According to figures from the Federal Statistical Office, a good five million people in Germany are considered to be in need of care. You will receive help from relatives or professional carers. The support is paid for by the nursing care fund – provided there is a level of nursing care.
There are five levels of care. The higher a person is classified, the more extensive the care insurance benefits are. The application goes through the health insurance company, which is where the nursing care insurance fund is located. Those with private insurance should contact their insurance company. Officially, one phone call is enough. However, Florian Schönberg, consultant for social policy at the German Social Association (SoVD), recommends sending an informal email or letter, ideally as a registered letter with acknowledgment of receipt. “Nursing funds have to decide on a level of care within 25 working days,” he says. “That’s why insured people should be able to prove when they contacted their insurance company.”
In the next step, the nursing care fund sends the insured person the forms for applying for benefits from the nursing care fund. If you need help filling it out, you can get advice from either care centers or social associations. Or ask your questions during the assessment by the medical service. This person is responsible for classifying the applicant into a care level. For private nursing care funds, the service is called Medicproof. The experts usually visit the applicants at home or in a nursing home. The aim is to find out how independently a person can cope with their everyday life or how much support they need. It makes sense to prepare for the assessment. For example, with notes about situations in which support is needed. Documents such as doctor’s letters or the medication plan should also be ready. “It is best to have a relative take part in the conversation to provide support and provide additional information about the situation,” advises Schönberg. “And it’s very important that nothing is glossed over in the conversation.” So if today is a good day, then it should be reported honestly if it is more difficult on other days. Based on the interviews, the expert uses a point system to assess how severely the abilities are limited in areas such as mobility, communication and – this is the most important factor – self-care.
As soon as the nursing care insurance company has received a notification with a level of care, the nursing care insurance can pay out the benefits – retroactively to the day of the application. Anyone who is fully inpatient in a nursing home will have part of the costs reimbursed by their nursing care insurance. The insurance covers between 125 euros and 2005 euros per month. From care level two onwards, the health insurance fund also contributes more to the care costs, the longer the stay lasts.
The benefits for people who are cared for at home are a little more confusing. There are, for example, subsidies for care aids or for apartment renovations. The most important ones, however, are the care allowance and the care benefits in kind. People only receive this from care level two. The care allowance is paid if you organize home care yourself or with the help of relatives. The nursing care insurance fund provides 316 to 901 euros per month. “The care allowance is used to provide financial support. What it is used for does not have to be proven,” says Schönberg.
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If a family commissions an outpatient care service, they receive so-called care benefits in kind: the care insurance pays for the service. “It is also possible to combine both,” says Schönberg. For example, if you do not fully utilize the care benefits in kind, you can also have care allowance paid out on a pro-rata basis.
In addition, all those in need of care from level one who are cared for at home are entitled to the monthly relief amount of 125 euros. Those in need of care can use the money, for example to finance help with the household or other everyday assistance.
Those in need of care and their relatives do not always agree with the classification by the medical service. You have one month from receipt of the decision to file an objection. A justification can be submitted later. “It makes sense to always look at the report carefully and compare it with your own notes. This way you can explain where, for example, your independence is more limited than the expert assesses,” says Schönberger. A contradiction is particularly worthwhile if the score for the next higher level of care is not far away.
This article first appeared on Capital.
