Understanding Care Levels: An Overview for You and Your Relatives
Under the long-term care insurance system, there are five care levels that describe the degree of a person's need for care. Classification into one of these care levels is crucial for being able to claim various benefits from the long-term care insurance. But how does the classification work, what are the differences between the individual care levels, and what benefits are available to you? In this article, you will learn everything you need to know.
What is a care grade?
A care grade indicates the extent to which a person's independence is impaired and what care services are required. The five care grades range from minor impairment to severe impairments with special care requirements. You receive your care grade upon application to your long-term care insurance, after a comprehensive assessment of your personal situation has been carried out.
The Five Care Levels in Detail
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Care Level 1:
Minor impairment of independence. -
Care Level 2:
Significant impairment of independence. -
Care Level 3:
Severe impairment of independence. -
Care Level 4:
Most severe impairment of independence. -
Care Level 5:
Most severe impairment of independence with special care requirements.
The Path to a Care Level
To receive a care degree, you must submit an application to your long-term care insurance. This application can be for an initial registration or an upgrade to a higher care degree. The application is important because benefits can be granted retroactively from the date of the application.t
The Assessment Procedure
A care expert will visit you at home or in your nursing home to assess your situation. Your ability for mobility, communication, self-care, and more will be evaluated. In some cases, telephone or virtual assessments may also be conducted. Based on this, an assessment report will be created, containing the recommendation for your care grade. However, the final decision is made by your long-term care insurance.
Score Table and Classification Criteria
The care assessment is based on a point system. Various categories such as mobility, cognitive abilities, and self-sufficiency are evaluated. The corresponding care level is determined based on the total score.
- Care Level 1: 12.5 to less than 27 points
- Care Level 2: 27 to less than 47.5 points
- Care Level 3: 47.5 to less than 70 points
- Care Level 4: 70 to less than 90 points
- Care Level 5: 90 to less than 100 points
What services can you receive?
With a care degree, you can claim various benefits from long-term care insurance. The amount of support depends on the respective care degree. These benefits include, among others:
- Care allowance (e.g., for care by relatives)
- Care in kind (e.g., by professional caregivers)
- Household help
- Aids for daily support
- Short-term care or respite care
Depending on your care degree, different amounts are available for these benefits.
Appeal in case of rejection or demotion
If you disagree with a care level decision, whether due to a rejection, a downgrade, or a care level that is too low, you should appeal. It is advisable to first check whether a successful appeal is possible.
An appeal can be successful if you convincingly demonstrate where the assessment incorrectly evaluated the care situation and how this affects the care level classification.
With a care level appeal, you can request a repeat assessment. In this, a new assessment will be prepared that more closely examines the disputed points. This gives you the opportunity to receive the correct care level on the second attempt.
From care level 1, the monthly fees for the Gardia emergency wristband with fall detection can be fully covered by the long-term care insurance fund.
More than just an emergency wristband
With Gardia, you receive an emergency wristband that combines fall detection, GPS tracking, and direct communication in one device. The costs for the monthly subscription can be fully covered by the long-term care insurance fund.
FAQ - Frequently Asked Question
What is a care level and what care levels are there?
A care grade indicates the level of care a person needs and the extent to which their independence is limited. It is the crucial prerequisite for entitlement to care benefits. There are a total of 5 care grades.
How often is the care level reviewed?
According to the Social Code, it states: "The examination must be repeated at appropriate intervals" (Paragraph 18a SGB XI). Therefore, it is at the discretion of the long-term care insurance to schedule a re-assessment of the care grade.
How are the different care levels assigned?
Care levels 1 to 5 are assigned according to a standardized procedure. A person's care level is determined by the limitations in their independence.
When do you get a care degree?
People who permanently and regularly require support in their daily lives are considered in need of care. They have the option of applying for a care level with their long-term care insurance.
Can a care grade be revoked or downgraded?
Yes, that is possible. Every care assessment is open-ended and can lead to different results, regardless of the existing care level. As a result, the care level may be downgraded or even completely withdrawn.
