If you have a care level between 1 and 5, you will receive supportive services from the nursing care fund. This is how you apply for a degree of care and care allowance.
Frankfurt – When a person can no longer go about his or her everyday life alone, he or she needs support. It doesn't matter whether age, an accident or a chronic illness is the reason. This support can be provided in the form of family caregivers or caregivers or moving to a nursing home. Regardless of the option, there are often high costs associated with this lifestyle change. Therefore, it is possible to apply for a degree of care and associated support services from the nursing class. Here's how it works.
Step 1: Apply for a degree of care
The application for a degree of care must be submitted to the respective health and long-term care insurance fund with which the person concerned is insured. This can be done informally by phone, letter or e-mail. It is sufficient to inform us that you would like to apply for benefits from the long-term care insurance fund and a degree of care. The sooner the application is submitted, the better. This is because benefits are only available from the month in which the application is submitted.
Step 2: Fill out the application form from the long-term care insurance fund
The health insurance company forwards the application to the associated long-term care insurance fund, which then sends those affected a form for applying for long-term care services. In it, people in need of care or their authorized relatives can specify exactly which benefits are to be applied for and whether care is needed at home, by an outpatient care service or in a home. Filling out the application is sometimes complicated, verbraucherzentrale.de says. Getting help filling out the form from the long-term care insurance fund or counselling centres is a safe bet. Mistakes are quickly made, which can have serious consequences and the level of care is rated too low.
Step 3: After the application for the degree of care: The state of health is checked in an expert opinion
As soon as the application has been submitted, the long-term care insurance fund commissions an expert opinion. In this case, the applicant's actual need for care is checked. This is done during a home visit. Six areas of everyday life are scrutinized. According to the pflegeberatung.de, these include:
- Mobility and physical agility
- Cognitive and communication skills
- Motor skills and psyche
- Ability to self-sufficiency
- Dealing with illness and therapy-related requirements
- Everyday life and the opportunity to maintain social contacts
The degree of care is determined by the expert opinion. The long-term care insurance fund then makes the decision on the degree of care and issues the notice.
Prerequisite for the degree of care: What must be available at the time of application and how much is the care allowance?
According to verbraucherzentrale.de, in order to get a degree of care, two circumstances must be present. Firstly, the person concerned must really be in need of care, otherwise the expert opinion will be to his or her disadvantage. And secondly, she must have paid into the health insurance fund or been covered by family insurance for at least two years within the last ten years.
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My areaCare services vary from care level to care level. (Symbolic photo) © Zoonar/Imago
Step 4: Long-term care insurance fund decides on the degree of care
If these conditions are met, those in need of care receive a care level of 1 to 5, depending on the severity of the restriction in everyday life. According to pflege.de, points are awarded in the appraisal that determine the degree. You need at least 12.5 points for care level 1, 27 points for care level 2, 47.5 points for care level 3, 70 points for care level 4 and from 90 points you have the highest level, namely care level 5.
In the case of care allowance and other benefits alone, this staggering makes a big difference, which can be helpful if, for example, the retirement provision is not enough for the nursing home or home care. According to the pflege.de, the entitlement to care allowance for home care per month for 2022, for example, is between 316 euros for care level 2 and 901 euros for care level 5. At care level 1, no care allowance is due.
| Degree of care | Care allowance for care at home (as of 2022) |
| 2 | 316 Euro |
| 3 | 545 Euro |
| 4 | 728 Euro |
| 5 | 901 Euro |
The entitlement to the relief amount or care benefits in kind, care costs, short-term care, night care and other benefits also increases with the degree of care. If the long-term care insurance fund rejects the application, those in need of care can file an objection. An objection to the determined degree of care is also possible within a certain period of time - usually four weeks. A detailed justification can be submitted later. After the objection, a second expert opinion will be drawn up. If, at the end of the proceedings, the application is rejected in a notice of appeal, the path to the social court is open.
