Care levels: What you are entitled to if you require care

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Care levels: What

you are entitled to

if you require care

The issue of “care level” often becomes pressing when a family member requires care for the first time. The care level is a crucial factor: it determines which benefits you can claim from your long-term care insurance. These include, for example, care allowance, in-kind care benefits, respite care allowance, and assistive devices.

Below you will find answers to the most important questions about care levels.

What is a care grade, what is a care level?

What is a care grade

what is a care level?

Since January 2017, care grades have replaced the care levels used until the end of 2016. Eligibility for care benefits depends on the degree of impairment of the person requiring care and their level of independence. This ultimately determines the level of care required and the specific care benefits to which the person requiring care and their family members are entitled. Therefore, the three care levels are no longer in use.

How many care levels are there?

How many care

levels are there?

Five levels of care are distinguished:

Care level 1: Minor impairment of independence or abilities
Care level 2: Significant impairments of independence or abilities
Care level 3: Severe impairments of independence or abilities
Care level 4: Most severe impairments of independence or abilities
Care level 5: Most severe impairments of independence or abilities with special requirements for nursing care

How is the level of care determined?

How is the level of

care determined?

Once the application for a care level assessment has been received, the long-term care insurance provider will contact you to schedule an appointment for an assessment using the “New Assessment Procedure” (NBA). This assessment must be offered to the person requiring care within 14 days of the application being received. At the appointment, an assessor from the Medical Service (formerly “MDK” for Medical Service of the Statutory Health Insurance; now “MD” for Medical Service if the person requiring care has statutory health insurance) or from MEDICPROOF (the medical service of the private insurance companies) will visit the person requiring care and assess their care needs. The caregiver who has been looking after the person up to this point should also be present at this appointment. The decisive factor for the approval of benefits is primarily how independently the person can act – also described as “everyday competence”.

The assessors consider the individual degree of independence and abilities of the person requiring care in six different areas as criteria for their evaluation:

Mobility: How mobile is the person? How can they still move around safely on their own?
Mental and communicative abilities: How well does the person understand what is happening around them? How well can they hold a conversation with others?
Behavioral and psychological problems: What is the state of their mental health? Is the person perhaps restless or anxious at times? Do they feel the need to resist whenever, for example, someone wants to help them get dressed?
Self-care: Is the person in question able to care for themselves? For example, can they wash, dress, or eat independently?
Independent handling of illness- or therapy-related requirements and burdens – and coping with them: For example, is it possible for the person to take medication independently or use their walker alone?
Organization of daily life and social contacts: Can the person organize their daily life independently and also make contact with others?

The assessors award points based on the degree of independence and abilities in these six areas of life. Following the care assessment, the assessor has five weeks to prepare the report and arrive at a classification. Those affected will receive the result, and thus their care level, no later than five weeks after the on-site appointment.

What benefits are provided at each care level?

What benefits are

provided at each

care level?

The care assessment determines which benefits the person in need of care and their relatives are entitled to. Depending on the care level, these can include, for example, the following benefits:

Care consultation: You can take advantage of a care consultation service to receive support with all topics related to care.
Care allowance: Care allowance is used to pay for care.
Care benefits in kind: Care benefits in kind are nursing and care services, which are provided, for example, by an outpatient care service.
Day care/night care: In order to guarantee round-the-clock care at home, it is often necessary to receive support in the night or day care of those in need of care.
Short-term care: Short-term care is designed to cover the care of a person in need of care for a limited period of time.
Respite care: Within the framework of respite care, for example an outpatient care service can take over the care if the caregiver is unavailable, for example due to a holiday or a rehabilitation measure.
Benefit amount for inpatient care: If care is provided in an inpatient setting, the long-term care insurance fund covers a portion of the costs, depending on the level of care required.
Relief allowance: The so-called relief allowance is a form of financial support and can be used to engage a care service for specific tasks (e.g., for help with household chores or shopping). This provides relief for family caregivers.
Care supplies: Care supplies are products needed for caregiving. These include consumable care supplies (such as disposable gloves or disinfectants) as well as other aids, such as subsidies for a home emergency call system or positioning aids.
Caregiving courses: As a family caregiver or volunteer caregiver, you can, for example, attend a course to learn the basics of caregiving and receive helpful tips. The costs are covered by long-term care insurance.
Home adaptation: If a care level is approved, you are entitled to subsidies to adapt your living space so that your independence at home is preserved as much as possible and it is easier for caregivers to take over the care.
Subsidy for a shared living arrangement: It is also possible to establish a shared living arrangement and receive a one-time subsidy from the long-term care insurance for this purpose.

Applying for a care level assessment: Here's what matters

Applying for a care

level assessment:

Here's what matters

One of the most pressing questions for many affected individuals is: How do I apply for a care level assessment? Many suspect it will be a major undertaking, so the application is often delayed, as there is often so much to clarify in a care situation.

Important to know: If benefits are approved, you will generally receive them retroactively from the month of your care level application. Therefore, it is worthwhile to complete this task promptly if there is even a hint of a need for care (e.g., if the person in question is experiencing some limitations in their independence).

Where to apply for a care level assessment?

Where to apply for a

care level assessment?

You have several options for applying for a care level assessment:

Care support center or care advice: Do you feel unsure about your initial application? Then take advantage of the support offered by a care advisor and use the local care support centers in your area to submit your application for a care level assessment.
Long-term care insurance: Contact your health insurance provider, as your long-term care insurance provider is also located there. You can request the application form for a care level assessment by phone, which you can then fill out at home and return. Alternatively, you can send an informal letter stating that you wish to apply for a care level assessment for the insured person. The long-term care insurance provider will then contact you for further information. Often, the necessary documents can also be downloaded and printed from the long-term care insurance provider’s website.

Care level: How long is it valid?

Care level: How

long is it valid?

A care level rating can be valid for a limited time. After this period expires, the care level rating is reassessed. The resulting assessment can then be used to determine the next steps.

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