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Applying for home care for people with disabilities with long-term care insurance


As a person with a disability, do you live in a residential home or other fully inpatient facility that enables you to participate in society and supports you in integrating into working life? In this case, your long-term care insurance will cover 15 percent of the costs under certain conditions.

However, the long-term care insurance pays a maximum of EUR 266.00 per month. The remaining costs are borne by you. If your income is not sufficient for this, you are entitled to benefits from basic security in old age and in the event of reduced earning capacity or housing benefit. To do this, you must submit an application to the social assistance agency. As a rule, this is the social welfare office of your place of residence.

This also applies to special forms of housing such as a dormitory or a group home for people with disabilities. In doing so, it is necessary to

  • the focus is on living together and integration into society,
  • the Housing and Care Act apply, and
  • the scope of care should largely correspond to the care provided in a fully inpatient facility.

If you are at home with your relatives at the weekend or during the holidays, you are entitled to the following benefits during this period:

  • Care benefits in kind: This refers to the services provided by an outpatient care service. Your entitlement to care benefits in kind is reduced by the amount paid by the long-term care fund in that month for accommodation in a residential home or boarding school. For example, if you are at home 10 days a month, the amount paid by your long-term care fund for the 20 days you spent in a dormitory or boarding school will be deducted from the amount you are entitled to monthly benefits in kind.
  • Care allowance: If you are supported at home by relatives or volunteers, you can receive care allowance. For every day you spend at home, you receive 1/30 of the monthly care allowance. The day of arrival and departure is considered a full day at home. You will also receive care allowance if you claim care benefits in kind at the same time. This does not reduce your care allowance.
     

Process flow

You can, for example, submit the application for the assumption of costs for care in a fully inpatient facility for people with disabilities by post or – in the case of many long-term care insurance funds – hand it in in person at the office or submit it online.

  • Submit the application for full inpatient care in facilities for people with disabilities to your long-term care insurance fund. If you are unable to do so yourself, you can authorize someone in writing.
  • The long-term care insurance fund will review your application and inform you of the result.
  • After your application has been processed, your long-term care insurance fund will transfer the monthly benefit contribution directly to your institution.
  • Your long-term care insurance fund can also provide you with a list of approved facilities for the disabled, where you can compare services and prices.

Requirements

  • They have care level 2, 3, 4 or 5.
  • They live in a
    • inpatient facility for people with disabilities or
    • comparable form of housing.

Which documents are required?

  • If applicable: power of attorney, supervisor ID card
  • Notification of the long-term care insurance fund on the determination of the degree of care (expert opinion of the medical service of the long-term care insurance)
  • if applicable: medical records
  • If applicable: Severely disabled person's pass
  • Proof of health and long-term care insurance

Depending on the individual case, further documents may be required. Please contact your long-term care insurance company for more information.
 

What are the fees?

You don't have to pay anything for the application.

What deadlines do I have to pay attention to?

You will only receive the benefit from your long-term care insurance fund from the month in which you submitted the application, but at the earliest from the date on which the eligibility requirements are met. If the application is not made in the calendar month in which the need for care arose, but later, the benefits are granted from the beginning of the month in which the application is submitted.

Processing duration

It usually takes about 2 to 6 working days to process.

In order to process and make a decision quickly, your long-term care insurance fund must have the necessary information and, if necessary, documents complete and meaningful.

The long-term care insurance fund decides on applications in a timely manner.
Please note that the stated processing time is an average value for all long-term care insurance funds. It may vary in individual cases.

The exact processing time also depends on the complexity of the individual case and can be extended accordingly. The same applies if documents or records are sent by post to you or your long-term care insurance fund.

If the need for care or entitlement to care benefits has not yet been determined in your case, or if an application is made for an upgrade in terms of the level of care, the medical service must be involved. As a result, the processing of your request is usually extended by about 3 to 4 weeks.
 

Applications / forms

- Forms: yes

- Online procedure possible: Many long-term care insurance companies offer an online procedure.

- Written form required: no

- Personal appearance required: no
 

Appeal

  • Contradiction
  • Appeal to the Social Court

Technically approved by

Federal Ministry of Health

Professionally released on

22.11.2021

Author

The text was automatically translated based on the German content.

Source: Serviceportal Niedersachsen (Portalverbund des Bundes und der Länder)