population 82 million

Population density

GDP per capita

Education expenditures


44,700 $ (2014)

5,1 % of GDP (2010)

Hospital bed density

Physician density

Health expenditures

8,2 beds/1.000 people (2011)

3,69 /1.000 people (2010)

11,3 % of GDP (2012)



Following here you will find information about Hospital and Home Education (HHE) in those countries where HOPE has members.
The information has been researched and compiled by the HOPE Committee Member/s(CM) of the specific country; the information sources are listed at the end of this document.
We’ll be glad to get your feedback, please contact the CM of your country, or else – if your feedback is of a more general character – please contact the Board of HOPE.
You will find the e-mail addresses on this website under ‘Who We Are’.


Overview of topics; click on one of them and you will jump directly to the information:

1. HHE as part of the Education System

2. HHE Operation

3. Teaching Staff

4. Pupils

5. Some Thoughts about the Future

6. Sources and further Links



Germany is a federal republic made up of 16 states. The state governments have – among other powers – the privilege to determine and administrate education on the primary and secondary level; tertiary education is the privilege of the national government.
Thus there are many variations in how education is organized, also how the education of children with medical conditions in hospitals or at home is provided for in the individual states.
The differences reflect also the specific frameworks of either a “city state” (e.g. Berlin, Hamburg, etc.) or a geographically spread out state (e.g. Bavaria, Baden-Württemberg, Niedersachsen, etc.).


1. HHE as part of the Education System

Generally HHE in Germany is part of the public education system. However, state legislation, guidelines and school policies vary.
Almost all states have hospital schools and they are part of the public school system. They usually have the legal framework of independent schools, with a headteacher, their own permanent teaching staff, and their own budget.
The material equipment (furniture, black-/whiteboards, books, computers, software, etc.) is usually paid for by the city or the region.
The teachers are paid by the Education ministry.
Some services (telephone expenses, heating, cleaning of rooms, etc.) are typically included in the hospital budget.
There are three states which do not have independent hospital schools.
Instead teachers working in a hospital are ‘on loan’ to the hospital by a regular school in the vicinity.


2. HHE Operation

The structure of a school in hospital is mostly the same as of any other school. One difference is that it is physically located within another institution (a hospital). (And so, for example, there are no guidelines as to what kind of rooms the hospital school should get.)
Another difference is that there are very small schools with only a handful of teachers (e.g. at smaller hospitals); there are also very big schools with several locations but managed as one school.
The task of the school is to follow the state curriculum as implemented in the home school, while also adjusting it to the needs and current health and/or mental condition of the pupil. The aim is to enable the kid to continue his or her education.
A pupil with a medical condition – whether in hospital or at home – cannot sustain the same workload of lessons, tests and homework as a healthy one. So the task of the hospital teacher is to reduce that workload, in consultation with the home school.
The major subjects (mother tongue, foreign language/s, mathematics) usually have priority, arts are often offered as well. Additionally other subjects (biology, geography, natural sciences, etc.) are taught, depending on preferences of the pupil, academic requirements (upcoming exam), and depending on the availability of staff. The schools offer also project-work (film making, school magazine, cooking, etc.).
Most hospital schools have their own classrooms, in some cases even their own building on the hospital campus. When necessary, lessons take place also at the bedside.
Home education is usually the task of the hospital teachers. They go to the private home of the pupil [typically he or she has been a pupil of the hospital school while hospitalized], they are in touch with the doctors or psychiatrists in charge. When it is not possible, e.g. for reasons of distance, the hospital school will try to cooperate either with a hospital school located nearer to the home of the pupil, or else will cooperate with the home school to ensure bridging the gap.
Hospital schools also have out-patient students.
There are no fixed operating hours. Each school has to find ways which serves best its requirements. Generally a full-time teacher in a public school has to teach 23 – 28 lessons a week.


3. Teaching Staff

Hospital schools are often categorized as special education schools (like those for the blind, the hearing impaired, etc.); this category provides a better teacher / pupil ratio. The hospital school staff, however, is made up of teachers representing different school types: primary school, secondary school [trained in different subjects], upper secondary school, special education.
The teachers, with very few exceptions, are licensed public teachers, and are for the most part civil servants.
There is no specific training before being chosen (by the education authorities and the individual school) to teach in a hospital. However, there are in-service training seminars.
At this time there is a push to include elements of education of children with medical and/or mental health needs in the academic training of teachers in general (and to make it part of their state exams).
The teachers in hospital have the mandate to try and ensure the academic re-integration in the home school and home class – where possible. Often, students are quite worried to fall behind scholastically. For this aim the hospital teachers are in frequent contact with the teachers at the home school. However, the teachers need to take into account also the individual health situation of their students, (strength, impact of therapies, ability to concentrate, psychological state, etc.) – in consultation with the medical staff – and find a good path between academic achievement and physical and mental recovery.
In some states there are specific legal regulations to give students with medical conditions equitable chances, e.g. during tests and exams (more time, splitting a school year in two, etc.
There are cases where a completely new educational route needs to be developed.
Besides HOPE there are two national organisations for hospital teachers:
The VdS, a big organization for special education schools, which has a special section for hospital teachers; and SchUPs, an organization specifically for teachers working in mental health hospitals.


4. Pupils

The hospital schools enroll pupils as soon as a medical doctor has given his or her okay. There are regulations as to the length of expected hospital stay; in practice, however, this plays a minor role. If the doctor and the school feel it makes sense the new student will be included in the hospital schools lesson plan.
There are no different regulations for teaching students with medical vs. mental health needs.
The other criteria including a young person into the lesson plan is that he or she is enrolled in a regular school. So the age range generally covers 6-year-olds to 18+-year-olds.
The teacher/pupil ratio differs from state to state. Sometimes it is related to the number of beds for school-age children in a hospital, at other times it is a function of the number of sick children enrolled in the hospital school plus ‘external’ pupils (at home or out-patients).
Psychiatric hospitals sometimes get extra teachers.


5. the Future

There are various developments and initiatives:
One is to include the issue of students with medical needs into regular teacher training. After all, every teacher at a regular school will at some point have to deal with a student in his class who has a medical condition and thus requires special attention and care.
Since in-patient times have become much shorter in recent years, many students, their parents, and home teachers need more support about how best to handle problems or insecurities in the home school. – Thus there are also developments to include counselling and consultation into the task list of hospital teachers, i.e. that the time used for these activities are paid for.
There are also initiatives to set up a nationwide accepted training scheme for hospital teachers. Not an easy process in a country with 16 states with educational independence.
There is also small progress in getting the item ‘hospital school’ into the planning process for new hospitals.


6. Resources and further Links

The following sources were used for the data and information given in this document:
Wikipedia – Germany
The World Factbook – Germany
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