Applying for replacement care in the social long-term care insurance

If your private caregiver is ill, on holiday or temporarily unable to care for you for other reasons, your nursing care fund will pay you the costs for replacement care upon request. This representation can, for example, be taken over by a family member or an outpatient care service. Replacement care is sometimes also called preventative care.

In order to be entitled to replacement care, you must, at the time of application:

• be classified at care level 2, 3, 4 or 5 and
• have been cared for at home by the prevented caregiver for at least 6 months.
• Care level 2 does not have to have already existed during the 6-month pre-care period.
• It is not necessary that the same caregiver must have cared for the patient for 6 months.
• The replacement care must be ensured by the substitute nurse to the extent of the respective degree of care.
• You can apply for replacement care for a total of up to 42 days per calendar year. A replacement care is possible both
• by the hour, if your caregiver is prevented for less than 8 hours, as well as
• daily.

The amount up to which your nursing care fund reimburses the costs depends on who takes over the replacement care.

• If a family member up to the second degree or a person living in your household provides replacement care, proven costs can be reimbursed up to 1.5 times the care allowance, which are:
  • for care level 2 EUR 474,00
  • for care level 3 EUR 817,50
  • for care level 4 EUR 1.092,50
  • for care level 5 EUR 1.351,50.
• For all other persons or a nursing service, up to EUR 1,612.00 will be reimbursed.
• Alternatively, substitute care can take place in an inpatient facility such as a nursing home. Here, too, the nursing care fund pays a maximum of EUR 1,612.00 of the costs.

If the close family member or the person living in your household incurs expenses such as travel allowances or loss of earnings as a result of the replacement care, the nursing care fund can also increase the reimbursement amount to up to EUR 1,612.00.

For the period of replacement care, half of your previous care allowance will continue to be paid.

You can top up replacement care benefits with up to 50 percent of your annual entitlement to short-term care. Your entitlement to short-term care will then be reduced accordingly. You can find out how you can combine the services in concrete terms from your nursing care insurance fund or from recognised counselling centres, such as Pflegestützpunkte.