1283 Advance care planning in Germany: a progress report

<h3>Background and Aim</h3> In 2015, the German parliament passed a legislation providing financial coverage for advance care planning (ACP) for residents in nursing homes and care homes for persons with disabilities which came into effect in December 2017. It is the aim of this presentation to give a progress report on how ACP has developed in Germany over the last years and discuss what lessens can be learned for the implementation of ACP on national levels. <h3>Summary of Content</h3> Many nursing homes and care homes for persons with disabilities have meanwhile implemented the option of facilitated ACP for their residents. However, the quality of the facilitator training varies considerably – and thereby also the quality of the facilitated ACP conversations. The German society for advance care planning, Advance Care Planning Deutschland (ACP-D), has meanwhile elaborated standards for the qualification of facilitators and the facilitator trainers. One of the major challenges in implementing effective ACP in Germany has been the lack of funding for institutional and regional implementation of ACP. We just completed a multi-center, cluster-randomized controlled trial (BEVOR trial, publication just accepted) in German nursing homes which indicates in an explorative analysis that ACP is only effective if individual ACP conversations are accompanied by respective interventions on the institutional (nursing homes) and regional level (emergency care services). Another important development concerns the planning for emergency situations. These are not covered by the official advance directive forms by the German Federal Ministry of Justice. There are several initiatives to establish emergency plans in Germany to close this important gap in advance care planning. For this purpose, the German ACP society developed the concept of ‘integrated emergency planning’ which combines eliciting general attitudes to living, severe illness and death with a one-side emergency plan. The concept will be implemented in the state of Bavaria and is currently pilot tested in the region of Nuremberg. <h3>Unique Contribution</h3> The presentation will give the audience the unique possibility to learn about the challenges of national ACP implementation focused on nursing homes and how the deficits can be compensated by ‘grass-roots initiatives’. <h3>Implications</h3> The German experiences show that ACP can only achieve its goal effectively if it is also implemented, in addition to ACP conversations, on an institutional and regional level. It will stimulate debate on how especially emergency situations can be planned in advance, when limited prognostic information is available.