for the disabled put Spahn under massive pressure and he, therefore, changed his reform plans: According to these plans, affected persons may now decide for themselves where they want to be cared for and treated. The sick person now determines the place where care is to be provided. In doing so, care must be guaranteed, because personal, family and local circumstances must be taken into account. The draft bill of the Federal Ministry of Health now provides that the Medical Service of the health insurance companies will take over the evaluation of out-of-hospital intensive care at least once a year. Refusal by the patient or his or her environment is not possible and means a refusal of home care. The current draft by the Federal Ministry of Health violates the UN Convention on the Rights of Persons with Disabilities and encroaches on people’s basic rights, even though faster weaning in this way is not the goal of out-of-hospital intensive care. However, with the help of the updated plans, a reduction of the ventilation time up to the complete weaning of patients should also be achieved. The potential is thus also given in the home environment. The measures necessary for this must be collected and documented. The total expenditure in 2018 for artificially ventilated patients with or without tracheostoma was 1.9 billion euros. Many dubious nursing care providers have taken advantage of the situation and made a good deal of money, which Spahn wanted to prevent with his reform plans.
