[Feasibility study and analyses of the service records for advance care planning (ACP according to sect. 132g SGB V) in nursing homes - Results of the 'Gut-Leben' project].

Abstract

Background: With the entry into force of sect. 132g of the Social Code Book [SGB] V in 2018, nursing homes and homes for persons with disabilities providing integration support in Germany can get reimbursed by the statutory health insurance funds for advance care planning (ACP) services. The aim of this feasibility study was to evaluate the number of service records to be submitted, examine the containing information about the consultation process, and assess their potential for research.

Methods: We analyzed aggregated data from a large German statutory health insurance fund (AOK Lower Saxony) for 2018-2022 on the contracts concluded for ACP. In addition, anonymized service records from nursing homes and homes for persons with disabilities providing integration support from 2020 to 2022 (no records available for 2018 and 2019) were evaluated descriptively. These records contained information on the type and duration of the consultation process, as well as the number of consultations conducted. Furthermore, facility-specific information was available for facilities with at least one service record, including the number of care places and the number of consultants meeting the qualification requirements of sect. 132g SGB V.

Results: In 2018-2022, n = 101 ACP contracts were concluded between the n = 1,415 nursing homes located in Lower Saxony and the state associations representing the interests of the health insurance providers (homes for integration support: n = 104). For the years with service records available (2020-2022), n = 134 contracts were signed. Of these facilities, n = 50 (37 %) had at least one service record, and only one facility (2 %) had more than one facilitator. Of the total n = 230 service records, 97 % documented a first-time consultant process. The process had a mean duration of 33 days and included an average of 2.9 consultant sessions. 13 % of the processes were completed in one day and almost 90 % after three months.

Discussion/conclusion: We found a low number of (1) signed ACP contracts, (2) facilitators in the facilities, and (3) service records available at the health insurance company. However, service records are only one part of ACP. This is why, overall, service records in their current form appear to be of poor usability in the context of both scientific research and the further development of ACP.