German nursing homes fail residents' end-of-life wishes—except this one

A recent report has criticised German nursing homes for failing to meet the individual needs of residents in their final phase of life. However, Diakonie Bethanien in Solingen claims it already provides structured end-of-life counselling. The facility ensures residents discuss their wishes soon after admission to maintain dignity and self-determination.

The 2022 Long-Term Care Report by AOK's Scientific Institute (WIdO) highlighted gaps in care for residents nearing the end of life. It found that many facilities lack systematic approaches to address personal preferences and comfort. In response, Diakonie Bethanien has rejected the findings, stating it offers dedicated counselling within weeks of a resident's arrival.

Counsellors at the Solingen facility ask key questions about what a dignified life means to each resident. They explore sources of comfort, strength, and treatment priorities. This approach aims to prevent unnecessary hospital transfers or unwanted medical interventions. Despite such efforts, challenges remain. One in five care professionals reports monthly cases where residents are sent to hospitals against their best interests. Relatives sometimes push for life-prolonging treatments, even when advance directives suggest otherwise. No nationwide data currently exists on how many facilities provide similar structured counselling programs.

Diakonie Bethanien's model shows how early discussions on end-of-life wishes can support residents' autonomy. The facility's approach contrasts with broader concerns raised in the 2022 report. Without wider adoption of such systems, residents in many care homes may still face treatments that do not align with their preferences.