70-year-old Wolfgang A. has been paralysed from the neck down since a serious cycling accident and cannot breathe on his own. When he can be discharged from the rehabilitation clinic, he wants to go home to his wife and his familiar surroundings. He applied to the state of Salzburg and his health insurance company, the SVS, to have the costs covered. The state of Salzburg refused, and Wolfgang A. is to be accommodated in the Hallwang retirement home instead, where beds are available for people requiring artificial respiration. The state has so far ignored an enquiry by the Ombudsman Board. The SVS also initially refused, but after the Ombudsman Board intervened, it is now prepared to co-finance the treatment at home. However, this requires an agreement with the state of Salzburg.
First organise treatment, then work out in the background who pays how much
Achitz refers to several judgements by the Supreme Court (OGH): "People have a right to be cared for at home. The state and the health insurance fund should make this possible quickly and then agree afterwards who will pay how much of the costs. The families of those affected are left with high costs anyway."
Of course, it would make sense if there was a standardised solution for such cases throughout Austria that all provinces and all social insurance providers would adhere to. But those affected can't wait for that. "I can no longer hear the standard excuse that the federal government should do something. The states and the health insurance funds are clearly responsible," says Achitz.
"Disappointed that nobody from the state of Salzburg is discussing this with me"
The second case concerns 64-year-old Günter S., who has had incomplete paraplegia since a serious accident in 2010. He was implanted with a diaphragmatic pacemaker in 2011. He needs a respiratory mask at night and when lying down. He has been receiving 24-hour intensive care for 13 years. He finances this partly from his disability pension and care allowance, with the rest covered by the state of Salzburg. Since 28 November 2024, Günter S. has been undergoing treatment at the paraplegic centre of the BG Klinikum Hamburg. Fortunately, ÖGK is covering the costs of treatment at this specialised clinic.
Although it was confirmed there that Günter S. is still dependent on 24-hour intensive care, the state of Salzburg suddenly no longer wanted to pay. "This is difficult to condemn and must be rectified urgently," said Ombudsman Achitz in the ORF programme "Bürgeranwalt", broadcast on 8 March. Günter S. also does not want to go to a home, but home to his family in Wagrain. "I've been waiting unconsciously for three months. Please help me!" he appealed. And his wife can't understand something else: that no one from the state of Salzburg has even come to the ORF studio: "I'm disappointed that no one has come and had a dialogue with me." It was only after the Ombudsman's Office intervened and "Bürgeranwalt" was recorded that the state promised ORF that intensive care would be made possible again. "Why not right away?" asks Ombudsman Achitz, and: "I expect the state to finally take action in the case of Wolfgang A. as well."
Auf ORF ON können Sie die Sendungen des Bürgeranwalts auch online sehen