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Applying for full inpatient home care for people with long-term care insurance


As a person with long-term care insurance, you are entitled to care in a nursing home or other fully inpatient facility if home or day-care is not possible or is not possible due to the special nature of your case.

In addition to the actual care services, the scope of services also includes social care and medical treatment care.

The maximum monthly amount that long-term care insurance funds pay for full-time inpatient care services depends on your level of care (as of 2021):

  • for care level 2 up to EUR 770.00
  • for care level 3 up to EUR 1,262
  • for care level 4 up to EUR 1,775
  • for care level 5 a maximum of EUR 2,005

In most cases, the costs of full inpatient care are higher than the amount covered by your long-term care insurance. You then pay a co-payment. This is the same for all residents within a facility, regardless of the level of care. So, for example, if you have care level 5, you will pay the same amount as someone with care level 2.

 
From January 2022, your own contribution to care-related expenses will be reduced. The long-term care insurance fund will then pay a supplement to your own contribution. The surcharge depends on the duration of full inpatient care.
This surcharge on top of your own contribution is

  • 5 per cent in the case of full inpatient care of up to and including 12 months,
  • 25 percent in the case of more than 12 months of inpatient care,
  • 45 percent in the case of more than 24 months of full inpatient care,
  • 70 percent in the case of more than 36 months of full inpatient care.

The cost of care in a nursing home can vary greatly between institutions. In addition, you will be able to:

  • Costs for accommodation and meals
  • costs for predictable investments. These are costs that the nursing home has, for example for building rent or purchases. These costs can be passed on to the residents of the facility
  • additional service costs may apply. These are also referred to as "comfort services". This means, for example, a single room, special meals or special care services.

If you cannot afford the additional costs yourself, your relatives will have to pay for it. However, children with an annual gross income of more than EUR 100,000 only have to contribute to the costs of the care facility. If your relatives are also unable to cover the costs, you will receive state support from the Social Welfare Office.

If you live in a nursing home during the week and are cared for at home by relatives at the weekend, you can also apply for home care benefits, such as care allowance or care aids.

If you need help choosing a suitable care facility, contact your long-term care insurance fund or your nearest care support point.
 

Process flow

You can, for example, submit the application for full inpatient home care by post or – in the case of many long-term care insurance companies – hand it in in person at the office or submit it online.  

  • You submit the application for full inpatient care to your long-term care insurance fund. If you are unable to do so yourself, you can authorize someone in writing.
  • If you have not yet been diagnosed with a care level of at least 2, the long-term care insurance fund commissions the medical service or other independent expert services to check whether there is a need for care to at least this extent.
  • The long-term care insurance fund evaluates the report, examines your application and informs you of the result.
  • Your long-term care insurance company can provide you with a list of approved nursing homes where you can compare services and prices.
  • Your long-term care insurance fund will bill the service directly to the care facility you have chosen.
     

Requirements

  • You have care level 2, 3, 4 or 5
    • If you have care level 1, you can apply for the relief amount
  • You cannot be cared for at home or on a day-care basis
     

Which documents are required?

  • If you already have a degree of care: if applicable, notification from the nursing care insurance fund on the determination of the degree of care (report from the medical service of the long-term care insurance)
  • If applicable: power of attorney, supervisor ID card
  • if applicable: medical records
  • If applicable: Severely disabled person's pass

Depending on the individual case, further documents may be required. Please contact your health 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. Therefore, you should submit the application in good time.
If the long-term care insurance fund does not issue the written decision within 25 working days of receipt of the application or if one of the assessment deadlines specified in the law is not met, the long-term care insurance fund must pay you EUR 70.00 immediately after the deadline has expired for each week in which the deadline is exceeded. This does not apply if the long-term care insurance fund is not responsible for the delay or if you are already in full inpatient care and at least care level 2 has already been determined.
 

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 statutory long-term care insurance funds offer an online procedure.

- Written form required: no

- Personal appearance required: no
 

Appeal

  • Contradiction
  • Appeal to the Social Court

What else should I know?

In some federal states, you can apply for long-term care housing benefit in addition to the benefits of your long-term care fund.
You can change nursing homes at any time.
 

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)