Aids in home care - Aids in home care
If you or your relative are in need of care and have been classified in a care degree, you cannot avoid the medical supply store. From consumables for daily hygiene to special stockings or crutches to a rollator, wheelchair or care bed - the medical supply store has everything to make care easier. You can get many of them on prescription, but some are not. Some aids are only lent, others you have to buy and keep for hygienic reasons, even if they are no longer needed. In the following, you will get a short introduction to the topic of care aids, so that you know what you should look out for. The following is a short introduction to the topic of care aids, so that you know what you should look out for.
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Aids and care aids: Who pays for what?
There is a difference between care aids and medical aids: You have to apply for care aids at the care insurance fund. By definition, they serve to facilitate care. You are entitled to them if you have a corresponding care degree. A further distinction is made between nursing aids for consumption (for example, disposable gloves) and technical nursing aids, for example, home emergency call systems or nursing beds.
For aids, on the other hand, you receive a subsidy from the health insurance fund. They are used to compensate for a disability. These include hearing aids or prostheses. A medical prescription is required. You can find out which aids are available in each case in the list of aids. There, the aids are divided into product groups. Each aid is assigned a number. It is also specified for which of these aids you must obtain additional authorisation from the health insurance fund. Basically, the following applies: The doctor prescribes what is medically necessary.
Frequently needed technical aids, so-called "rehabilitation aids", are, for example, the following
- Walking aids
- Rollators
- Wheelchairs
- Nursing beds
- commode chairs
- Toilet seat raisers
- Bath lifts
- Alternating pressure mattresses
- Click ramps
- Patient lifts
Stair lifts, by the way, do not belong in the category of "aids". They fall under "conversion measures for accessibility" and are funded from a different, specially earmarked pot.
For prescription nursing aids, there are agreements between long-term care insurance funds and medical supply stores or other service providers approved by the insurance fund. This means that you do not have to pay in advance because you can settle directly with the health insurance fund. You only have to pay ten percent of the price (and at least five euros) as part of the statutory co-payment. Some products especially for the bathroom are also available over-the-counter and have no special medical benefit, but serve only to provide comfort - you have to pay for these so-called "white goods" yourself.
Health insurance only pays for standard models
However, you must bear in mind that the budget for certain aids is limited and that even luxury versions of some rehabilitation aids are not paid for in full. Here, the principle applies: "The extent of what is necessary must not be exceeded". So if the health insurance fund approves a rollator, for example, then it is a question of the "standard model" without additional frills. If, for example, the health insurance company approves a rollator for about 80 euros, but you choose the high-end model for 350 euros in a medical supply store, then you have to pay 270 euros out of your own pocket.
Even if you want a second, additional rollator, you usually have to pay for it yourself - unless it is absolutely necessary. This would be the case, for example, if the flat is on the mezzanine floor and a second rollator has to be placed by the exit because the steps cannot be climbed with a rollator.
The settlement prices of the different health insurance companies vary. For example, if health insurance A pays around 80 euros for a rollator, health insurance B may pay around 100 euros. The amount of the flat rate for wheelchairs or bath lifts also varies from health insurance fund to health insurance fund.
Medical prescription not sufficient in certain cases
Smaller and correspondingly cheaper products, such as a shower stool or a walking frame, may be dispensed by medical supply stores simply on presentation of the doctor's prescription. Very expensive aids, such as a nursing bed or an alternating pressure mattress, can be prescribed by the doctor. Nevertheless, a so-called "enquiry form" must always be filled out for the health insurance fund. This form asks for very specific details that can only be answered by specialised staff.
Special data entry form asks for medically relevant details
For example, when it comes to an alternating pressure mattress for the prevention of decubiti, there is the special "decubitus recording sheet". The questions refer to the type of wound care, the documentation of skin damage and certain characteristics of a possibly already existing wound. In addition, the pressure ulcer risk must be assessed with the help of a fixed scale and a suggestion for effective care must be made. Therefore, the nursing service, the doctor or another trained professional fills out these survey forms for the health insurance company. You only need to know that this form is mandatory for the approval of larger aids.
Nursing service helps
The nursing service that provides care for the patient at home usually fills out the questionnaire on nursing beds or alternating pressure mattresses. In addition, the care service can give advice on which aids could be useful for daily care.
Larger tools need longer processing time
It takes time until the larger aids are finally in place. Medical supply stores are not allowed to put pressure on the health insurance companies - but relatives are! If the processing time is too long, a friendly enquiry or an indication of the need for quick processing to the person in charge can definitely help. After all, you know best how urgently your relative needs a certain aid.
Medical supply store is responsible for maintenance
For example, if you get a care bed, a rollator or a wheelchair, the medical supply store is responsible for maintenance. If something breaks or does not work properly, the medical supply store will repair it. However, with some products, for example a standard rollator, the maintenance costs are often disproportionately high in relation to the new price. Therefore, in such cases, the common practice is that a defective rollator is simply exchanged for a new one.
Not every medical supply store works with every health insurance fund
It can happen that a medical supply store refers you to another provider. This is because not every medical supply store has a corresponding agreement with every health insurance fund. This is quite normal and has nothing to do with bad service. Some providers have even specialised completely in one type of aid. One of the reasons for this is that the health insurance funds issue invitations to tender for some medical aids so that they can then work with the cheapest provider. This is why, for example, incontinence material is only available on prescription from a limited number of manufacturers.
Nursing aids for consumption
For so-called "aids for consumption", you do not need to submit a prescription from your doctor. If you have been classified into a care degree, it is sufficient to apply for the lump sum for care aids for consumption at the care insurance fund. You then have 40 euros per month at your disposal. You can use this to pay for the following:
- Disposable gloves
- Disinfectant for hands and surfaces
- Absorbent disposable bed pads
- Mouth protection
- Protective clothing (aprons that protect the caregiver from contamination)
In most cases, the approved nursing homes settle directly with the long-term care insurance fund. You do not have to pay in advance. You only have to pay the rest yourself if your needs exceed the cost of 40 euros per month. The costs are covered by the insurance.
Ask medical supply stores
The first point of contact for all questions about medical aids is the medical supply store. Even if you need a certain aid but do not yet have a doctor's prescription for a certain product, the experts there can advise you. If you want a rollator, for example, it can happen that a doctor's prescription is refused - perhaps because it only states "walking difficulties" as a diagnosis. However, the health insurance funds need the exact name of the aid and the exact diagnosis on the prescription in order to approve it. They can tell you exactly what has to be written on the doctor's prescription.
