Applying for home care for persons with long-term care insurance with disabilities
As a person with a disability, do you live in a residential home or other fully inpatient facility that enables you to participate socially and supports you in integrating into working life? Then, under certain conditions, your long-term care insurance will cover 15 percent of the costs.
However, the nursing care fund 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 the basic provision 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 welfare institution. 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 residential group for people with disabilities. In doing so:
- the focus is on living together and integration into society,
- the Housing and Care Act applies, and
- the scope of care largely corresponds 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 for this period:
- Care benefits in kind: This refers to the services of an outpatient care service. Your entitlement to care benefits in kind is reduced by the amount paid by the nursing 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 you are entitled to in kind each month will be deducted from the amount paid by your nursing care fund for the 20 days you spent in the dormitory or boarding school.
- Care allowance: If you are supported by relatives or volunteers during your time at home, you can receive care allowance. For every day you spend at home, you will 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 reimbursement of costs for care in a fully inpatient facility for people with disabilities by post and – at many care insurance funds – hand it in personally at the office or submit it online.
- Submit the application for full inpatient care in institutions for people with disabilities to your nursing care fund. If you are unable to do so yourself, you can authorize someone in writing.
- The care insurance fund will examine your application and inform you of the result.
- After your application has been processed, your nursing care fund transfers the monthly contribution directly to your institution.
- Your care fund can also give you a list of approved facilities for the disabled, where you can compare services and prices.
Who should I contact?
Contact form Lower Saxony State Office for Social Affairs, Youth and Family
Requirements
- You have care level 2, 3, 4 or 5.
- They live in a
- fully inpatient facility for people with disabilities or
- comparable form of housing.
Which documents are required?
- if applicable: power of attorney, supervisor card
- Decision of the nursing care fund on determination of the degree of care (report of the medical service of the nursing care insurance)
- where applicable: medical documents
- 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 nursing care insurance fund for more information.
What are the fees?
You do not 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 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 submitted in the calendar month in which the dependency occurred, but later, the benefits shall be granted from the beginning of the month in which the application was submitted.
Processing duration
Processing usually takes about 2 to 6 working days.
For a quick processing and decision, your nursing care fund must have the necessary information and, if necessary, necessary documents complete and meaningful.
The nursing care fund decides on applications promptly.
Please note that the stated processing time is an average value of all 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 documents are sent by post to you or your nursing care fund.
If the need for long-term care or the entitlement to care benefits has not yet been determined in your case or an application for an upgrade with regard to the degree of care is made, the Medical Service must be involved. This usually extends the processing of your request by about 3 to 4 weeks.
Legal basis
§ 43a Eleventh Book of the Social Code (SGB XI)
§ 71 Abs. 4 Nr. 1 und 3 Sozialgesetzbuch Elftes Buch (SGB XI)
Applications / forms
- Forms: yes
- Online procedure possible: Many care insurance companies offer an online procedure.
- Written form required: no
- Personal appearance required: no
Appeal
- Contradiction
- Action before 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.
