Long-term care benefits from long-term care insurance (SGB XI) from social assistance funds, if applicable

The risk of becoming dependent on care can affect anyone. In principle, therefore, everyone is obliged to insure themselves against this risk with a social or private care fund.

According to the current legal situation, there is a need for long-term care for persons who, because of an illness or disability, require considerable long-term assistance for the usual and regularly recurring activities of daily life. However, it is not the illness or disability that is decisive for determining the need for long-term care, but rather the resulting need for help with daily activities.

On 01.01.2017, the previously applicable care levels "0", 1, 2 and 3 for the classification of the need for care of those affected were replaced by the five new care levels 1, 2, 3, 4 and 5.

The determination of whether and to what extent there is a need for care is carried out by the Medical Service of the Health Insurance (MDK). The MDK is commissioned by the competent nursing care fund when an application for long-term care insurance benefits is submitted.

The MDK uses the new NBA assessment instrument to determine how independent a person still is using a points system. The following applies: The more points the person receives, the higher the degree of care and the more care and support services approved by the respective care fund.
The following classification of the nursing degrees with the necessary scores applies:

• Care level 1: Low impairment of independence (12.5 to less than 27 points)
• Care level 2: Significant impairment of independence (27 to less than 47.5 points)
• Care level 3: Severe impairment of independence (47.5 to less than 70 points)
• Care level 4: Severe impairment of independence (70 to less than 90 points)
• Care level 5: Severe impairment of independence with special demands on nursing care (90 to 100 points).

The social assistance provider is also bound by the findings of the MDK. If someone does not have long-term care insurance, the social welfare institution will contact the respective health authority with a request for an opinion on the need for care.

In the case of home care, persons in need of care are entitled to basic care and domestic care as a benefit in kind (home care assistance)
Alternatively, it is possible to receive a care allowance if people in need of care can use it to ensure basic care and domestic care themselves.
A combination of cash and benefits in kind (combined benefit) is possible.

The benefit framework of long-term care insurance also includes offers in the event of prevention of the caregiver (home care), day or night care (semi-inpatient care) and short-term care (temporary inpatient care).
Persons in need of care are entitled to care in inpatient care facilities if home or semi-inpatient care is not possible or is not considered due to the specificity of the individual case.
In addition, care aids and technical aids, subsidies for measures to improve the individual living environment and care courses for relatives and voluntary carers can be granted.
Caring relatives or caring neighbours and friends may, if necessary, receive social security benefits for the carer in the form of contributions to the competent pension insurance institution.

The benefits of long-term care insurance are covered by long-term care insurance, depending on the type of benefit, up to certain maximum limits, which you will learn from your long-term care insurance fund in the specific case. In the case of inpatient care, the costs for accommodation and meals, which you would also have to bear in the home environment, are not covered.
If it is not possible for persons in need of care to assume uncovered residual costs, social assistance benefits (SGB XII) may be considered.
However, social assistance as state assistance only occurs if and to the extent that self-help and the help of maintenance debtors – usually relatives in the direct line or spouse – are not sufficient.