The benefits of long-term care insurance for care at home are varied and complex. They are only available upon request. Get an overview of the various services and what you need to consider here.
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| Nursing Care At Home: Services Provided By The Nursing Care Insurance Fund |
Private and statutory: what does long-term care insurance pay for?
Long-term care insurance benefits are granted by:
- the statutory nursing care funds.
- private insurance companies based on a long-term care insurance contract or
- the aid agencies.
- The law ensures that the benefits of private health insurance correspond to those of the statutory long-term care insurance funds.
The statutory long-term care insurance funds usually provide the benefits of long-term care insurance as benefits in kind. This means that the provider, eg a nursing service, settles accounts directly with the cash register.
In private long-term care insurance, reimbursement of costs is granted instead of benefits in kind.
Since, according to the law, long-term care insurance only partially covers actual needs, those in need of care must reckon with their costs. If you can prove that you are financially needy, you can apply for care benefits from social welfare agencies. If you receive social assistance, the social assistance agency will check whether the home is necessary before you move into the nursing home. For this purpose, an employee of the social welfare office will make a home visit or, if necessary, send you a questionnaire.
Otherwise, as a person in need of care, you can decide for yourself which assistance you choose, provided that care is guaranteed. On this topic page, you will find a clear graphic of which services you can take advantage of at the various care levels.
How do I get benefits from the nursing care fund?
If you want to receive long-term care insurance benefits, you must meet certain requirements. Those entitled to benefits are those who have been determined to need care. The extent of the need for care is recorded in a care grade.
You must apply to your long-term care insurance company to determine whether you need long-term care. Further information on the degree of care can be found on the topic page. If the need for care has changed, you must submit another application. For consumers with private and statutory insurance, their health insurance is always their long-term care insurance.
Home care: what is a care benefit in kind?
Persons in need of care in care grades 2 to 5 who are cared for at home can take advantage of physical care measures, nursing care measures, and/or "home care assistance" as care benefits in kind. "Home care help" means help with household chores. You can commission an outpatient nursing service or outpatient care service to provide the necessary assistance.
Anyone classified as care grade 1 can also commission a care service, but must largely pay for it themselves. The nursing care fund pays a subsidy of 125 euros as a so-called relief amount. This is earmarked and invoices must be submitted for it.
The nursing staff provides "body-related care measures". They help with washing or eating, for example) and are supported by caregivers who provide "nursing care measures". This includes going for walks, reading aloud, or doing household chores.
The nursing care fund pays for care at home
The person in need of care and the care service conclude a contract on the type, content, and scope of the care service. How much long-term care insurance pays for outpatient care depends on the need for support.
The last "care reform" (the so-called Health Care Development Act, GVWG) of June 2021 provides for financial relief for those in need of care from care level 2 who are cared for in their own four walls. Since January 1, 2022, care benefits in kind have increased by 5 percent:
- Care level 2: 724 euros
- Care level 3: 1,363 euros
- Care level 4: 1,693 euros
- Care level 5: 2,095 euros
Home care: what is care allowance?
Persons in need of care in care grades 2 to 5 who are cared for at home by relatives, friends, or neighbors are entitled to a care allowance. The nursing allowance can be granted on application.
The nursing allowance is paid to the person in need of nursing care every month, depending on the degree of nursing care required. The money can then be passed on to the helpers.
- Care level 2: 316 euros
- Care level 3: 545 euros
- Care level 4: 728 euros
- Care level 5: 901 euros
Home care: When are combined benefits possible?
Persons in need of care in care levels 2 to 5 who do not make full use of the care benefits in kind can, under certain conditions, also receive a care allowance. The care allowance is paid in the amount of the percentage of the care allowance that has not been exhausted.
Example:
A person in need of care with care grade 5 has claimed benefits in kind of more than 838 euros in one month, the maximum amount is 2,095 euros. He thus claimed 40 percent of the benefit in kind. He is still entitled to 60 percent of the care allowance of 901 euros, i.e. 540.60 euros.
Offers for support in everyday life: What additional services are there?
Every person with a determined level of care who is cared for at home is entitled to a relief amount of 125 euros per month.
With the relief amount, those in need of care can be reimbursed for costs that they have spent on certain services in-home care. This includes, for example, care offers or offers to relieve caregivers. Important: The offers used must be recognized under state law.
When are there supplements for residential groups with outpatient care?
In addition to the entitlement to care benefits in kind, care allowance, combined benefits, or the relief amount, those in need of care who live in residential groups with outpatient care are also entitled to a flat-rate residential group supplement of 214 euros per month.
The surcharge is intended to finance expenses for caregivers who carry out general organizational, administrative, caring, or community life-promoting activities or help in the household. If part-time inpatient day or night care services are to be used, the medical service of the health insurance company must first certify the necessity.
Respite care: What support is there when the caregiver is ill or on vacation?
The following applies to people in need of care from care level 2: If the private caregiver is absent due to vacation, illness, or other reasons, the care insurance will cover the costs of preventive care at home for up to 6 weeks per calendar year, but up to a maximum of 1,612 euros. If no funds from short-term care were used, the amount can be increased to up to 2,418 euros. The prerequisite is that the caregiver has already cared for the person in need of care in their home environment for 6 months.
What do health insurance companies pay for nursing aids?
Care aids should make care easier, alleviate symptoms or enable a more independent lifestyle. Recognized people in need of care who are cared for at home can apply to their care insurance fund for so-called care aids. During a care-level assessment or counseling visit, the care professional may recommend a care aid if they identify a need. This also counts as an application. A doctor's prescription is not necessary.
A distinction is made between nursing aids intended for consumption and technical nursing aids. Up to 40 euros per month are paid for care aids intended for consumption, such as disposable gloves or hand and surface disinfectants. Technical aids should primarily be provided on loan. You can find out more about nursing aids and how they are covered in this article.
Measures that improve the living environment: What grants are there for a home conversion?
Suppose an apartment conversion is necessary to enable or facilitate home care or to restore as independent a lifestyle as possible. In that case, those in need of care can apply for a subsidy from the care insurance fund. Up to 4,000 euros are possible, regardless of the degree of care.
Possible Conversions are Approx
- door extensions,
- the installation of a ramp or a stair lift as well as
- the remodeling of the bathroom.
If further measures become necessary due to a changed care situation, consumers can apply for a new subsidy of a maximum of 4,000 euros from their care insurance fund.
Note: Start with the conversion only after the nursing care fund has approved the application. You can find support at the housing advice centers.
What other support options are there?
Day or night care
Persons in need of care in care grades 2 to 5 can be cared for as part of a day or night care facility. The benefits are in addition to the full care allowance. You must apply for this benefit from the nursing care fund. This is particularly relevant for people in need of care who cannot stay alone during the absence of their caregiver(s), but who are otherwise cared for at home. You have the following monthly entitlements:
Care level 2: EUR 689
Care level 3: EUR 1,298
Care level 4: EUR 1,612
Care level 5: EUR 1,995
Persons with care level 1 can use the relief amount proportionately to finance day and night care.
Respite Care
People in need of care in care grades 2 to 5 who are dependent on complete inpatient care for a limited period can take advantage of short-term care. It is used, among other things, in crises. A typical case is when
you need to bridge the time after a hospital stay,
Renovation measures are necessary for the home of the person in need of care or
the caregiver cannot take over immediately.
You are entitled to short-term care for up to 8 weeks per calendar year. The long-term care insurance fund covers the costs of general care services up to an amount of EUR 1,774 per year. If you have not yet used funds from respite care, the amount for short-term care can be increased to up to 3386 euros.
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Health