Caring for the terminally ill in the Czech Republic remains largely outside of the scope of the state health system. Unlike neighboring countries, where palliative care is a standard part of the state healthcare system, the dying are not priorities in the Czech welfare system. There are 20 to 30 non-profit organizations dedicated to this kind of care, but none receives full reimbursement for the cost of their services, and all of them are operating on the edge in a kind of a "guerrilla healthcare."

A total of 14 inpatient hospices are currently operating in the Czech Republic, together with several mobile hospices that provide care for patients in their home environment. All but one are functioning as private medical organizations. Health insurance companies reimburse inpatient hospices approximately half their operating costs, while the remaining portion must be raised through subsidies or sponsorship. Mobile hospices are completely dependent on their own financing.

"A shame"

"We know that every year in the Czech Republic, 100,000 people die, of which 70-80,000 die in a manner and timeframe that is predictable from their diagnosis, and these people could benefit quite well from supportive, human-friendly care. And though you can cross the near border to Saxony and find a fully functional, state-organized system of such care, here only around three percent of the dying patients gets into the palliative medicine care. That's a shame," says Marek Uhlir, director of one of the non-profits. The lack of comprehensive services supported by the state, not just in palliative care, often forces patients into difficult situations in which they find themselves in facilities on the edge of the law and in appalling conditions.

The state's inertia has allowed unregistered, uncontrolled facilities to emerge, leading to cases of unjustified restrictions of personal freedom, privacy intrusion and hazardous and non-transparent use of drugs, including tranquilizers. These facilities have also been found to serve substandard food, even to patients with dietary requirements. These facilities have often failed to respect human dignity and sometimes even hygiene standards, and the costs of these services often exceed the average pension.